Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior research fellow Rita Santos, University of York,
- Second opponent: Researcher Paul Lambert, FHI - Norwegian Institute of Public Health,
- Third member and chair of the evaluation committee: Professor Jahn Frederik Frøen, University of Oslo
Chair of the Defence
Associate Professor Louise Emilsson, University of Oslo
Principal Supervisor
Associate Professor Knut Reidar Wangen, University of Oslo
Summary
This thesis investigates place-based drivers and policies contributing to geographical differences in colorectal cancer (CRC) outcomes at the municipality and hospital levels in Norway, where substantial regional variation exists. It also examines spatial health economic factors that predict spatial dependence and interactions among networked entities (e.g., GPs, hospitals, municipalities, counties), as well as geographic clustering of unobserved place-based characteristics, using spatial methods. It lies at the intersection of health economics and epidemiology/public health.
Using nationwide registry data at the municipality and hospital levels, the thesis applies advanced spatial causal models to account for spatial dependence and spatial confounding. The methods include comparisons between traditional spatial regression models and novel causal spatial approaches designed to address unmeasured spatial confounding, as well as comparisons of traditional and spatial difference-in-differences approaches.
Papers 1 and 2 examine place-specific drivers, such as physician density and screening uptake, and their effects on CRC outcome. The results show that increased access to general practitioners and higher screening rates significantly reduce late-stage CRC incidence. These findings highlight the importance of improving access to physicians and screening services in underserved and rural areas. Paper 3 evaluates the hospital centralization reform—specifically, the closure of surgical treatment services in one hospital—and its impact on the quality and efficiency of nearby hospitals facing increased workloads. The findings show that neighboring hospitals improved efficiency without compromising quality.
Overall, the findings emphasize the importance of accounting for spatial dimensions when analyzing regional CRC outcomes to avoid biased results and misinformed policy decisions. Tailored, place-based policies are essential to reduce disparities and improve patient outcomes.
Additional information
Contact the research support staff.