Area Deprivation Index Quartile Research Articles

Associations Between Residential Greenspace, Socioeconomic Status, and Stroke: A Matched Case-Control Study.

Studies have shown increased residential greenspace is associated with improved outcome following stroke. This study sought to determine if residential greenspace is an independent stroke risk factor. A retrospective 1:4 matched case-control study involving 1174 stroke and 4696 control patients over a 3-year period from Milwaukee County, Wisconsin, was conducted. Greenspace was determined using normalized difference vegetation index (NDVI) for a 250-meter radius surrounding a subject's residence. The area deprivation index (ADI) for the census block tract of a subject's residence was obtained from the Neighborhood Atlas® (University of Wisconsin School of Medicine and Public Health). Relationship between greenspace, ADI, and stroke was determined using conditional logistic regression. Relationships among NDVI, state and national ADI, and proximity to public parks were determined using Spearman's rank-order correlation. NDVI and stroke risk were inversely correlated (odds ratio [OR]: 0.33, 95% CI: 0.111-0.975; P=0.045), with 19% lowered odds of stroke for patients living in the highest greenspace quartile compared to the lowest quartile (OR: 0.81, 95% CI: 0.672-0.984; P=0.045). Patients living in the most deprived ADI quartile had 28% greater stroke risk than those living in the least deprived ADI quartile (OR: 1.28, 95% CI: 1.02-1.6; P=0.029). Non-Hispanic Black patients lived in residential areas with lower greenspace (P<0.001) and neighborhoods of greater state and national ADI (P<0.001 for both) than non-Hispanic White patients. In Milwaukee County, living with greater surrounding greenspace or areas of lower deprivation is associated with lower odds of stroke. NDVI represents an independent risk factor for stroke, not simply a proxy for socioeconomic status.

Association of socioeconomic disadvantage and neighborhood disparities with clinical outcomes in multiple sclerosis patients

BackgroundSocioeconomic disadvantage may be an important contributor to clinical outcomes in MS but is not well understood. Our objective was to examine the associations between Area Deprivation Index (ADI), a validated measure of neighborhood-level disadvantage, with clinical outcomes. MethodsWe assessed the longitudinal association between MS Performance Test (MSPT) and quality of life in Neurological Disorders (Neuro-QoL) measures with ADI quartiles (Q1: lowest deprivation – Q4 highest deprivation) in relapsing remitting MS (RRMS) and progressive MS cohorts. ResultsOur study included 2,921 patients (65.8% RRMS and 34.1% progressive MS) with 13,715 visits. Patients living in the most disadvantaged areas had almost universal worsening on baseline MSPT and Neuro-QoL scores (p < 0.05) when compared to patients living in areas of lowest deprivation. Manual Dexterity Test (MDT) illustrated particular disparity as RRMS patients living in the greatest area of deprivation had MDT score which averaged 2.9 seconds longer than someone living in areas of least deprivation. Longitudinal analysis illustrated less favorable MSPT and Neuro-QoL outcomes across visits between Q1 versus Q4 ADI quartiles within in the RRMS cohort but not within the progressive MS cohort. After adjustment, linearly increasing area deprivation scores reflected less favorable Processing Speed Test (PST) and six Neuro-QoL outcomes among the RRMS cohort. Within the progressive cohort, higher deprivation was associated less favorable MDT, PST and 11 of 12 Neuro-QoL outcome measures. ConclusionsThis study provides evidence for socioeconomic disadvantage as a risk factor for disability accrual in MS and may be targeted to improve care while informing resource allocation.

Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage?

While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs. We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient's ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05. There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] (P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage. Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care. Level III.

Association Between Neighborhood Disadvantage and Pediatric Readmissions.

Although individual-level social determinants of health (SDH) are known to influence 30-day readmission risk, contextual-level associations with readmission are poorly understood among children. This study explores associations between neighborhood disadvantage measured by Area Deprivation Index (ADI) and pediatric 30-day readmissions. This retrospective cohort study included discharges of patients aged < 20years from Maryland's 2013-2016 all-payer dataset. The ADI, which quantifies 17 indicators of neighborhood socioeconomic disadvantage within census block groups, is used as a proxy for contextual-level SDH. Readmissions were identified with the 30-day Pediatric All-Condition Readmissions measure. Associations between ADI and readmission were identified with generalized estimating equations adjusted for patient demographics and clinical severity (Chronic Condition Indicator [CCI], Pediatric Medical Complexity Algorithm [PMCA], Index Hospital All Patients Refined Diagnosis Related Groups [APR-DRG]), and hospital discharge volume. Discharges (n = 138,998) were mostly female (52.7%), publicly insured (55.1%), urban-dwelling (93.0%), with low clinical severity levels (0-1 CCIs [82.3%], minor APR-DRG severity [48.4%]). Overall readmission rate was 4.0%. Compared to the least disadvantaged ADI quartile, readmissions for the most disadvantaged quartile were significantly more likely (aOR 1.19, 95% CI 1.09-1.30). After adjustment, readmissions were associated with public insurance and indicators of medical complexity (higher number of CCIs, complex-chronic disease PMCA, and APR-DRG severity). In this all-payer, statewide sample, living in the most socioeconomically disadvantaged neighborhoods independently predicted pediatric readmission. While the relative magnitude of neighborhood disadvantage was modest compared to medical complexity, disadvantage is modifiable and thus represents an important consideration for prevention and risk stratification efforts.

Socioeconomic disadvantage and human papillomavirus (HPV) vaccination uptake

ImportanceDespite availability of safe and effective human papillomavirus (HPV) vaccines, vaccination uptake remains low in the U.S. Research examining the impact of neighborhood socioeconomic status on HPV vaccination may help target interventions. ObjectiveTo examine the association between area deprivation and HPV vaccine initiation and completion. Design, setting, participantsRetrospective cohort study of individuals aged 11–18 years residing in the upper Midwest region. Receipt of HPV vaccination was examined over a three-year follow-up period (01/01/2016–12/31/2018). Main outcomes and measuresOutcomes of interest were initiation and completion of HPV vaccination. Demographic data were collected from the Rochester Epidemiology Project (REP). Area-level socioeconomic disadvantage was measured by calculating an Area Deprivation Index (ADI) score for each person, a measure of socioeconomic disadvantage derived from American Community Survey data. Multivariable mixed effect Cox proportional hazards models were used to examine the association of ADI quartiles (Q1-Q4) with HPV vaccine series initiation and completion, given initiation. ResultsIndividuals residing in census block groups with higher deprivation had significantly lower likelihood of HPV vaccine initiation (Q2: HR = 0.91, 0.84–0.99 Q3: HR = 0.83, 0.76–0.90; Q4: HR = 0.84, 0.74–0.96) relative to those in the least-deprived block groups (Q1). Similarly, those living in block groups with higher deprivation had significantly lower likelihood of completion (Q2: HR = 0.91, 0.86–0.97; Q3: HR = 0.87, 0.81–0.94; Q4: HR = 0.82, 0.74–0.92) compared to individuals in the least-deprived block groups (Q1). Conclusions and relevanceLower probability of both HPV vaccine-series initiation and completion were observed in areas with greater deprivation. Our results can inform allocation of resources to increase HPV vaccination rates in our primary care practice and provide an example of leveraging public data to inform similar efforts across diverse health systems.

PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Rebecca Campbell, Jarrod Dalton, Prithvi Murthy, Georges-Pascal Haber, and Byron Lee Jacob KnorrJacob Knorr More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jarrod DaltonJarrod Dalton More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent efforts to optimize recovery following radical cystectomy have not led to substantial improvement in complication rates. Though clinical risk factors have been routinely studied, the contribution of socioeconomic factors has not been well-defined. The Area Deprivation Index (ADI) is derived from 17 U.S. Census variables in income, education, employment, and housing, and describes neighborhood disadvantage down to the geographic block-group (600-3,000 people). Our objective was to examine associations between ADI and perioperative outcomes following radical cystectomy. METHODS: A prospective database of radical cystectomy patients was queried from 2010-2018. Residential locations at time of surgery were geocoded using SQL Server with TIGER/LINE census data to assign a block-group for each patient. National ADI percentile ranks were imported from the Neighborhood Atlas. Patients were stratified by national ADI quartile with the 1st quartile representing least disadvantaged and 4th quartile the greatest disadvantaged. Outcomes were compared using Cochran Armitage Trend or Kruskal-Wallis tests. RESULTS: The distribution of 906 patients across ADI quartiles was: 12.7%, 31.8%, 35.1%, and 20.4%. The 4th quartile was associated with younger age (p=0.01), black race (p=<0.0001), and active smoking (p=<0.0001). The 90-day (90d) mortality rates observed in the 1st and 4th quartiles were 0% (0/115) and 6.5% (12/185), respectively. ADI quartile was significantly associated with 30d (p=0.01) and 90d (p=0.002) mortality. When evaluating ADI as a continuous variable, the unit and range odds ratios for 90d mortality were 1.021 (CI: 1.004 - 1.04) and 8.11 (CI: 1.5 - 47.83), respectively. ADI was also associated with late (30-90d) complications (p=0.04), though there were no significant differences in 30 and 90d major complications, readmission rates, or length of stay between ADI quartiles. CONCLUSIONS: We present the first use of the Area Deprivation Index at the block-group level in Urology. ADI was significantly associated with late complication and 30 and 90d mortality, with nearly half of all 90d deaths occurring in the most disadvantaged ADI quartile. Our findings suggest that post-cystectomy morbidity and mortality may be partially attributable to socioeconomic factors. Source of Funding: CWRU CCC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e833 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Knorr More articles by this author Rebecca Campbell More articles by this author Jarrod Dalton More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...

Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study

IntroductionIndividual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. ObjectiveOur aim was to assess the association between neighborhood-level SES and lung function. MethodsWe cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. ResultsGreater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: −30 mL (95% CI: −97, 36), βQ3vsQ1: −70 mL (95% CI: −135, −4) and βQ4vsQ1: −104 mL (95% CI: −171, −36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. ConclusionNeighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.

Evaluating the impact of social deprivation on Press Ganey\xae Outpatient Medical Practice Survey Scores

BackgroundSocial deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS).MethodsWe retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status).ResultsUnivariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001).ConclusionsSocial deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.

Area Deprivation Index Score is Associated with Lower Rates of Long Term Follow-up after Upper Extremity Vascular Injuries

The Area Deprivation Index (ADI) has been shown to be a determinant of healthcare outcomes in both medical and surgical fields, and is a measure of the socioeconomic status of patients. We sought to analyze outcomes in patients with upper extremity vascular injuries that were admitted over a five-year period to a Level I trauma center sorted by ADI. All patients with upper extremity vascular injury presenting to a level one trauma center between January 2013 and January 2017 were retrospectively collected. The patients were divided into two groups based on their ADI with the first group representing the lowest quartile of patients and the second group the higher three quartiles. Patient's demographics were analyzed as well as modes of trauma, hospital transfer status prior to receiving care, type of intervention received, follow-up rates and outcomes including both complication and amputation rates. Over this time period, a total of 88 patients with traumatic upper extremity vascular injuries were identified. The majority of injuries were due to penetrating trauma (74/88, 84%) with 41% (10/24) of patients in the lower ADI being victims of gunshot wounds compared to 27% (17/64) of those in the higher ADI (P = 0.19). Patients in the lowest ADI quartile were more likely to be African Americans (P= 0.0001), and more likely to be transferred to our university hospital prior to receiving care (P= 0.007). Arrival Glasgow Coma Scale and Injury Severity Score were similar as was time spent in the emergency room. Length of stay trended longer in the lowest ADI quartile as compared to the higher ADI (7.5 vs. 11.8, P= 0.59). The rates of long term follow-up were significantly lower in patients with the lowest ADI scores as opposed to the higher ADI group (P= 0.0098), however, there was no statistically significant difference in outcomes between the two groups including both complication and amputation rates. The ADI is associated with lower rates of long term follow-up after upper extremity vascular injuries, despite patients in both the high and low ADI groups having similar outcomes in regards to complication and amputation rates. Further study is warranted to investigate the role of the socioeconomic status in outcomes following traumatic injury.

Neighborhood deprivation index is associated with weight status among long-term survivors of childhood acute lymphoblastic leukemia.

Area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, has been linked to metabolic outcomes in the general population but has received limited attention in survivors of childhood acute lymphoblastic leukemia (ALL), a population with high rates of overweight and obesity. We retrospectively reviewed heights and weights of ≥ 5 year survivors of pediatric ALL (diagnosed 1990-2013). Residential addresses were geocoded using ArcGIS to assign quartiles of ADI, a composite of 17 measures of poverty, housing, employment, and education, with higher quartiles reflecting greater deprivation. Odds ratios (OR) and 95% confidence intervals (CI) for the association between ADI quartiles and overweight/obesity or obesity alone were calculated with logistic regression. On average, participants (n = 454, 50.4% male, 45.2% Hispanic) were age 5.5 years at diagnosis and 17.4 years at follow-up. At follow-up, 26.4% were overweight and 24.4% obese. Compared to the lowest ADI quartile, survivors in the highest quartile were more likely to be overweight/obese at follow-up (OR = 2.33, 95% CI: 1.23-4.44) after adjusting for race/ethnicity, sex, age at diagnosis, and age at follow-up. The highest ADI quartile remained significantly associated with obesity (OR = 5.28, 95% CI: 1.79-15.54) after accounting for weight status at diagnosis. This study provides novel insights into possible social determinants of health inequalities among survivors of childhood ALL by reporting a significant association between neighborhood deprivation and overweight/obesity. Survivors of childhood ALL residing in neighborhood with greater socioeconomic disadvantage may be at increased risk of overweight and obesity and candidates for targeted interventions.

Abstract 17079: Lower Socioeconomic Status Portends Higher Long Term Mortality Following Isolated Mitral Valve Surgery

Introduction: Lower socioeconomic status (SES) has been associated with worse outcomes in patients undergoing cardiac surgery; however, this has not been fully elucidated in mitral valve (MV) surgery. We sought to determine the effect of SES on short-term outcomes and long-term mortality following MV surgery. Hypothesis: Lower SES is associated with higher mortality following isolated MV surgery. Methods: Retrospective analysis of our institution’s MV database was performed between November 1998 and March 2019 for all adult patients undergoing isolated MV surgery in our state and 4 neighboring states. Patients for whom address data was missing were excluded. SES was determined by the Area Deprivation Index (ADI). The ADI uses 17 social determinants of heath to estimate the average SES for all US Census Block Groups (mean 1500 people). This score is then nationally indexed from 1 to 100, with lower SES represented by higher scores. Patients were stratified by ADI quartiles. Baseline characteristics and postoperative outcomes were compared between quartiles. Results: Overall, 3,860 surgeries met inclusion criteria during the study period. Of these, 1,795 (46.5%) patients fell into the lowest ADI quartile, 1,216 (31.5%) in the second quartile, 476 (12.3%) in the third quartile, and 344 (8.9%) in the highest quartile. 30-day mortality was not significantly different between ADI quartiles and ADI was not a significant determinate of 30-day survival in a multivariable logistical regression. Figure 1 show the distribution of patient addresses within Census Block Groups as well as 10-year survival by Kaplan-Meier estimates, stratified by ADI quartiles. Cox proportional hazards model revealed that lower SES as determined by ADI was associated with increased 10-year mortality (P = 0.008). Conclusions: Lower SES is associated with worse long-term survival in patients undergoing isolated MV surgery. Social interventions to bridge this survival gap are warranted.

Abstract 16044: Association of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?

Introduction: Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR. Methods: We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation. Results: In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p&lt;0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p&lt;0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p&lt;0.01) and mortality (p&lt;0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group. Discussion: We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.

Social Deprivation and Congenital Upper Extremity Differences—An Assessment Using PROMIS

Social deprivation, a measure of socioeconomic status, has been shown to negatively affect perceptions of orthopedic conditions and outcomes of treatment. The objective of this study was to assess whether social deprivation correlates with subjective assessment of function in pediatric patients with congenital hand differences. Patients enrolled in the Congenital Upper Limb Differences (CoULD) registry were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). The PROMIS scores for Pain Interference, Peer Relations, Anxiety, Depression, and Upper Extremity (UE) function were obtained for all patients 5 years and older at initial presentation. Social deprivation was determined by the Area Deprivation Index (ADI); the index ranges from 0 to 100 with higher scores being the most deprived. The PROMIS scores were correlated with the ADI for all patients. Three hundred seventy-five pediatric patients with congenital UE differences were evaluated. Average age was 11 years, 56% were female, and 55% had bilateral involvement. Overall, PROMIS scores were within 1 SD of normal for Peer Relations, Pain, Depression, and Anxiety. However, child-reported scores for UE function (39) were more than 1 SD below the national average (50). The mean ADI for the cohort was lower than the national average, indicative of less deprivation, with 14% of patients in the most deprived national quartile. Children in the highest ADI quartile reported PROMIS scores that reflected higher Pain Interference (41 vs 45), lower Peer Relations (55 vs 50), higher Anxiety (44 vs 49), and higher Depression (43 vs 47) than children in the lowest ADI quartile. The PROMIS scores were normal for psychosocial measures in children with congenital hand differences when evaluated as an entire cohort. However, child self-reported PROMIS scores for Pain Interference, Peer Relations, Anxiety, and Depression were worse in more socially deprived areas, suggesting more psychosocial challenges in these children. Pediatric patients with congenital upper extremity differences in areas of higher social deprivation report lower psychosocial well-being. The care of these individuals must be considered within the context of their environment because they may be more at risk for negative outcomes secondary to environmental and societal stressors.

Assessing disparities in engagement in a post-discharge virtual visit follow-up program.

100 Background: Transitions of care are a frequent focus of quality improvement initiatives. In attempt to improve upon the transitions of care for oncology patients, our institution implemented a post discharge virtual visit follow-up program. Previous studies have suggested that socioeconomic status impacts engagement in technology based interventions. Herein, we report the impact of socio-economic status based on area deprivation index (ADI) on engagement with the program. Methods: All patients admitted to the elective chemotherapy service were included. Retrospective analysis of characteristics of each participant was conducted. Data included eligibility (access to the internet, appropriate device, English language proficiency, ability to set up video visit and a patient portal account) for video visit, interest in participating, completion of the visit and any interventions performed during the visit. In addition, ADI was calculated for each individual. Patients were classified into quartiles based on ADI (quartiles increased with ADI). Chi squared testing was performed to assess whether socioeconomic status affected enrollment in video visits. Simple descriptive analysis was also performed. Results: One hundred seven unique patients were included for review. Of these, 33 (31%), 39 (36%), 16 (15%) and 19 (18%) were in quartile(Q) 1, 2, 3 and 4 respectively. Eligibility per quartile was 29 (88%), 34(87%), 13(81%), and 15(83%). ADI quartile did not significantly affect virtual visit eligibility (p = .50). A total of 91 patients (85%) were eligible for video visits; of these, 46 patients declined. Of the 46 patients that declined 9 (19%), 20 (43%), 8 (17%), and 9 (19%) were in Q1, Q2, Q3 and Q4 respectively. Fifteen patients cited technology issues as reasons for declining telehealth visits - 10 (67%) from Q1 and Q2 and 5 (33%) from Q3 and Q4. The vast majority cited lack of interest as reason for declining. Conclusions: ADI as a measure of socioeconomic status did not significantly affect eligibility for or enrollment in video visits. This may be explained by more ubiquitous access to internet services in a large urban setting. Current research is currently being conducted to understand patient barriers to engagement in virtual visits.

Impact of Geographic Socioeconomic Disadvantage on Minor Amputation Outcomes in Patients With Diabetes

BackgroundSocioeconomic disadvantage is a known contributor to adverse events and higher admission rates in the diabetic population. However, its impact on outcomes after lower extremity amputation is unclear. We aimed to assess the association of geographic socioeconomic disadvantage with short- and long-term outcomes after minor amputation in patients with diabetes. Materials and methodsGeographic socioeconomic disadvantage was determined using the area deprivation index (ADI). All patients from the Maryland Health Services Cost Review Commission database (2012-2019) who underwent minor amputation with a concurrent diagnosis of diabetes were included and stratified by the ADI quartile. Associations of the ADI quartile with 30-day readmission and 1-year reamputation were evaluated using Kaplan–Meier survival analyses and multivariable logistic regression models adjusting for baseline differences. ResultsA total of 7415 patients with diabetes underwent minor amputation (70.1% male, 38.7% black race), including 28.1% ADI1 (least deprived), 42.8% ADI2, 22.9% ADI3, and 6.2% ADI4 (most deprived). After adjusting for demographic and clinical factors, the odds of 30-day readmission were greater in the intermediate ADI groups than those in the ADI1 group, but not among the most deprived. Adjusted odds of 1-year reamputation were greater among ADI4 than those among ADI1. Kaplan–Meier analysis confirmed a greater likelihood of reamputation with an increasing ADI quartile over a 1-year period (P < 0.001). ConclusionsGeographic socioeconomic disadvantage is independently associated with both short- and long-term outcomes after minor diabetic amputations in Maryland. A targeted approach addressing the health care needs of deprived regions may be beneficial in optimizing postoperative care in this vulnerable population.

The effect of neighborhood Area Deprivation Index on residential burn injury severity

IntroductionResidential fires account for the majority of burn-related injuries and fatalities. Established risk factors for burn injury include male gender, racial minority, children and elderly individuals, poverty, and substandard housing characteristics. In North Carolina, the rate of residential fire injuries and deaths is higher than the national average. Therefore, we sought to describe residential fire hospitalizations at a large regional burn center and describe the neighborhoods in which they live. We hypothesized that patients living in areas with higher Area Deprivation Index (ADI) are more likely to have major residential burns. MethodsWe conducted a retrospective analysis of burn admissions from January 2002 to December 2015. We dichotomized patients into two cohorts: residential and non-residential burns and performed a bivariate analysis. Multivariate Poisson regression models were utilized to determine if ADI was associated with inhalation injury and ≥20% total body surface area burn. ResultsOf the 10,506 patients presented during the study period. Of these, 10,016 (95.3%) patients resided in North Carolina, and 7894 (78.8%) had a residential burn. Of the overall cohort, 6.0% (n=458) of patients had ≥20% TBSA burns and 6.4% (n=506) had inhalation injury. The majority of patients were in the highest (most disadvantaged) ADI quartile (n=3050, 39.5%), and only 6.8% of patients (n=525) were in the lowest (least disadvantaged) ADI quartile. In the Poisson multivariate regressions to determine if the ADI was associated with severe burns, patients in the highest ADI quartile had an increased relative risk of ≥20% TBSA burn (RR 1.31, 95% CI 1.02–1.68) and inhalation injury (RR 1.39, 95% CI 1.09–1.76) when compared to patients in the second-lowest ADI quartile when controlled for pertinent covariates. ConclusionResidential structure fires represent the major source of burns and fatalities. People who reside in the highest ADI quartile are more like to present with higher burn injury severity in terms of burn size and the presence of inhalation injury. The use of the ADI to target neighborhoods for burn prevention is imperative.

Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia.

Few studies have evaluated social determinants of outcomes disparities for children with acute lymphoblastic leukemia (ALL). We investigated the association of area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, with overall survival (OS) among children and adolescents with ALL. We obtained demographic and clinical data, geocoded addresses at diagnosis, and vital status on all Texas children diagnosed with ALL from 1995 to 2011 (N=4104). Using the US Census Bureau 2010 geography, we computed ADI scores for all census tracts in Texas and grouped the tracts into quartiles: least, third-most, second-most, and most disadvantaged. We mapped children to ADI quartiles based on residence at diagnosis, and estimated OS using Cox regression adjusting for sex, race/ethnicity, age, and metropolitan/nonmetropolitan residence. Five-year OS ranged from 89% (95% confidence interval [CI] 87-91%) for children in the least disadvantaged tracts to 79% (95% CI 76-81%) for children in the most disadvantaged tracts (P=4E-7). An elevated hazard ratio (HR) for death was observed for children in the most disadvantaged tracts (HR 1.57, 95% CI 1.23-2.00), and trends toward increased mortality were observed in the third-most and second-most disadvantaged tracts (HR 1.23, 95% CI 0.97-1.57 and HR 1.27, 95% CI 0.99-1.62, respectively). In stratified analyses, area disadvantage was more strongly associated with OS in males than females. Neighborhood socioeconomic disadvantage is associated with inferior OS in this analysis of over 4100 children with ALL, highlighting the substantial contributions of social-environmental factors to childhood cancer survival. This association was stronger in males than females.

Beyond patient-level barriers: Evaluation of rural residency and area-level deprivation and clinical trial (CT) participation.

e19068 Background: Residents of rural and socioeconomically deprived areas have worse cancer outcomes and are less likely to participate in CTs. It is unknown whether these area-level attributes predict CT participation after accounting for individual sociodemographic variables. Methods: We combined data from two SWOG national survey studies. S0316, a multi-center prospective survey, was combined with data from a large web-based survey. Both studies examined CT treatment decision making from diagnosis in patients with common cancers. Zip codes of residences were classified as rural or urban using Rural-Urban Continuum Codes (urban, 1-3, vs. rural, 4-9) and a 3-level ordinal variable (urban, 1-3, vs. rural, 4-7, vs. very rural, 8-9). We identified socioeconomically deprived areas (SDAs) as those with an Area Deprivation Index (ADI) in the upper quartile. We also examined areas by ADI quartile. Multivariable logistic regression was used to evaluate the association of rural residency and area-level socioeconomic deprivation with CT participation after adjusting for important individual-level factors (age, sex, race/ethnicity, income, and education), stratified by study and cancer type. Results: Among 7080 patients, 1299 (18.5%) were from rural areas, 653 (9.4%) were from SDAs; and 715 (10.1%) participated in a CT. Patients had breast (56.1%), prostate (21.8%), lung (13.6%), and colorectal (8.4%) cancer. In univariate analysis, rural patients were 23% less likely to participate in a CT (OR=0.77, 95% CI: 0.62-0.95, p=.016); in multivariate analysis, results were similar (OR=0.80, 95% CI: 0.64-0.99, p=.037). Very rural residents were 34% less likely to participate than urban patients (OR=0.66, 95% CI, 0.55-0.80, ordinal p=.031). There was no statistically significant association between residence in SDAs and CT participation (p&gt;.30). Rural patients were more likely to have &gt;1 comorbid conditions (45.4% vs. 39.5%, p=.001), to be concerned about how to pay for their care (40.6% vs. 32.4%, p&lt;.0001), and to travel farther for care (median 50.0 vs. 12.0 miles, p&lt;.0001). Conclusions: Our findings are the first to show that rural residents are less likely to participate in CTs even after accounting for confounding individual factors. These results agree with prior observations that rural patients must travel longer distances for care, including for CT care. Reducing the travel burden for rural cancer patients could improve their CT participation and the generalizability of CT results to all patients.

800: Area deprivation index and adverse obstetric outcomes

Preterm birth and low birth weight continue to be vexing obstetric and pediatric problems, complicating many pregnancies, with few effective interventions, and troubling racial disparities. Our objective was to examine the associations between area deprivation index (ADI), race, and adverse obstetric outcomes to target populations at highest risk. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” (University of Wisconsin), which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Preterm birth < 37 weeks and low birth weight (birthweight < 2500 grams) were compared across ADI quartiles from the least (1st quartile) to the most (4th quartile) disadvantaged. The analysis was stratified by race to explore the effect of race on the relationship between deprivation and adverse obstetric outcomes. 848 pregnant women were included. Low birth weight significantly increased as ADI increased, from 7% in areas of lowest deprivation to 20% in areas of highest deprivation (Table). Preterm birth less than 37 weeks and less than 34 weeks increased as deprivation increased with a 2 times higher risk for PTB < 37 and and nearly 3 times the risk for PTB < 34 weeks at the highest quartile of neighborhood deprivation. Notable disparities exist with nonblack women even at the most highly disadvantaged ADI still having a lower risk for LBW (8.3%) than black women at low ADI (17.4%). Increasing ADI is associated with a significant increase in risk for LBW and to a smaller extent risk for preterm birth, with notable racial disparities. Future studies testing actionable screening and prevention interventions targeted specifically for populations living in high neighborhood disadvantage should be performed to minimize risk for LWB and PTB outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

394: The fourth trimester in high deprivation areas: Are we missing the highest risk patients?

The postpartum period is increasingly recognized as a critical time when women need access to medical care but may be lost to follow-up. SMFM and ACOG recently reinforced the “fourth trimester” as a critical component of both pregnancy care and life-long health for women. We aimed to examine the association between area deprivation index (ADI) and receipt of postpartum care (PPC) to test how race and other risk factors may inform targeting populations at highest risk of falling out of PPC. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” developed by the University of Wisconsin, which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Receipt of PPC was examined across ADI quartiles from least (1st quartile) to most (4th quartile) disadvantaged. Patient-level variables including race, stress levels, depression scores, and medical comorbidities were tested for effect modification in the relationship between deprivation and PPC. 848 pregnant women were included. Women are significantly less likely to receive PPC as deprivation levels increased, from 90% in areas of lowest deprivation to only 64% in areas of highest deprivation. Black race did not significantly modify this relationship although notable disparities exist with black women were less likely to receive PPC than non-black women in both areas of low (67.4% versus 91.5%) and high deprivation (64% versus 71%). 40% of women in areas of highest deprivation fall out of care during the postpartum period. There is also racial disparity in PPC with black women significantly less likely to receive PPC than non-black women in both areas of low and high deprivation. ADI can identify specific geographic regions where targeted interventions to improve PPC would be highest yield.View Large Image Figure ViewerDownload Hi-res image Download (PPT)