OBJECTIVES: Geographic characteristics such as county-level socioeconomic status (SES) or accessibility of health services may play a role in behavioral decisions to visit a physician following a diagnosis of Non-Hodgkin Lymphoma (NHL). There is limited research to identify which geographic characteristics factor into the behavioral decisions.

METHODS: We analyzed linked registry and Medicare claims data for individuals diagnosed with NHL between 2000 and 2013. Outcome measures were the proportion and counts of: 1) all outpatient physician (OP) visits; 2) medical oncologist (MO) visits. The primary predictors were county-level SES and health services supply factors (HSSF). We utilized hierarchical generalized linear models (HGLM) with an offset for differential follow-up. We reported intraclass correlation coefficients (ICC) for the binary models. For both binary and count models, we reported median odds ratios (MORs) for the county-level random effect and interval odds ratios (IORs) for the county-level fixed effects.

RESULTS: The sample included 72,973 individuals living in 590 counties. The average age was 78 years and the sample was 87% White, non-Hispanic. The median number of OP visits and MO visits per person was 19 and 14, respectively, over a median follow-up of 883 days. For the OP logistic HGLM: 1) the ICC was 3%; 2) the MOR was 1.3; 3) the IORs were [0.65; 1.21] for the SES index and [1.04; 1.93] for the HSSF index. For the MO logistic HGLM: 1) the ICC was 8%; 2) the MOR was 1.6; 3) the IORs were [0.4; 2.5] for the SES index and [0.35; 2.21] for the HSSF index. There was a larger role for county-level HSSF compared to the county-level SES in the HGLM count models.

CONCLUSIONS: Among individuals diagnosed with NHL, there is a larger role for the county-level measure of health services accessibility compared to the county-level measure of socioeconomic status.