Spatial relationship between ambulatory surgery centers and colorectal cancer mortality within Pennsylvania, United States

Objectives: The objective of this study was to evaluate the spatial relationship between colorectal cancer (CRC) mortality and ambulatory surgery center (ASC) density in Pennsylvania's 67 counties. Study design: This was an ecological study. Methods: Age-adjusted CRC mortality rates were linked to ASC densities per 1,000 people. The data set was analyzed using global, local, and regional Moran's I, to test for randomness in CRC mortality and ASC density. Results: CRC mortality rates (median: 15.30 per 100,000 of the US 2000 standard million population) exhibited hot spots in rural Pennsylvania counties. ASC densities (median: 0.35 providers/km² per 1,000 people) showed hot spots in urban southeastern Pennsylvania and cold spots in northern Pennsylvania. Conclusions: CRC mortality rates tended to cluster in rural northern Pennsylvania counties; ASC density tended to cluster in urban southeastern counties, indicating a spatial disparity between needed and provided healthcare resources. There is a need for public health and health system changes to increase the availability of CRC services to rural communities.