Indirect Effects of Municipal Public Health Nurse Workforce on Cancer Standardized Mortality Ratios Mediated by Cancer Screening Rates.

Objective: This study examined the indirect effects of the number of Japanese municipal public health nurses (PHNs) on cancer standardized mortality ratios (SMRs), using cancer screening and diagnostic follow‐up rates as mediators. Design: Ecological study using municipalities as the unit of analysis Measurements: Aggregate, municipal‐level government data were analyzed using a linear model with empirical Bayes estimates of SMRs (EBSMRs) for gastric, colorectal, and lung cancers as the dependent variables, and the number of PHNs, cancer screening rate, diagnostic follow‐up rate, and adjustment variables as independent variables. Structural equation modeling (SEM) was used to examine the indirect effects of PHNs. Results: Cancer screening rates were significantly negatively associated with EBSMR, except for gastric cancer in women. No significant association was observed between the EBSMR and diagnostic follow‐up rates. SEM revealed a significant indirect effect of the number of PHNs, most of which was due to the cancer screening rate. Conclusions: From a population‐based public health perspective, increasing the number of PHNs and focusing on improving cancer screening rates may effectively reduce cancer SMRs. [ABSTRACT FROM AUTHOR]