The inter-prefectural regional disparity of medical resources and representative surgical procedures in orthopaedics and general surgery: A nationwide study in Japan during 2015–2019

Background: : Few reports have examined the regional disparity in representative surgical procedures in orthopaedics and general surgery. This study aimed to clarify the inter-prefectural regional disparity and relationships between medical specialists, facilities, and representative surgical procedures using a nationwide database in Japan. Methods: : The annual incidence rate (IR) per 100,000 population of medical specialists in orthopaedics, general surgery, and anaesthesiology (OSS, GSS, ANS, respectively); medical facilities of hospitals (HP, only per 1,000 population); and representative surgical procedures in orthopaedics and general surgery were examined by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the aforementioned variables and the ageing rate (A/R). We also compared the urban and rural regional disparities between them. Results: : The total annual average IR and Gini coefficients were 110.6 and 0.11 for femur fracture surgery (IROF), 106.3 and 0.09 for cholecystectomy (IRCC), 14.2 and 0.11 for OSS, 17.6 and 0.09 for GSS, 5.9 and 0.13 for ANS, and 8.1 and 0.21 for HP, respectively. The correlation coefficients by IROF were 0.74 for OSS (p<0.001), 0.63 for HP (p<0.001), and 0.62 for the A/R (p<0.001); those by IRCC were 0.60 for GSS (p<0.001) and 0.59 for HP (p<0.001). The IROF, IRCC, OSS, HP, and A/R data were significantly higher in rural areas than in urban areas (p<0.05). Conclusions: : Inter-prefectural regional disparity was small, although some items were unevenly distributed in the rural areas, which is contrary to our expectations. Higher prevalence was recognised in rural areas than urban areas due to the higher A/R, but supply and demand are balanced. This study provides basic data for healthcare policy in a medium-sized community. Level of Evidence: III