Census Bureau Regions Research Articles

Abstract A015: Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022

Abstract Background: Mammography screening is associated with at least a 20% reduction in breast cancer mortality. However, there are racial/ethnic differences in breast cancer mortality. For example, non-Hispanic Black (NHB) women are significantly more likely to die of breast cancer than non-Hispanic White (NHW) women. Few studies have reported small-area estimates for mammography screening among the entire US population; differences by race were either not examined or resulted in mixed findings. The American Cancer Society (ACS) and the United States Preventive Services Taskforce (USPSTF) recommend regular mammography screening from age 40 through 74 years. The current study aims to identify areas of up-to-date mammography screening and to elucidate whether mammography screening varied by geographical location, race, or ethnicity. Methods: Mammography screening within the past 12 months was retrieved from the 2015-2022 Behavioral Risk Factor Surveillance System data. The study population consisted of adult women aged 40 and older residing within the United States. 2020 US census tract population estimates were used to generate gender (all women), race/ethnicity (NHB, NHW, non-Hispanic Asian, and Hispanic/Latina), income, and age group weights for each US census tract. Synthetic estimates of mammography screening uptake at the census tract were conducted using our novel PARIS model (Probability of mammography screening within the past year, given age, race/ethnicity, income, and state) using a multilevel logistic regression model. Regional differences in mammography screening by US Census Bureau regions and divisions were examined. Results: Up-to-date mammography among all women in the sample was 55.98% (SD = 2.07; F (3, 72429) = 2886.81, p < .0001). Mammography screening examined by race indicated the greatest screening rates among non-Hispanic Black women (M = 60.78, SD = 3.11) and least among Asian women (M = 48.68, SD = 3.15). Among four US Census Bureau regions, the West region had the lowest rates of mammography screening among women (M = 54.74, SD = 1.85) while the South region had the highest rates (M = 56.55, SD = 2.18; F(3, 72429) = 2886.81, p < .0001). After further parsing geographical units, the West Pacific region, among the 9 US Census Bureau divisions, had the lowest mammography screening (M = 54.53, SD = 1.81) while the East South Central division had the highest rates of mammography screening (M = 56.94, SD = 2.10; F(8, 72429) = 1360.60, p < .0001).Conclusion: Using novel geospatial methods, the current study elucidated significant differences in mammography screening by race and place. These results suggest that Black women and women living in the South have higher up-to-date mammography screening compared to other women. Thus, the existing inequities in breast cancer outcomes may be explained by differences in the cancer care continuum (delays in follow-up care, treatment, and breast cancer survival). Further examination of the interplay between screening uptake, late-stage diagnosis, and death is needed. Citation Format: Sydney P. Howard, Justin X. Moore, Elinita Pollard, Ryan Johnson, Lovoria Williams, Adebola Adegboyega, Jie Chen, Jorge Cortes, Aimee James. Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A015.

Understaffed and beleaguered: a national survey of chiefs of police about the post-George Floyd era

PurposeThe 2020 murder of George Floyd resulted in challenges to policing in the United States of America, but little is known about how police chiefs perceive them. At the same time, chiefs of police wield great influence over public perceptions of crime and disorder, the state of their profession, the laws and policies that govern the conduct of police officers and municipal public safety budgets. It is therefore critical to understand how police perceive the changes to their profession post-Floyd.Design/methodology/approachThis study surveyed a randomly selected national sample of 276 municipal chiefs of police. Items probed resignations, recruitment, efforts to defund departments, community support, officer morale, suspects’ likelihood of obeying lawful orders and career risks that could inhibit proactive police work. It examined associations between perceptions and Census Bureau region, length of tenure as chief, size of police department, population served and the urban or rural designation of the jurisdiction.FindingsChiefs overwhelmingly reported recruiting qualified candidates had become much harder, and the present risks of proactive police work encourage inaction. Chiefs of agencies in the Northeast perceived more challenges than those in the South. Respondents with more years of experience were less likely to perceive the current situation as dire. Approximately 13.5% reported an attempt to defund their department, 56.8% of which yielded some success. Our study suggests an increase in the number and scope of challenges perceived by chiefs of police. Results vary by region and police chief years of experience.Originality/valueThis study provides researchers and practitioners with the perspectives of chiefs about the post-Floyd era that influence their decisions, policies and initiatives.

Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis.

Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures. To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018. None. We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases , 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions. In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.

QuickStats: Percentage* of Adult Day Services Centers† That Use Any Telehealth,§ by U.S. Census Bureau Region - United States, 2022¶.

QuickStats: Percentage* of Adult Day Services Centers† That Use Any Telehealth,§ by U.S. Census Bureau Region - United States, 2022¶.

A 23-year analysis of litigation in orthopedic elbow surgery

BackgroundThe reasons for malpractice litigation in elbow surgery are not well understood. The aim of this study is to report the most frequently litigated surgeries of the elbow and analyze the reasons for litigation and case outcomes. MethodsA retrospective review of the Westlaw legal database was performed, and all federal and state jurisdiction litigation cases involving the elbow from 2000-2023 were queried. Cases were excluded if they did not involve an orthopedic surgeon, nor primary elbow injury or procedure. Cases were reviewed for demographic information, surgical procedure based on reference CPT codes, complications, symptoms, and reasons for litigation. Quantitative information, including settlement and indemnity cost to the defendant orthopedic surgeon, was analyzed. Cases were sub-divided based on United States Census Bureau regions and states to assess regional frequency of litigation with ANOVA tests. ResultsThere were 59 cases meeting inclusion criteria from 2000-2023.The most litigated cases involved were ulnar nerve transposition/release and open reduction and internal fixation of the proximal radius and/or ulna at the elbow. The most litigated complication was claimed nerve damage (46%) and permanent disability (27%). Of the total cases, the most frequently litigated symptoms were nerve damage (46%) and loss of function (37%), while the least frequent was postoperative stiffness (2%). The Pacific region demonstrated the highest litigation rate (20%), while the East South Central, Mountain, and New England regions had the lowest litigation rate (3% each). A favorable verdict was given to the defendant orthopedic surgeon in 59% of the cases. The average loss incurred through settlement was $245,590, while the average indemnity paid through verdict was $523,334. ConclusionOperative fixation of the proximal ulna/radius and ulnar nerve release/transposition are the most litigated procedures of the elbow. Litigation is most associated with nerve injury. Across Census Bureau regions, there is no significant difference in monetary cost incurred through settlements and verdict losses. Although a majority of litigated cases are won by the defending orthopedic surgeon, thorough informed consent and perioperative expectation management may mitigate litigation risk.

Development of Predictive Models to Inform a Novel Risk Categorization Framework for Antibiotic Resistance in Escherichia coli-Caused Uncomplicated Urinary Tract Infection.

In clinical practice, challenges in identifying patients with uncomplicated urinary tract infections (uUTIs) at risk of antibiotic nonsusceptibility may lead to inappropriate prescribing and contribute to antibiotic resistance. We developed predictive models to quantify risk of nonsusceptibility to 4 commonly prescribed antibiotic classes for uUTI, identify predictors of nonsusceptibility to each class, and construct a corresponding risk categorization framework for nonsusceptibility. Eligible females aged ≥12 years with Escherichia coli-caused uUTI were identified from Optum's de-identified Electronic Health Record dataset (1 October 2015-29 February 2020). Four predictive models were developed to predict nonsusceptibility to each antibiotic class and a risk categorization framework was developed to classify patients' isolates as low, moderate, and high risk of nonsusceptibility to each antibiotic class. Predictive models were developed among 87 487 patients. Key predictors of having a nonsusceptible isolate to ≥3 antibiotic classes included number of previous UTI episodes, prior β-lactam nonsusceptibility, prior fluoroquinolone treatment, Census Bureau region, and race. The risk categorization framework classified 8.1%, 14.4%, 17.4%, and 6.3% of patients as having isolates at high risk of nonsusceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, β-lactams, and fluoroquinolones, respectively. Across classes, the proportion of patients categorized as having high-risk isolates was 3- to 12-fold higher among patients with nonsusceptible isolates versus susceptible isolates. Our predictive models highlight factors that increase risk of nonsusceptibility to antibiotics for uUTIs, while the risk categorization framework contextualizes risk of nonsusceptibility to these treatments. Our findings provide valuable insight to clinicians treating uUTIs and may help inform empiric prescribing in this population.

Nation-Wide Variation in Presence of Legislation or Protocols for EMS Care of Operational Canines.

Deployment of law enforcement operational canines (OpK9s) risks injuries to the animals. This study's aim was to assess the current status of states' OpK9 (veterinary Emergency Medical Services [VEMS]) laws and care protocols within the United States. Cross-sectional standardized review of state laws/regulations and OpK9 VEMS treatment protocols was undertaken. For each state and for the District of Columbia (DC), the presence of OpK9 legislation and/or care protocols was ascertained. Information was obtained through governmental records and from stakeholders (eg, state EMS medical directors and state veterinary boards).The main endpoints were proportions of states with OpK9 laws and/or treatment protocols. Proportions are reported with 95% confidence intervals (CIs). Fisher's exact test (P <.05) assessed whether presence of an OpK9 law in a given jurisdiction was associated with presence of an OpK9 care protocol, and whether there was geographic variation (based on United States Census Bureau regions) in presence of OpK9 laws or protocols. Of 51 jurisdictions, 20 (39.2%) had OpK9 legislation and 23 (45.1%) had state-wide protocols for EMS treatment of OpK9s. There was no association (P = .991) between presence of legislation and presence of protocols. There was no association (P = .144) between presence of legislation and region: Northeast 66.7% (95% CI, 29.9-92.5%), Midwest 50.0% (95% CI, 21.1-78.9%), South 29.4% (95% CI, 10.3-56.0%), and West 23.1% (95% CI, 5.0-53.8%). There was significant (P = .001) regional variation in presence of state-wide OpK9 treatment protocols: Northeast 100.0% (95% CI, 66.4-100.0%), Midwest 16.7% (95% CI, 2.1-48.4%), South 47.1% (95% CI, 23.0-72.2%), and West 30.8% (95% CI, 9.1-61.4%). There is substantial disparity with regard to presence of OpK9 legal and/or clinical guidance. National collaborative guidelines development is advisable to optimize and standardize care of OpK9s. Additional attention should be paid to educational and training programs to best utilize the limited available training budgets.

Prevalence of intellectual disability among adults born in the 1980s and 1990s in the United States.

Prevalence of intellectual disability (ID) is currently estimated through parent report on surveys of children. It is difficult to estimate the number of adults living with ID in the United States because no comprehensive survey or surveillance allows for identification. The purpose of this study was to estimate the prevalence and number of adults with ID born between 1980 and 1999 using multiple years of the National Health Interview Survey (NHIS) and Census data. We concatenated the NHIS from 1997-2016 that evaluated parental response about whether a child aged 3-17years had an ID. Using weighted survey analyses, we estimated the prevalence of ID among individuals across four birth cohorts-(1) 1980-1984, (2) 1985-1989, (3) 1990-1994, and (4) 1995-1999. The number of adults with ID was then extrapolated by applying these prevalence rates to Census population estimates (as of 1 July 2021) of respective birth cohorts. Weighted prevalence of ID varied by birth cohort, sex, race and ethnicity, and US Census Bureau regions. The overall prevalence rate was 1.066 [95% confidence interval (CI): 0.831-1.302] for adults born between 1980 and 1984, 0.772 (CI: 0.654-0.891) for adults born between 1985 and 1989, 0.774 (0.675-0.874) for adults born between 1990 and 1994, and 1.069 (CI: 0.898-1.240) for adults born between 1995 and 1999. Overall, we estimate that 818564 adults with ID who were approximately 21-41years were living in the United States as of 2021. This study provides researchers examining adult health outcomes with an estimated denominator of young and middle-aged adults living with ID in the United States. Policymakers can use this information to support justification for resource and service needs, and clinicians may benefit from understanding that ID is a lifelong developmental condition often with additional physical, emotional and developmental needs requiring tailored care.

Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States

To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P<.001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.

Nonfatal and Fatal Falls Among Adults Aged ≥65 Years - United States, 2020-2021.

In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.

Illicitly Manufactured Fentanyl-Involved Overdose Deaths with Detected Xylazine - United States, January 2019-June 2022.

In 2022, provisional data indicated that more than two thirds (68%) of the reported 107,081 drug overdose deaths in the United States involved synthetic opioids other than methadone, principally illicitly manufactured fentanyls (IMFs) (1). Xylazine, a nonopioid sedative not approved for human use and with no known antidote, has been increasingly detected in IMF products in the U.S. drug supply* and in IMF-involved overdose deaths (2). Limited studies suggest xylazine can cause central nervous system depression, respiratory depression, bradycardia, and hypotension in humans (3,4); chronic use might lead to severe withdrawal symptoms† as well as skin ulcerations (4). This report uses data from CDC's State Unintentional Drug Overdose Reporting System (SUDORS) to describe IMF-involved§ overdose deaths with and without xylazine detected that occurred during January 2019-June 2022. Among 21 jurisdictions, which included 20 states and the District of Columbia, the monthly percentage of IMF-involved deaths with xylazine detected increased 276%, from 2.9% to 10.9%. Among IMF-involved deaths during January 2021-June 2022 in 32 jurisdictions, xylazine was detected in a higher percentage of jurisdictions in the Northeast U.S. Census Bureau region; listing detected xylazine as a cause of death varied across jurisdictions. Expanded postmortem and illicit drug product testing for xylazine is needed to clarify prevalence in drug supplies; further investigation of xylazine's effects on humans is necessary to characterize morbidity and overdose risk. It is important for overdose prevention and response messages to highlight the potential presence of xylazine in IMF products and emphasize the need for respiratory and cardiovascular support to address the sedative effects of xylazine.

Trends in the Vasectomy Rate Among Privately Insured Men Aged 18–64 in the United States Between 2014 and 2021

To update trends in the vasectomy rate among privately insured men aged 18-64 in the United States (U.S.) between 2014 and 2021. We used commercial health insurance claims data between 2014 and 2021 to calculate the annual vasectomy rate in men aged 18-64 in the U.S. We performed these calculations nationally and by age group, marital status, maternal age of a wife, number of children, U.S. Census Bureau region, geography, geographical region, and state. We calculated the absolute and relative changes in these rates from 2014 to 2021 to study how much and how quickly they changed. The vasectomy rate among privately insured men aged 18-64 in the U.S. increased by 0.11%-a 26% change-from 2014 (0.427%) to 2021 (0.537%). The absolute changes were greatest in men with 3 or more children (0.489%), with 2 children (0.295%), with a wife not of advanced maternal age (0.276%), and aged 35-44 (0.243%). The relative changes were greatest in men with no children (61%), with a wife of advanced maternal age (40.8%), who were single (40.6%), and aged 18-24 (36.7%). In every region except the Northeast, the absolute and relative changes were greater in rural geographies compared to urban geographies. The vasectomy rate among privately insured men aged 18-64 in the U.S. increased between 2014 and 2021. Further investigation is needed to ensure demand for vasectomies may continue to be met.

Disparities in African American oncology care in the US: A socioeconomic and geographic outlook.

e18590 Background: Mortality from cancer has been decreasing for all races and ethnicities. However, African Americans (AA) continue to have the highest mortality. Healthcare disparity contributes to poor outcomes. Here, we evaluate the differences in access to health care and socioeconomic status between different races and ethnicities in the US. Methods: We extracted data on demographic and healthcare coverage variables of patients diagnosed with cancer from the 2021 Behavioural Risk Factor Surveillance System (BRFSS), a national health-related telephone survey. We analyzed the effect of racial disparities in relation to socioeconomic factors and Census Bureau regions. R version 2.2.2 was used for all data extraction and analysis. Results: Out of 4,31,639 responders of BRFSS from the mainland US territory, 41,933 (9.71%) had been diagnosed with cancer other than skin cancer. Of these, 9,746 (9.74%) were from North East, 8,827 (9.11%) were from West, 10,806 (9.98%) were from South, and 12,554 (9.92%) were from Mid-West. In our sample, 35,137 (83.8%) were White, 2,356 (5.6%) were AA, 1,383 (3.3%) were Hispanic, and 3,047 (7.3%) were from others (Asian, American Indian/Alaskan Native, other race). More than 95% of oncology patients had health care coverage. However, the proportion of AA without healthcare coverage was higher than the White population (2.1% vs 1.2%, p &lt; 0.005). 5.3% of cancer patients did not see physicians due to cost. This percentage was significantly higher among AA compared to White (8.2% vs 4.3%, p &lt; 0.001). The rates of health care coverage and being unable to see a physician due to cost between AA and White were also statistically significant in each census region (not shown in table). Compared to White, AA patients with cancer were found to have statistically significantly lower education and income levels. This difference was present in all census regions of the US (not shown in table). Conclusions: Among cancer patients, AA are more likely not to have health care coverage, unable to see a physician due to cost, and have lower education and income level than White. These disparities impacting care of cancer patients exists in all major US regions, which likely promotes poor health outcomes. In addition, AA patients are underrepresented in this survey. [Table: see text]

Ventilation Improvements Among K–12 Public School Districts — United States, August–December 2022

Improving ventilation has been one of several COVID-19 prevention strategies implemented by kindergarten through grade 12 (K-12) schools to stay open for safe in-person learning. Because transmission of SARS-CoV-2 occurs through inhalation of infectious viral particles, it is important to reduce the concentration of and exposure time to infectious aerosols (1-3). CDC examined reported ventilation improvement strategies among U.S. K-12 public school districts using telephone survey data collected during August-December 2022. Maintaining continuous airflow through school buildings during active hours was the most frequently reported strategy by school districts (50.7%); 33.9% of school districts reported replacement or upgrade of heating, ventilation, and air conditioning (HVAC) systems; 28.0% reported installation or use of in-room air cleaners with high-efficiency particulate air (HEPA) filters; and 8.2% reported installation of ultraviolet (UV) germicidal irradiation (UVGI) devices, which use UV light to kill airborne pathogens, including bacteria and viruses. School districts in National Center for Education Statistics (NCES) city locales, the West U.S. Census Bureau region, and those designated by U.S. Census Bureau Small Area Income Poverty Estimates (SAIPE) as high-poverty districts reported the highest percentages of HVAC system upgrades and HEPA-filtered in-room air cleaner use, although 28%-60% of all responses were unknown or missing. Federal funding remains available to school districts to support ventilation improvements. Public health departments can encourage K-12 school officials to use available funding to improve ventilation and help reduce transmission of respiratory diseases in K-12 settings.

Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region — United States, 2020

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Physical activity is important in health promotion and disease prevention; rural-urban and regional disparities among adults in meeting the combined leisure time physical activity guidelines exist. WHAT IS ADDED BY THIS REPORT?: Analysis of 2020 National Health Interview Survey data found a low proportion of U.S. adults met leisure-time aerobic, muscle-strengthening, and combined physical activity guidelines. Residents in larger metropolitan areas and in the West U.S. Census Bureau region were more likely than were those in less populated urban and rural areas or other regions to meet these guidelines. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Rural residents might benefit from investments in structural capacity and policy, systems, and environment change to support leisure-time physical activity.

Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region — United States, 2020

The healthful effects of physical activity on a multitude of physical and mental health outcomes are well documented (1). Despite promising increases in the percentage of U.S. adults meeting aerobic and muscle-strengthening physical activity guidelines (guidelines)* (1) during leisure time in nearly all demographic and regional subgroups 1998-2018 (2,3), differences by rurality and U.S. Census Bureau region (Northeast, Midwest, South, and West), persist (4). Before 2020, analyses of rural-urban differences were dichotomized into nonmetropolitan (rural) versus metropolitan (urban) areas; however, in 2020 a four-category rural-urban variable† to classify rural-urban status was included in the National Health Interview Survey (NHIS) public-use dataset. NHIS 2020 data were used to conduct multivariate logistic regression analyses by rural-urban status and U.S. Census Bureau region of the prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines during leisure time among adults aged ≥18 years, controlling for demographic characteristics. Prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines was consistently the lowest in Nonmetropolitan counties (38.2%, 21.1%, and 16.1%, respectively) and highest in the West region (52.1%, 35.3%, and 28.5%, respectively). Regardless of rural-urban classification and region, no more than 28% of adults met combined aerobic and muscle-strengthening guidelines. Adults in the most rural category were significantly less likely to meet aerobic, muscle-strengthening, and combined guidelines than were adults in each of the three other categories (adjusted odds ratio [aOR] range = 0.68-0.89). In addition, adults in medium and small metropolitan counties were less likely to meet guidelines than were adults in the two most urban categories (aOR range = 0.85-0.89). Adults in the Northeast, Midwest, and South U.S. Census Bureau regions were less likely to meet guidelines than were adults in the West region (aOR range = 0.75-0.82). These analyses identify geographic disparities in leisure-time physical activity where focused population-level intervention efforts could help reduce or eliminate the consequent disparities in chronic conditions (e.g., cardiovascular diseases) and the resulting mortality (5,6).

An Examination of Predictors of Attrition in Physician Assistant Programs

The purpose of this study was to explore the relationship between program characteristics and attrition rates. Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.

GSOR21 Presentation Time: 12:10 PM: Racial, Ethnic, and Regional Disparities in the Utilization of Vaginal Brachytherapy in Patients Meeting PORTEC-2 Criteria: A SEER Analysis

<h3>Purpose</h3> Brachytherapy remains a critical component of locoregional therapy for many women with gynecologic cancers. Other groups have demonstrated racial disparities in the utilization of brachytherapy. Specifically, black women with locally advanced cervical cancer are less likely to receive brachytherapy compared to non-black women. We hypothesized that similar disparities may exist for the utilization of vaginal brachytherapy (VBT) for women who meet PORTEC-2 criteria for high-intermediate risk (HIR) endometrial cancer. <h3>Materials and Methods</h3> Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients who were diagnosed with endometrial cancer between 2011 to 2018, who met PORTEC-2 criteria for HIR disease (age 60 or greater with 1) FIGO stage IC (1988) and grade 1-2 disease or 2) FIGO stage IB (1988) and grade 3 disease). We limited our analysis to the year following the initial PORTEC-2 publication (2010) and beyond in order to allow for adoption into routine clinical practice. The impact of race and ethnicity on utilization of VBT versus external beam radiation therapy (EBRT) was analyzed on univariate and multivariate analyses (binary logistic regression, with significance assumed if p≤0.05), as was the impact of marital status, United States (U.S.) Census Bureau region, and whether or not a lymph node dissection was performed. <h3>Results</h3> A total of 2,182 patients were included in the analysis with a median age of 68 (range 60-97). The majority of patients were White (77.3%), married (50.8%), resided in the Western U.S. (45.1%), diagnosed with adenocarcinoma (97.2%), underwent lymph node dissection (84.7%), and received VBT (75.5%). On UVA, patients who were Hispanic (HR 1.58, CI 95% 1.15-2.16, p=0.005) and Asian or Pacific Islanders (HR 1.47, CI 95% 1.01-2.15, p=0.046) were less likely to receive VBT compared to White patients. There was a non-significant trend for Black patients (HR 1.43, 95% CI 0.98-2.08, p=0.066). Patients in the Southern (HR 1.69, CI 95% 1.24-2.31, p=0.001), Western (HR 1.7, CI 95% 1.31-2.20, p<0.001), and Pacific (HR 2.89, CI 95% 1.09-7.64, p=0.032) U.S. Census regions were less likely to receive VBT compared to the Northeast. Those who were divorced were more likely to receive VBT (HR 0.65, 95% CI 0.43-0.98, p=0.038). Finally, those patients who underwent lymph node dissection were more likely to receive VBT on UVA (HR 0.28, CI 95% 0.22-0.36, p<0.001). On MVA, patients who were Hispanic (HR 1.43, CI 95% 1.01-2.03, p=0.046), lived in the Southern (HR 1.82, CI 95% 1.30-2.55, p=0.001), Western (HR 1.61, CI 95% 1.21-2.14, p=0.001), or Pacific regions (HR 3.04, CI 95% 1.05-8.78, p=0.04) were less likely to receive VBT. Although it did not meet statistical significance, there was a trend for decreased utilization of VBT for Asian or Pacific Islanders (HR 1.45, CI 95% 0.94-2.25, p=0.094) and Black patients (HR 1.42, CI 95% 0.94-2.15, p=0.099), potentially a reflection of small patient numbers. Lastly, patients who underwent lymph node dissection were more likely to receive VBT on MVA (HR 0.27, CI 95% 0.21-0.35, p<0.001). <h3>Conclusions</h3> Brachytherapy remains a critical component of locoregional therapy for many women with endometrial cancer. VBT provides a significant improvement in local control in the pelvis with an improved toxicity profile compared to EBRT. Efforts should be made to make VBT available to those women in which it is clinically indicated, with apparent disparities based on the patient's race, ethnicity, and/or their geographic location within the U.S. in the setting of HIR disease. These disparities may have been further exacerbated during the ongoing COVID-19 pandemic, which has been shown in other settings to widen many pre-existing healthcare disparities.

Receipt of First and Second Doses of JYNNEOS Vaccine for Prevention of Monkeypox - United States, May 22-October 10, 2022.

Vaccination with JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) to prevent monkeypox commenced shortly after confirmation of the first monkeypox case in the current outbreak in the United States on May 17, 2022 (1). To date, more than 27,000 cases have been reported across all 50 states, the District of Columbia (DC), and Puerto Rico.* JYNNEOS vaccine is licensed by the Food and Drug Administration (FDA) as a 0.5-mL 2-dose series administered subcutaneously 28 days apart to prevent smallpox and monkeypox infections (2) and has been found to provide protection against monkeypox infection during the current outbreak (3). The U.S. Department of Health and Human Services (HHS) allocated 1.1 million vials of JYNNEOS vaccine from the Strategic National Stockpile, with doses allocated to jurisdictions based on case counts and estimated size of population at risk (4). However, initial vaccine supplies were severely constrained relative to vaccine demand during the expanding outbreak. Some jurisdictions with highest incidence responded by prioritizing first dose administration during May-July (5,6). The FDA emergency use authorization (EUA) of 0.1 mL dosing for intradermal administration of JYNNEOS for persons aged ≥18 years on August 9, 2022, substantially expanded available vaccine supply† (7). The U.S. vaccination strategy focuses primarily on persons with known or presumed exposures to monkeypox (8) or those at high risk for occupational exposure (9). Data on monkeypox vaccine doses administered and reported to CDC by U.S. jurisdictions were analyzed to assess vaccine administration and completion of the 2-dose series. A total of 931,155 doses of JYNNEOS vaccine were administered and reported to the CDC by 55 U.S. jurisdictions during May 22-October 10, 2022. Among persons who received ≥1 dose, 51.4% were non-Hispanic White (White), 22.5% were Hispanic or Latino (Hispanic), and 12.6% were non-Hispanic Black or African American (Black). The percentages of vaccine recipients who were Black (5.6%) and Hispanic (15.5%) during May 22-June 25 increased to 13.3% and 22.7%, respectively, during July 31-October 10. Among 496,888 persons who received a first dose and were eligible for a second dose during the study period, 57.6% received their second dose. Second dose receipt was highest among older adults, White persons, and those residing in the South U.S. Census Bureau Region. Tracking and addressing disparities in vaccination can reduce inequities, and equitable access to and acceptance of vaccine should be an essential factor in planning vaccination programs, events, and strategies. Receipt of both first and second doses is necessary for optimal protection against Monkeypox virus infection.

National claims data analysis of outcomes of hospitalized cancer patients without COVID-19 infection during versus prior to the COVID-19 pandemic.

e18679 Background: There has been growing concern regarding the impact of the COVID-19 pandemic on health care delivery and disruption of care to cancer patients. Reductions in cancer surgeries, delays in administration of life saving chemo and radiation therapies, and lower rates of cancer-related hospitalizations have been reported. While cancer patients with COVID-19 infection have poor hospitalization outcomes, less is known about the outcomes of hospitalized cancer patients without the infection. This study aimed to describe the impact of the COVID-19 pandemic on outcomes of the most common cancer-related hospital admissions for patients without COVID-19 infection at a national level using insurance claims. Given the concern for disruptions in their care, we hypothesized that hospitalized cancer patients may have worse outcomes. Methods: We used the Optum Clinformatics Data Mart, consisting of claims records linked to electronic health records, including an average of 8 million adult Americans per year enrolled for at least 6 months. We identified cancer-related hospitalizations from 02/2018-05/2021 and included patients with at least of one of these cancer types: breast, prostate, bladder, ovarian, cervical, lung, colorectal, esophageal, liver, small intestine, gastric, or gallbladder cancer. Patients with cancer-related hospitalization who had COVID-19 infection were excluded. The main outcome was “severe adverse outcome” and included at least one of the following: mortality during or within 30 days of hospitalization, mechanical ventilation during hospitalization, intensive care unit admission, or discharge to hospice. We used Poisson regression to compare the number of hospitalizations before (2/1/2018-1/30/2020) and during (2/1/2020-5/30/2021) the pandemic and a Chi-squared test to compare the proportion of cancer-related hospitalizations with severe adverse outcomes over that time period in 4-month intervals and across cancer types, gender, (male vs female) and geography (the 9 Census Bureau regions). Results: There were 82,796 cancer-related hospitalizations in the period 2/2018-05/2021. A slightly higher proportion of cancer-related hospitalizations resulted in a severe adverse outcome during the pandemic as compared to prior to the pandemic (41.8% vs 40.9%; p = 0.012). There were no differences by cancer site, gender, or geography. The number of hospitalizations was lower during vs prior to the pandemic (p &lt; 0.0001). Conclusions: The number of cancer-related hospitalizations during the pandemic was lower compared to before the, and a slightly higher proportion of those hospitalized experienced severe adverse outcomes among insured U.S. cancer patients without COVID-19 infection. The lower number of cancer-related hospitalizations during the pandemic warrants further investigation.