Census Bureau Research Articles

Regional and social disparities in cessation behavior and motivation to quit among U.S. adult current smokers, Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey 2014–15 and 2018–19

IntroductionVariation in smoking cessation behaviors and motivators across the United States may contribute to health disparities. This study investigates regional differences over time in two key cessation motivators (quit interest and doctor's advice to quit) and two cessation behaviors (past-year quit attempts and recent successful cessation) across diverse demographic factors.MethodsData were analyzed from two releases of the Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey (TUS-CPS) for the years 2014–15 and 2018–19. The analysis included sex, age, race and ethnicity, education, marital status, employment status, and household income.ResultsFindings from 2018 to 2019 TUS-CPS revealed that quit interest was highest in the Northeast and lowest in the Midwest, while doctor's advice to quit was most prevalent in the Northeast and least in the West. Past-year quit attempts were most common in the Northeast and least in the South. Recent successful cessation (defined as quitting for 6 to 12 months) was highest in the Northeast and Midwest, with the South showing the lowest rates. Compared to the 2014–15 survey, 14 demographic groups (7 in the Midwest, 6 in the South, and 1 in the West) showed decreases in both quit interest and actions to quit. Notably, the Asian non-Hispanic group in the Northeast experienced a significant decrease in quit interest (–17.9%) but an increase in recent successful cessation (+369.2%).DiscussionOverall, the study indicates that while quit interest was highest in the West, the South exhibited the lowest rates of quit attempts and successful cessation. Significant differences were also noted between age groups. These findings highlight the need for further research into cessation behaviors at more granular levels to inform policies aimed at reducing smoking-related health disparities among populations facing the greatest challenges in cessation.

Regional Distribution of Foreign-Born Medical Graduates in US Primary Care Specialty Residencies from 2010 to 2022.

The United States has more foreign-born (FB) individuals than any other country and a large international medical graduate (IMG) workforce. Yet little is known about the trends of FB IMGs matching into primary care specialties residency programs or the alignment between FB individuals and FB IMGs. This study examined the recent trends in FB IMGs entry into primary care specialty residency programs and their distribution in relation to the US FB population. In this retrospective study, we used archives of National Resident Matching Program (NRMP) data on the main residency match from 2010 to 2022. We extracted match data and program directors' policies for internal medicine, pediatrics, family medicine, and internal medicine/pediatrics. We also extracted data on the total population and FB individuals from the US Census Bureau for each US state from 2010 to 2022. From 2010 to 2022, 17.2% of primary care specialty positions were filled by FB IMGs, with 22.1% for internal medicine, 11.3% for pediatrics, 10.7% for family medicine, and 3.2% for internal medicine/pediatrics. The percentage of primary care specialty positions filled by FB IMGs was significantly higher than the percentage of FB people in the US overall and 7 of 9 US regions (p < 0.001) (excepting Pacific and Mountain). The percentage of family medicine, pediatrics, and internal medicine/pediatrics positions filled by FB IMGs was significantly lower than the proportion of FB people (p < 0.001). Internal medicine had a higher proportion of positions filled by FB IMGs compared to the proportion of FB individuals in the general population (p < 0.001). Distribution of FB IMGs varies in primary care specialties compared to FB people in the US. Given the importance of aligning medical education with patients' needs, programs could take into account population demographics while assessing and admitting the applicants.

Key themes of community-oriented primary care projects from a longitudinal, rural interprofessional health professions curriculum (1997–2023)

BackgroundThe Community Oriented Primary Care Project Model (COPC) has been well studied globally as well as in the United States as a way to provide both community-centered primary care and to engage in community based research. Rural trainees through the University of Illinois College of Medicine’s Rural Medical Education Program (RMED) and Rural Pharmacy Education Program (RPHARM) students through the University of Illinois Chicago College of Pharmacy have participated in a COPC project as a capstone to a four month longitudinal, immersive community-based experience in a rural primary care setting. The purpose of this study was to assess the type of projects implemented through a rural health professions curriculum over a 30 year project period. .MethodsA research team reviewed projects on 30 elements; including topic and demographics. Patterns in COPC topics and rurality of the location in which the COPC project were also examined by using 2021 U.S. Census Bureau population data and Rural Urban Commuting Area (RUCA) Code.ResultsCOPC projects were categorized into 31 main topic areas with mental health being the most prevalent topic area covered by projects (n = 67, 15.7%) followed by 43 (10.1%) projects that focused on nutrition/exercise, and 41 (9.6%) focused on substance use (presented as a separate category from mental health in this analysis).ConclusionsFor three decades, COPC themes reflect priority health issues in rural communities while providing a scholarly activity for health profession student trainees Past projects have also been implemented in highly rural areas where research is not often conducted. The COPC research process can be easily replicated in other trainee models such as to fulfill ACGME requirements of scholarly activity and can provide a template for trainees of this model to implement community-engaged research in the future.

Prevalence, Correlates, and Impacts of Displacement Because of Natural Disasters in the United States From 2022 to 2023.

Objectives. To quantify the prevalence, correlates, and impacts of displacement because of natural disasters in the United States. Methods. We pooled data across 10 independent survey samples from the Census Bureau Household Pulse Survey from December 2022 to September 2023. Survey questions asked about displacement from home because of natural disasters, duration of displacement, and impacts of disasters. Results. In our weighted sample of 213 234 003 adults, 3 166 500 (1.5%) reported displacement in the past year because of a natural disaster. People of color, sexual and gender minority populations, and those with lower incomes, disabilities, or unfavorable social determinants of health (SDOH) such as food insecurity were more likely to report displacement. Long-term displacement was more common with fires compared with other disasters. Disaster impacts, including food and water shortage, electricity loss, unsanitary conditions, feeling isolated, and experiencing scams, were more common among people of color and individuals with lower education or income. Conclusions. Many people in the United States, particularly from health disparity populations, are displaced because of natural disasters. Addressing SDOH and other vulnerability factors may help improve disaster preparedness and mitigate postdisaster impacts. (Am J Public Health. Published online ahead of print October 24, 2024:e1-e11. https://doi.org/10.2105/AJPH.2024.307854).

Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015–2020: a cross-sectional analysis

BackgroundAntibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients’ risks for acquiring antibiotic-resistant (AR) uropathogens.MethodsWe identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients’ age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients’ sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients’ census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients’ risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.ResultsWe included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients’ odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients’ odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.ConclusionThe social determinants of health may play important and intersecting roles in determining a patient’s risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

US Primary Care WorkforceGrowth: A Decade of Limited Progress, and Projected Needs Through 2040.

Despite efforts to mitigate a projected primary care physician (PCP) shortage required to meet an aging, growing, and increasingly insured population, shortages remain, compounded by the COVID-19 pandemic, growing inequity, and persistent underinvestment. We examined primary care workforce trends over the past decade and revisited projected primary care clinician workforce needs through the year 2040. Using data from the AMA Masterfile and Medical Expenditure Panel Survey (MEPS), we analyzed trends in the number of primary care physicians (PCPs) and in outpatient PCP visits by age and gender over the past decade. We then used the Medicare PECOS and Physician & Other Practitioners datasets to identify nurse practitioners (NPs) and physician assistants (PAs) in primary care. Using these baseline clinician enumerations and projected population growth estimates from the US Census Bureau for the years 2020-2040, we calculated estimated primary care workforce needs by 2040. The effects of aging and population growth and baseline shortages in the primary care workforce call for significant increases in the primary care workforce to accommodate rising demands. Office visits to primary care clinicians are projected to increase from 773,606 in 2020 to 893,098 in 2040. We project a need for an additional 57,559primary care clinicians by 2040. Workforce shortages in primary care continue to expand due to populationaging, growth, and heightened rates of clinicianburnout& egress.

Resumption Of Medicaid Eligibility Redeterminations: Little Change In Overall Insurance Coverage.

In anticipation of the end of the COVID-19 public health emergency, Congress ended the Medicaid continuous coverage requirement on March31, 2023, allowing states to terminate coverage for ineligible people and resume eligibility determinations through a process known as unwinding. Although administrative data have documented substantial declines in Medicaid enrollment since April2023, the impact on uninsurance is unknown. Using data from the Census Bureau's Household Pulse Survey, we estimated the early effect of Medicaid unwinding on insurance coverage among people ages19-64. We found that within the first three months of unwinding, the number of people self-reporting Medicaid coverage declined by approximately two million, and there was a much smaller, statistically insignificant decline in overall coverage of approximately 467,000 people. It appears that for many people, the availability of employer-sponsored insurance and other private coverage offset Medicaid coverage loss. These results suggest that the resumption of redeterminations has had less impact on uninsurance than was initially feared. Our findings highlight the importance of tracking coverage transitions during unwinding. By identifying populations at risk for uninsurance after Medicaid loss, these data could enhance the effectiveness of state outreach and enrollment assistance for people eligible for Marketplace coverage and subsidies.

Prevalence of Hearing Loss and Hearing Aid Use Among Persons Living With Dementia in the US

Dementia and hearing loss are prevalent and represent public health priorities, but little is known about the prevalence of hearing loss among persons living with dementia at a population level. To estimate the prevalence of hearing loss and hearing aid use among a nationally representative sample of persons living with dementia. In this cross-sectional study, we analyzed data from Medicare beneficiaries who participated in round 11 of the National Health and Aging Trends Study (NHATS). The analytic sample included participants who had complete audiometric data and a dementia classification, and survey weights were applied to yield nationally representative estimates. Data were collected from June to November 2021, and analyzed from October 12, 2023, to February 27, 2024. Audiometric measures of hearing loss and self-reported hearing aid use. National prevalence estimates of possible and probable dementia and hearing loss were estimated by applying NHATS survey weights of sex and age to the population aged 71 years or older based on the US Census Bureau's 2020 American Community Survey data. The analytic sample comprised 2613 NHATS participants (74.6% aged 71-79 years and 25.4% aged ≥80 years; 52.9% female). Overall prevalence of hearing loss among participants with dementia was estimated at 79.4% (95% CI, 72.1%-85.3%). The prevalence of hearing loss increased with age, from 61.1% (95% CI, 37.7%-80.2%) among participants aged 71 to 74 years to 94.2% (95% CI, 88.8%-97.0%) among those aged 85 years or older. Among participants with hearing loss, 21.7% (95% CI, 16.2%-28.3%) reported hearing aid use. In this cross-sectional study, the findings suggest that hearing loss is highly prevalent among individuals with dementia, with a low prevalence of hearing aid use. These findings reveal a potential opportunity for intervention.

Prevalence of Glaucoma Among US Adults in 2022

Glaucoma is the leading cause of irreversible blindness worldwide and, in the US, disproportionately affects people from racial and ethnic minority groups. Glaucoma prevalence has not been estimated for the US in more than a decade, and state- and county-level estimates are not available. To estimate glaucoma and vision-affecting glaucoma prevalence by demographic factors and US state and county for the Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System (VEHSS). This meta-analysis used data from the National Health and Nutrition Examination Survey (2005-2008), Medicare fee-for-service claims (2019), IBM MarketScan commercial insurance claims (2016), population-based studies of eye disease (1985-2003), and 2022 population estimates from the US Census Bureau. PubMed was searched for population-based studies of glaucoma prevalence published between 1991 and 2016. Bayesian meta-regression methods were used to estimate the prevalence of glaucoma and vision-affecting glaucoma stratified by age, undifferentiated sex/gender (a measure that captures an unclear mix of aspects of sex and or gender), race and ethnicity, and US county and state. Prevalence of any type of glaucoma (open or closed angle) among people 18 years or older and vision-affecting glaucoma, defined as glaucoma and a visual field abnormality. For 2022, an estimated 4.22 million people (95% uncertainty interval [UI], 3.46 million to 5.23 million) in the US were living with glaucoma, with a prevalence of 1.62% (UI, 1.33%-2.00%) among people 18 years or older and 2.56% (UI, 2.10%-3.16%) among people 40 years or older. An estimated 1.49 million people (UI, 1.17 million to 1.90 million) were living with vision-affecting glaucoma, with a prevalence of 0.57% (UI, 0.45%-0.73%) among people 18 years or older and 0.91% (UI, 0.71%-1.16%) among people 40 years or older. Prevalence of glaucoma among people 18 years or older ranged from 1.11% (UI, 0.89%-1.40%) in Utah to 1.95% (UI, 1.57%-2.39%) in Mississippi. Black adults had a prevalence of 3.15% (UI, 2.32%-4.09%) compared with 1.42% (UI, 1.10%-1.85%) among White adults; adults in the Hispanic and all other racial and ethnic categories combined had a prevalence of 1.56% (UI, 1.13%-2.06%). This meta-analysis found that an estimated 2.56% of people 40 years or older have glaucoma, slightly more than estimated by previous studies. Black individuals are disproportionately affected. Prevalence estimates at the state and county level can help guide public health planning.

Identifying measures for understanding and addressing county-level disparities in adolescent HPV vaccination coverage in North Carolina.

HPV vaccination coverage is characterized by geographic disparities in the US, with national studies finding lower coverage in rural versus nonrural areas. To direct quality improvement efforts in North Carolina, we sought to understand how different rurality measures characterize these disparities. We used separate negative binomial regression models to test associations between 5 dichotomized county-level rurality measures and HPV vaccination coverage (≥1 dose) among North Carolina adolescents, ages 11-12 (n=326,345). Rurality measures were derived from: Office of Management and Budget's Metropolitan Statistical Areas, Rural-Urban Continuum Codes, Index of Relative Rurality, US Census Bureau classifications, and North Carolina Rural Center classifications. Models controlled for Social Vulnerability Index (SVI) percentile and rate of pediatricians per county. Vaccination data came from the North Carolina Immunization Registry. HPV vaccination coverage was 29% across North Carolina's 100 counties (range: 13%, 46%). Agreement between rurality measures ranged from 54% to 93% of counties. In adjusted analyses, none of the 5 rurality measures correlated with HPV vaccination coverage, but higher SVI and higher rate of pediatricians were positively associated with coverage (p< 0.01). Exploratory moderation analyses suggested regional variation in the relationship between rurality and coverage, with a positive association in one region, a negative association in one region, and no association in four regions. County-level rurality measures did not identify disparities in HPV vaccination coverage in North Carolina. Measures related to social vulnerability and access to pediatricians may be better suited for understanding and addressing the state's substantial county-level vaccination disparities.

Epidemiology of Sports-Related Tendon Ruptures Presenting to Emergency Departments in the United States.

Participation in recreational and competitive sports can predispose people to musculoskeletal injuries. Chronic overuse with insufficient recovery, overloading, and direct contact can result in acute primary tendon ruptures. There is scarce literature regarding the epidemiology of sports-related acute primary tendon ruptures in the United States (US). To identify the incidence rate (IR) of sports-related acute primary tendon ruptures presenting to US emergency departments using the National Electronic Injury Surveillance System (NEISS) database and describe the trends in the IR from 2001 to 2020. Descriptive epidemiology study. The NEISS database was queried using injury case narratives; cases with a clear diagnosis of an acute primary tendon rupture were included in the final analysis. National estimates, estimated IRs (reported as per 1,000,000 person-years at risk), and temporal trends in the annual IR (reported as average annual percent change) of acute primary tendon ruptures were calculated using NEISS sample estimates and US Census Bureau population estimates. An estimated total of 141,382 patients (95% confidence interval [CI], 107,478-175,286) presented to US emergency departments with a sports-related tendon rupture over the study period (IR, 22.9 person-years at risk [95% CI, 17.4-28.3]). The mean age was 37.7 years (95% CI, 37.0-38.5). Of all cases of a tendon rupture identified from 2001 to 2020, 60.1% were secondary to exercise/sports-related injury mechanisms. An Achilles tendon rupture was the most common injury, representing 55.9% of cases. Basketball was the most common sports-related injury mechanism, accounting for 36.6% of cases. The overall injury rate in male patients was 7.7 times that of female patients (IR ratio, 7.7 [95% CI, 4.4-13.5]; P < .05). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (average annual percent change, 1.9 [95% CI, 1.0-2.8]; P < .01). Recreational/competitive sports participation accounted for a large proportion of acute primary tendon ruptures in the US during the study period.

Environmental Inequality in Estimated Cancer Risk from Airborne Toxic Exposure across United States Communities from 2011 to 2019.

US Census Bureau data were matched to U.S. Environmental Protection Agency estimated cancer risks from airborne toxics from 2011 to 2019 to explore environmental inequality with nationwide census tract resolution. Spearman correlations showed modest associations between various socioeconomic status factors and estimated cancer risk. Multiple linear regression analyses show positive associations with increased estimated cancer risk (p < 0.05) for high proportions of Blacks in suburban and rural areas. A positive relationship with estimated cancer risk was found for increasing proportions of Asians and Hispanics in nonurban areas. Urban tracts that suffer from the highest estimated cancer risks were concentrated among the communities with a population of higher proportion of minorities. While environmental inequality seems to have improved across the examined years for certain demographics with respect to estimated cancer risk from air toxics, equity is far from achieved, and future work in identifying the sources of environmental inequality could help in achieving a more just environment.

Social Determinants of Health Affect Psychological Distress among People with Disabilities

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau’s Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51–5.60), were food insecure (OR = 3.75, 95% CI: 3.43–4.10), housing insecure (OR = 3.17, 95% CI: 2.82–3.58), or were unable to work (OR = 1.98, 95% CI: 1.80–2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11–13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.

A Study of Property Intrinsic Value Prediction Based on Machine Learning Modeling

When purchasing goods, buyers consistently prioritize the fairness of the price to make informed decisions, particularly for high-value items. This consideration becomes even more crucial in the real estate market, where verifying the fairness of a property's asking price through conventional methods can be challenging. This study addresses this issue by aiming to develop a functional predictive model that can estimate a property's intrinsic value using various machine learning techniques. By analyzing the California Census Data published by the US Census Bureau, this research investigates the potential for determining a property's intrinsic value based on readily available information about the block in which the property is situated. The study's objective is to create a model that provides accurate and reliable property valuations, helping buyers make more informed decisions and promoting transparency in the real estate market. This model leverages demographic, economic, and housing data from the census to predict property values, potentially transforming how properties are appraised and traded. By offering a method to verify asking prices, the research seeks to enhance fairness and efficiency in real estate transactions, providing a valuable tool for buyers, sellers, and real estate professionals alike.

The impact of entrepreneurs’ military experience on small business exit: A conservation of resources perspective

Based on insights drawn from the conservation of resources (COR) theory, this paper examines the impact of military experience on small business exit decisions among entrepreneurs. We theorize that entrepreneurs with military backgrounds are more conservative regarding the potential resource loss associated with the entrepreneurial process than those without military experience, making them more likely to exit their business as a coping mechanism. We further theorize that these entrepreneurs are more likely to exit the business voluntarily rather than involuntarily, using business exit as a coping mechanism to preemptively manage risks before the actual losses occur. An empirical analysis of data from the 2007 Survey of Business Owners (SBO 2007) provided by the United States Census Bureau supports our hypotheses. This study contributes to our knowledge of how military service affects entrepreneurs’ decisions regarding business exit.

A closer look at the demographics of same-sex marriage in the United States: Implications for research, practice, and policy.

In 2015, the United States Supreme Court legalized same-sex marriage nationwide, setting in motion a sweeping social change for sexual minority people and their romantic relationships. The United States Census Bureau collects demographic data on same-sex couple households, offering an opportunity to better understand the demographic makeup of same-sex marriage today. This knowledge is essential for researchers, practitioners, and policymakers who aim to understand and support same-sex couples' relationships. We used national probability data from the American Community Survey collected in 2021 (the most recent year these data are available) on married and unmarried, cohabiting same-sex and opposite-sex households. Respondents reported their own age, race, ethnicity, education, employment, income, home ownership, and whether they had children living with them in their household. Differences between married and unmarried opposite-sex couples were observed in race, ethnicity, age, and socioeconomic status, consistent with prior research. Many of these demographic gaps also existed for same-sex couples, although these were often smaller. Several of these differences further varied between male and female same-sex couples. Same-sex married couples appear to be more demographically diverse than opposite-sex married couples. However, like opposite-sex couples, same-sex couples from multiple minoritized groups were less likely to be married. Future research is needed to understand drivers of these differences (e.g., different attitudes about marriage or lack of access to marriage) and their impact. Policymakers and clinicians will need to bear these group differences in mind when designing policy and delivering services to support the well-being of sexual minority couples.

Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

BackgroundSocial determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). MethodsThis cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. ResultsQuery of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. ConclusionsCommunity-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.

State of Geographic Access to Cancer Treatment Trials in the United States: Are Studies Located Where Patients Live?

In this study, we describe the geographic distribution of US cancer treatment trials to identify disparities and opportunities for targeted improvements in access to research for people with cancer. US-based phase I-III cancer treatment trials registered on ClinicalTrials.gov were tabulated for the years they were open to enrollment (2017-2022), overall and by county, and supplemented with data from the US Census Bureau, National Cancer Institute, Centers for Disease Control and Prevention, and US Department of Agriculture. We evaluated geographic differences in trial availability. We assessed 5-year trends in trials per capita and mapped 1-hour drive time areas around sites. A total of 6,710 trials were open to enrollment in 2022 across 1,836 sites. Trials increased by 4%, whereas sites decreased by 3% annually per capita from 2017. Seventy percent of US counties had no reported active trials in 2022 (2,211/3,143), representing 19% of people age ≥55 years. Eighty-six percent of nonmetropolitan counties had no trials versus 44% of metropolitan counties. Trial availability varied by county-level cancer mortality and social vulnerability (an index derived from demographic and socioeconomic data from the US Census). Eighteen percent of counties without trials had oncologist care sites (n = 618). Notably, 26% of people age ≥55 years lived beyond an hour drive of a site with ≥100 trials. Most US counties have limited to no trial offerings, a disparity magnified in counties that are nonmetropolitan, with high social vulnerability, and with high cancer mortality. Effort to facilitate diverse site participation is needed to promote equitable access to trials and to ensure patients participating in trials match the characteristics of patients who will receive interventions once approved. Counties with oncology care sites but no trials provide potential expansion areas.

Are new pediatric trauma centers located close to the high-risk populations? A geolocation study.

Higher rates of injury occur in children who live in low socioeconomic areas. Since 2010, the number of verified Level I and Level II pediatric trauma centers (PTCs) has doubled. The purpose of this study is to look at the location of new verified PTC in relation to children living in high-risk areas. Historical and recent data about verified Level I and Level II PTCs were obtained from the American College of Surgeons (ACS), the American Trauma Society, and State Data where available. Census data were obtained from the US Census Bureau's American Community Survey for 2010 and 2020 for children younger than 18 years. The pediatric population was stratified by (1) poverty threshold and (2) living within 30 miles of PTC. The census data and trauma center locations were geocoded using the ArcGIS Pro program. Data analysis was performed at the census tract level. A total of 55 Level I or Level II ACS-verified PTCs were in the United States in 2010 and 116 in 2020. In 2010, there were 14.5 million children (19.6%) below the poverty threshold and 12.9 million (17.8%) in 2020. In 2010, 23 states did not have an ACS-verified PTC either in the state or in a neighboring state within 30 miles. By 2020, only nine states did not have an ACS-verified PTC or a center in a neighboring state within 30 miles. When state level data were included, this dropped to four. The 19 states who had new verified PTCs covered between 14% and 21% of children below the poverty level. The percentage of children below the poverty threshold and less than 30-mile access to a Level I or Level II PTC in 2010 was 74.56% compared with children above poverty and less than 30-mile access, which was 70.34% (p < 0.0001). In 2020, children below poverty without 30-mile access had been reduced to 52% and 45.54% for children above poverty level (p < 0.0001). Thus, there was a greater increase in 30-mile access for children above the poverty level than for those below the poverty level (24.8% vs. 22.6%, p < 0.001). On a national level, despite doubling the number of PTC, it has not improved 30-mile access for high-risk children. Alternatively, 19 states now have better access. Retrospective Cohort Study, Level III.

Social Determinants of Health and Timing of Tracheostomy for Severe Bronchopulmonary Dysplasia

To estimate the association of ZIP code-level social determinants of health (SDoH), specifically household income, education level, and unemployment rate, with post-menstrual age (PMA) at tracheostomy placement in patients with severe bronchopulmonary dysplasia (BPD). This was a retrospective observational study of infants born <32 weeks' gestation and discharged from a Children's Hospitals Neonatal Consortium newborn intensive care unit. Patients were diagnosed with severe BPD and received tracheostomies before discharge. Maternal ZIP code at admission was linked to that ZIP code's SDoH via the 2021 US Census Bureau 5-year data. Unadjusted and adjusted analyses were completed with separate models fit for each SDoH marker. 877 patients received tracheostomies at median (interquartile) 48 (44-53) weeks' PMA. In multivariable models, patients in the highest education groups received tracheostomies earlier (OR: 95% CI = 0.972: 0.947-0.997, p=0.031), and non-Hispanic Black patients received tracheostomies later compared with non-Hispanic White patients (OR: 1.026; 95% CI =1.005-1.048, p=0.017). For household income and unemployment, the PMA at tracheostomy did not differ by SDoH or race. For all three models, male sex, small for gestation status, and later PMA at admission were associated with later PMA at tracheostomy. For each SDoH marker, significant inter-center variation was noted as several centers had independently increased PMA at tracheostomy. Education at the ZIP code-level influenced PMA at tracheostomy after adjusting for patient and clinical factors. Adjusted for each SDoH studied, significant differences were noted among centers. Factors leading to the decision and timing of neonatal tracheostomy need further evaluation.