Combined Statistical Areas Research Articles

Keep your head above water: Explaining disparities in local drinking water bills

Rising water bills across the U.S. underscore the need to understand the factors that contribute to disparities in local system bills. In this paper, we examine residential water bill amounts from 1,720 systems in four states in different regions of the U.S. (Arizona, Georgia, New Hampshire and Wisconsin) to (1) examine how local system bills at a constant consumption level (4,000 gallons per month or 15.14m3) for drinking water vary within and across states, as well as within combined metropolitan statistical areas (MSAs), and (2) study the relationship between local system bills and system-level characteristics. We find a high degree of similarity in median bill amounts between states but substantial variation within them at the MSA and local system scale. Our multivariate analysis suggests that municipally-owned systems are more likely to have lower water bills relative to for-profit systems, while factors such as purchasing water and having neighboring systems with high bills significantly correlate with higher water bills. Though we find that water systems with high levels of poverty tend to have higher water bills, our results also suggest that local systems that serve populations with higher levels of income inequality and higher proportions of non-White population tend to have lower water bills. These findings point to future research and data needs to better inform federal, state and local water affordability policy and underline the importance of examining and addressing water affordability at local scales.

Analyzing the Connectivity of Combined Statistical Areas in Different Census Regions Using ArcGIS

The study aims to analyze the spatial relationship between critical infrastructure and socioeconomic regions in Texas cities, identify areas at risk, and develop effective emergency response strategies. It also focuses on analyzing the connectivity of Combined Statistical Areas (CSAs) in different census regions through various modes of transportation, identify areas that require infrastructure upgrades, and inform policy decisions aimed at improving transportation infrastructure and increasing connectivity. The goal is to provide a comprehensive understanding of the complex relationship between critical infrastructure, emergency response, and transportation infrastructure in Texas cities, and inform policy decisions aimed at addressing disparities and improving connectivity.

A comparison of COVID-19 outbreaks across US Combined Statistical Areas using new methods for estimating [formula omitted] and social distancing behaviour

We investigated the initial outbreak rates and subsequent social distancing behaviour over the initial phase of the COVID-19 pandemic across 29 Combined Statistical Areas (CSAs) of the United States. We used the Numerus Model Builder Data and Simulation Analysis (NMB-DASA) web application to fit the exponential phase of a SCLAIV+D (Susceptible, Contact, Latent, Asymptomatic infectious, symptomatic Infectious, Vaccinated, Dead) disease classes model to outbreaks, thereby allowing us to obtain an estimate of the basic reproductive number R0 for each CSA. Values of R0 ranged from 1.9 to 9.4, with a mean and standard deviation of 4.5±1.8. Fixing the parameters from the exponential fit, we again used NMB-DASA to estimate a set of social distancing behaviour parameters to compute an epidemic flattening index cflatten. Finally, we applied hierarchical clustering methods using this index to divide CSA outbreaks into two clusters: those presenting a social distancing response that was either weaker or stronger. We found cflatten to be more influential in the clustering process than R0. Thus, our results suggest that the behavioural response after a short initial exponential growth phase is likely to be more determinative of the rise of an epidemic than R0 itself.

National-Scale Assessment of Environmental Justice Trends in Public School Proximity to Industrial Lead Sources.

Lead poisoning can severely affect neurological development in small children. Communities with environmental justice concerns often face higher levels of lead exposure via multiple routes of exposure. School-aged children can be exposed to lead at their schools through the deposition of lead emissions onto soil over time. Public school students' demographics in 'proximate schools;' those within 1.5 km of facilities with lead emissions were compared to other schools in their area. The average proximate emissions per student were calculated for different demographic groups in various geographic areas. Schools in combined statistical areas within 1.5 km of lead facilities were found to be composed of significantly more Black (22%) and Hispanic (30%) students than other schools in the area (17% and 26% respectively). Meanwhile, schools close to lead sources tended to have smaller proportions of white students (37% in 'proximate schools', but 47% overall. When average emissions around students were calculated for a handful of combined statistical areas, inequality in lead exposure could be seen in almost every geographic area, across income and racial lines. Students of color consistently faced the highest emissions in every area, though amounts, inequities, and at-risk populations differed throughout the different geographic areas. The unique history of each location regarding immigration, discrimination, zoning laws, urban sprawl, and industrial past can contribute to this variety in inequities. These findings are not only consistent with environmental justice trends but also highlight other vulnerabilities for students like age and food security.

Are commuter air taxis coming to your city? A ranking of 40 cities in the United States

Given the high levels of congestion that many commuters in the United States experience, the urban air mobility community has been exploring the potential of using a new class of electric vertical takeoff and landing (eVTOL) aircraft for commuters. To date, only a few studies have been conducted that compare how potential air taxi demand across cities varies. This study calculates a measure of air taxi demand for commuters for the 40 most populous combined statistical areas (CSAs) in the U.S. by using: (1) cell phone data to identify regular commuters in cities, (2)census data to associate household income characteristics with commuters, and (3)a mode choice model calibrated from a stated preference survey to predict the number of commuters that would use an air taxi. Air taxi commuter demand is concentrated in a handful of CSAs; the CSAs for New York City, LosAngeles, and Washington, D.C., generate 33percent of the overall air taxi demand. Results are sensitive to location of existing vertiports, existing ground infrastructure and congestion levels on competing modes, and current commute patterns. A resultant set of online maps of potential air taxi routes allows readers to visualize how air taxi commuter routes differ across CSAs. Results will be of value both to aircraft manufacturers seeking to design air taxi vehicles to serve different cities as well as city planners for identifying where investments in port infrastructure may be needed to support a commuter air taxi service.

Geographic Distribution of Radiation Oncologists in the United States

PurposeThe geographic distribution of radiation oncologists determines access to care for patients and job opportunities for practicing physicians, yet available data on practicing radiation oncologists are outdated or use large geographic unit definitions precluding granular analysis. We present an updated county-level analysis of the American radiation oncology workforce. Methods and MaterialsWe used the Area Health Resource File published by the Health Resources and Services Administration of the U.S. Department of Health and Human Services to determine the number of radiation oncologists per 100,000 people in every or equivalent area in the United States as of 2017 (the most recently published data). We then analyzed geographic distribution per U.S. Census Bureau–defined regions, subregions, and combined statistical areas. ResultsThe Area Health Resource File reports 5338 practicing radiation oncologists for an estimated American population of 326.1 million people as of 2017, resulting in a nationwide average of 1.64 radiation oncologists per 100,000 people. Counties located outside of a metropolitan area had a lower density of radiation oncologists than those within a metropolitan area. Among combined statistical areas (representing most large cities) the variations in density of radiation oncologists are small, with the highest-density areas located in smaller communities with academic medical centers. There was no relationship between population of combined statistical areas and density of radiation oncologists. ConclusionsThe geographic distribution of American radiation oncologists varies widely; the primary variation exists along the urban/rural continuum, with rural areas having fewer practitioners than urban areas. This analysis informs future work in understanding how to optimize the delivery of radiation oncology services throughout the United States.

Disparities in Clinical Trial Access Across US Urban Areas

This cross-sectional study uses combined statistical areas to explore whether the availability of clinical trial seats in nonrural regions varies with population, racial and socioeconomic compositions, research activity, or the amount of health care infrastructure.

Local referrals as a strategy for increasing value of surgical care among medicare patients undergoing liver and pancreatic surgery

BackgroundThe focus of the current Medicare payment reform is to increase value – i.e. improve health care quality while lowering costs. This study sought to define cost variation and surgical quality among hospitals within small geographic areas typical of work commute patterns. MethodsMedicare Provider Analysis and Review (MEDPAR) Inpatient Files was used to identify patients undergoing elective liver and pancreatic surgery between 2013 and 2015. Hospitals were assigned to combined statistical areas (CSAs) based on zip codes. Average price-standardized Medicare payments were used to identify highest- and lowest-cost hospitals within CSAs, and clinical outcomes were compared. ResultsThe study included 12,016 patients. Medicare payments for index hospitalization were 45% ($12,580), 42% ($16,831), 44% ($12,901) and 50% ($18,605) higher for the highest-vs. lowest-cost hospitals for non-complex pancreatic procedures, complex pancreatic procedures, non-complex liver procedures, and complex liver procedures, respectively. Surgical quality was worse at highest-vs. lowest-cost hospitals, demonstrated by higher rates of complications, prolonged LOS and 90-day mortality. ConclusionThere was a significant variation in surgical cost for each procedure between CSAs, and within CSAs. Highest-cost hospitals demonstrated worse quality metrics than the lowest-cost hospitals. Local referrals to low-cost hospitals represent an opportunity for increasing value of surgical care.

Synergy in the knowledge base of U.S. innovation systems at national, state, and regional levels: The contributions of high‐tech manufacturing and knowledge‐intensive services

Using information theory, we measure innovation systemness as synergy among size‐classes, ZIP Codes, and technological classes (NACE‐codes) for 8.5 million American companies. The synergy at the national level is decomposed at the level of states, Core‐Based Statistical Areas (CBSA), and Combined Statistical Areas (CSA). We zoom in to the state of California and in more detail to Silicon Valley. Our results do not support the assumption of a national system of innovations in the U.S.A. Innovation systems appear to operate at the level of the states; the CBSA are too small, so that systemness spills across their borders. Decomposition of the sample in terms of high‐tech manufacturing (HTM), medium‐high‐tech manufacturing (MHTM), knowledge‐intensive services (KIS), and high‐tech services (HTKIS) does not change this pattern, but refines it. The East Coast—New Jersey, Boston, and New York—and California are the major players, with Texas a third one in the case of HTKIS. Chicago and industrial centers in the Midwest also contribute synergy. Within California, Los Angeles contributes synergy in the sectors of manufacturing, the San Francisco area in KIS. KIS in Silicon Valley and the Bay Area—a CSA composed of seven CBSA—spill over to other regions and even globally.

On the Choice of Combined Statistical Areas

Some Metropolitan Statistical Areas (MSAs) fail to encompass the full extent of metropolitan areas. Combined Statistical Areas (CSAs), combinations of Core-Based Statistical Areas, are larger and may be more a more appropriate choice for certain analyses. Differences between MSAs and CSAs (and some MSAs are not even included in CSAs) range from minor to the combination of large MSAs, with population increases ranging from a few percent more than doubling. The sharing of transportation infrastructure in the form of commuter rail service and shared airports demonstrates the integration of areas combined into CSAs. In addition, the extent of the MSAs defined for the 2000 census are comparable to current CSAs, which arise from a subsequent change in how metropolitan areas are defined.

Geographic access to hematopoietic stem cell transplantation (HSCT).

e16517 Background: Hematopoietic Stem cell transplantation (HSCT) has been used with considerable success in the management of patients with otherwise incurable malignant and nonmalignant conditions. Transplantation is a resource-intensive endeavor that requires specialized personnel and equipment available through a limited number of institutions. Transplant patients tend to undergo prolonged hospitalizations and require frequent follow up visits. The optimal geographic distribution of transplant centers has not been determined, in fact the current distribution of centers relative to geographic area and population is unknown. Methods: Using the 2008 county level census estimate data, the proportion of the population living within a combined statistical area (CSA) with a transplant center or within an hour-travel of one was determined. Combined Statistical Areas, as defined by the Office of Budget and Management (OMB), comprise two or more adjacent Metropolitan or Micropolitan Statistical Areas that have moderate social and economic ties as measured by commuting. Travel time was determined by the shortest driving time between county centroids and the closest HSCT center, regardless of state lines. The list of adult HSCT centers was obtained from the National Marrow Donor Program (NMDP). Results: In 2009, there were 102 adult HSCT centers listed by the NMDP in the United States. An estimated 60.92% of the US population have easy access to a HSCT center as defined above. Regional access was as follows: Northeast, 78.26%; West, 64.16%; Midwest, 57.03%; and South, 52.65%. Nine states have no centers, while 10% of centers are located in just 2 counties; Philadelphia, Pa and Cook, Il. Conclusions: 60.92% of the U.S. population have easy geographic access to a HSCT center, however, there is both state and regional variation in access to these centers. The greatest proportion of the population with access was highest in the Northeast and lowest in the South. There is need for further research to determine the impact of geographic access in rates of transplantation, outcomes and the economic and social impact of lack geographic of access. No significant financial relationships to disclose.

Barriers to implementing protocol-based sepsis resuscitation in the emergency department—Results of a national survey*

To identify barriers to implementation of a written protocol for early goal-directed therapy for severe sepsis in the busiest emergency departments in the United States. Telephone survey with both quantitative and qualitative analysis. Two busiest teaching and two busiest nonteaching emergency departments in each of the 25 most densely populated combined statistical areas in the United States. Twenty-four physician directors and 40 nursing managers representing 53% of the 100 emergency departments surveyed. Survey questionnaire. Respondents identified lack of available nursing staff to perform the procedure, the inability to monitor central venous pressure in the emergency department, and challenges in identifying septic patients as the most frequent barriers. Although nurse managers and physicians identified similar barriers, nurses were more likely than physicians to list central venous catheter insertion as an important barrier (38% vs. 5%; p = .01), and physicians were more likely to endorse lack of agreement with the early goal-directed therapy resuscitation protocol (16% vs. 0%; p = .03). There were no statistically significant differences in the rankings assigned by clinicians from teaching and nonteaching hospitals. Qualitative analysis of open-ended questions identified barriers in a number of areas, including barriers to initiating the protocol process and factors that distinguish sepsis from other time-sensitive diseases in the emergency department. Nurse managers and physician directors of busy emergency departments representing the largest urban areas in the United States identify multiple barriers to implementing time-sensitive resuscitation to patients with severe sepsis. More than half of all respondents recognized a critical shortage of nursing staff, problems in obtaining central venous pressure monitoring, and challenges in identification of patients with sepsis as the largest roadblocks to overcome in implementing early goal-directed therapy.