Community-level Effects Research Articles

Community-level effects of ivermectin and moxidectin from cattle dung: zooplankton as study case

Context Ivermectin (IVM) and moxidectin (MOX), are widely used internal and external antiparasitic drugs for livestock. They enter into the aquatic environment because the treated animals metabolise only a small percentage of the administered doses, and the rest is eliminated through the faeces posing a risk to aquatic organisms. Aims This study aimed to evaluate the responses of zooplankton to environmentally relevant concentrations of IVM and MOX spiked in cattle dung in a short-term exposure. Methods We compared the composition of the community, density, species richness, diversity and total biomass between treatments with parasiticides and controls. Key results The presence of both antiparasitic drugs altered the zooplankton community structure, leading to a shift in species composition. Cladocerans were the most affected, with a drastic reduction in their density. Additionally, a decrease in the density of copepods and an increase in the density of rotifers were observed in the MOX treatments. Conclusions Both drugs caused a simplification of the zooplankton community as species richness and diversity decreased. Overall, MOX was more toxic than IVM. Implications Our results suggest that long-term consequences on ecosystem services could arise, which merits the development of control and livestock management tools for the protection of these environments.

Applying palaeoecological analogues to contemporary challenges: community-level effects of canopy gaps caused by systematic decline of a prevalent tree species

Temperate woodland vegetation is initially determined by spatiotemporal and historical factors, mediated by complex biotic interactions. However, catastrophic events such as disease outbreaks (e.g., sweet chestnut blight, ash dieback), infestations of insect pests, and human-accelerated climate change can create canopy gaps due to systematic decline in, or loss of, tree species that was once an important part of the canopy. Resultant cascade effects have the potential to alter the composition of woodland ecosystems quickly and radically, but inherent lag times make primary research into these effects challenging. Here, we explore change in woodland vegetation at 10 sites in response to canopy opening using the Elm Decline, a rapid loss of Ulmus in woodlands across northwestern Europe ~ 5800 years ago that coexisted alongside other stressors such as increasing human activity, as a palaeoecological analogue. For arboreal taxa, community evenness significantly decreased, within-site turnover significantly increased, and richness remained unchanged. Changes in arboreal taxa were highly site-specific but there was a substantial decline in woody climbing taxa, especially Hedera (ivy), across the majority of sites. For shrub taxa, richness significantly increased but evenness and turnover remained consistent. Interestingly, however, there was a significant increase in abundance of shrubs at 70% of sites, including Calluna (heather), Ilex (holly) and Corylus (hazel), suggesting structural change. Surprisingly, there was no change in richness, evenness or turnover for herb taxa, possibly because change was highly variable spatially. However, there was a marked uptick in the disturbance indicator Plantago (plantain). Overall, these findings suggest that woodlands with sustained reduction in, or loss of, a tree species that once formed an important part of the canopy has profound, but often spatially idiosyncratic, impacts on vegetation diversity (richness), composition (evenness), stability (turnover), and on abundance of specific taxa, especially within the shrub layer. Use of this palaeoecological analogue, which was itself complicated by cooccurring changes in human activity, provides a valuable empirical insight into possible cascade effects of similar change in canopy opening in contemporary settings, including Ash Dieback.

Metal Mixture Effects of Ni, Cu, and Zn in a Multispecies, Two-Trophic-Level Algal-Daphnid Microcosm Can Be Predicted From Single-Trophic-Level Effects: The Role of Indirect Toxicity.

Effect assessments of metals are mostly based on single-metal, single-species tests, thereby ignoring metal-mixture effects and indirect effects through species interactions. We tested the combined effects of metal and species interactions in two-trophic algal-daphnid microcosms. Metal-mixture effects on daphnid communities may propagate from effects on the generally more sensitive algal communities. Four different algal communities (three species each), with and without addition of the same daphnid community (three species) were exposed to single metals and one metal mixture (17:17:51 µg/L Ni:Cu:Zn). Daphnid densities were negatively affected by metals in the two-trophic test, the magnitude of which depended on the algal community composition. Algal densities were overall positively affected by the metals in the two-trophic test but negatively in the single-trophic test, illustrating an indirect positive effect in the two-trophic system due to a reduced grazing pressure. Metal effects on daphnid communities in the two-trophic test (day 21) were correlated with metal effects on the single-trophic-level algal communities during exponential growth (R2 = 0.55, p = 0.0011). This finding suggests that metal effects propagate across trophic levels due to a reduced food quantity. However, the indirect positive effects on algal densities, resulting in abundant food quantity, suggests that metal effects can also propagate to daphnids due to a reduced food quality (not measured directly). Metal-mixture interactions on daphnid densities varied during exposure, but were additive or antagonistic relative to independent action when final daphnid densities were considered (day 56). This suggests stronger indirect effects of the mixture compared with the single metals. Overall, our study highlights the dynamic aspect of community-level effects, which empirical reference models such as independent action or concentration addition cannot predict. Environ Toxicol Chem 2024;43:2350-2364. © 2024 SETAC.

Nutrient competition predicts gut microbiome restructuring under drug perturbations.

Human gut commensal bacteria are routinely exposed to various stresses, including therapeutic drugs, and collateral effects are difficult to predict. To systematically interrogate community-level effects of drug perturbations, we screened stool-derived in vitro communities with 707 clinically relevant small molecules. Across ∼5,000 community-drug interaction conditions, compositional and metabolomic responses were predictably impacted by nutrient competition, with certain species exhibiting improved growth due to adverse impacts on competitors. Changes to community composition were generally reversed by reseeding with the original community, although occasionally species promotion was long-lasting, due to higher-order interactions, even when the competitor was reseeded. Despite strong selection pressures, emergence of resistance within communities was infrequent. Finally, while qualitative species responses to drug perturbations were conserved across community contexts, nutrient competition quantitatively affected their abundances, consistent with predictions of consumer-resource models. Our study reveals that quantitative understanding of the interaction landscape, particularly nutrient competition, can be used to anticipate and potentially mitigate side effects of drug treatment on the gut microbiota.

Discussion: An Analysis of Community-Level Socioeconomic Status Effects on Pricing Transparency and Variability of Hand Surgery Procedures.

Discussion: An Analysis of Community-Level Socioeconomic Status Effects on Pricing Transparency and Variability of Hand Surgery Procedures.

Do community changes persist after irruptive population dynamics? A case study from an invasive species boom and bust.

Irruptive or boom-and-bust population dynamics, also known as 'outbreaks', are an important phenomenon that has been noted in biological invasions at least since Charles Elton's classic book was published in 1958. Community-level consequences of irruptive dynamics are poorly documented and invasive species provide excellent systems for their study. African Jewelfish (Rubricatochromis letourneuxi, "jewelfish") are omnivores that demonstrate opportunistic carnivory, first reported in Florida in the 1960s and in Everglades National Park (ENP) in 2000. Twelve years after invasion in ENP, jewelfish underwent a 25-fold increase in density in one year. By 2016, jewelfish represented 25-50% of fish biomass. Using a 43-year fish community dataset at two sites (1978-2021), and a 25-year dataset of fish and invertebrate communities from the same drainage (1996-2021), with additional spatial coverage, we quantified differences in fish and invertebrate communities during different phases of invasion. During jewelfish boom, abundant, native cyprinodontiform fishes decreased in density and drove changes in community structure as measured by similarity of relativized abundance. Density of two species declined by > 70%, while four declined by 50-62%. Following the jewelfish bust, some species recovered to pre-boom densities while others did not. Diversity of recovery times produced altered community structure that lagged for at least four years after the jewelfish population declined. Community structure is an index of ecological functions such as resilience, productivity, and species interaction webs; therefore, these results demonstrate that irruptive population dynamics can alter ecological functions of ecosystems mediated by community structure for years following that population's decline.

Neighbourhood-level policing as a racialised gendered stressor: multilevel analysis of police stops and preterm birth in Seattle, Washington

BackgroundMost studies capturing the health effects of police violence focus on directly impacted individuals, but a burgeoning field of study is capturing the indirect, community-level health effects of policing. Few...

Proposal for a tiered regulatory framework for the aquatic risk assessment of pesticides in Brazil.

Aquatic risk assessment is essential to guarantee the sustainable use of pesticides and the conservation of water resources near agricultural fields. This article discusses a proposal for a tiered regulatory framework for the aquatic risk assessment of pesticides in Brazil. The first step is problem formulation, which includes establishing general and specific protection goals. In the exposure assessment, the Estimated Environmental Concentrations in water should be calculated based on realistic worst-case assumptions regarding application rate and frequency, the entry into the edge-of-field water body, and fate in the water body, using scenario-dependent models suggested by the Brazilian Environmental Agency. These calculations can be refined by including Efate studies with variable exposures to reflect realistic environmental conditions accurately and include mitigation measures that impact the modeling. In the hazard assessment, ecotoxicological data for toxicity to fish, aquatic invertebrates, algae, and aquatic plants should be required for all pesticides based on standardized protocols and species. Tier 2 has several refinement options, including incorporating toxicity data from additional test species and effect modeling. In Tier 3, population- and community-level effects are evaluated using semi-field studies. Considering the case study in Brazil, Tier 1 demonstrated that, from the 12 pesticides that were assessed, seven (58%) failed based on the value of the Risk Quotient. In Tier 2, when exposure refinement options and mitigation measures such as buffer zones are considered, all seven pesticides, for which Tier 1 indicated risk, still failed the assessment. The risk for four of these seven pesticides could be refined by considering toxicity information from additional species. Refinement options and mitigation measures that could be applied to the agricultural scenario in Brazil were discussed. In conclusion, the proposed tiered risk assessment is a feasible way to evaluate whether a pesticide will pose an unacceptable risk to aquatic organisms. Integr Environ Assess Manag 2024;20:1514-1528. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Field evaluation the effect of two transgenic Bt maize events on predatory arthropods in the Huang-Huai-Hai summer maize-growing region of China.

To illustrate the impact of genetically modified (GM) Bt maize on the natural enemy communities in the Huang-Huai-Hai summer maize-growing region in China, the abundance of 7 common predator taxa (Geocoris pallidipennis Costa, Harmonia axyridis (Pallas), lacewings, Orius sauteri (Poppius), Propylea japonica (Thunberg), spiders, and Staphylinidae) was quantitatively evaluated by comparing Bt-Cry1Ab DBN9936 and Bt-Cry1Ab/Cry2Aj Ruifeng 125 events to their near non-Bt isolines during the growing season from 2016 to 2019. A total of 10,302, 19,793, 13,536, and 5,672 individuals were observed during 4 years, and the abundance of each taxa on Bt maize varied between sample dates among those arthropod taxa. Shannon-Wiener diversity index of predator communities from 7 taxa showed very similar temporal dynamics and principal response curve analyses to examine community-level effects showed no significant differences in predator abundance in Bt maize compared with non-Bt maize. We conclude that the 2 Bt maize hybrids did not adversely affect the predator community in the Huang-Huai-Hai summer maize-growing region of China.

Safer Bars: A cluster-randomized effectiveness evaluation of alcohol-related sexual violence prevention through bar staff bystander training

BackgroundSexual assault is consistently associated with social contexts that support high levels of alcohol consumption such as alcohol-serving establishments (i.e., bars). The significant rates of alcohol-involved sexual assault among college students demonstrate the critical need for evidence-based efforts to reduce alcohol-involved sexual assault in this population. Although bystander approaches have demonstrated some promise for reducing alcohol-involved sexual assault, to date no published studies have examined the effectiveness of implementing bystander prevention approaches with bar staff. Given the robust evidence indicating that bars serve as hot spots for sexual aggression, interventions that improve bar staff's ability to identify and intervene in sexually aggressive situations may offer a useful approach for reducing rates of alcohol-involved sexual assault. MethodsThe Safer Bars study utilizes a cluster-randomized trial design that randomizes participants at the bar level into intervention and waitlist control arms. The sample includes bars (Nbars = 56) within a three-mile proximity to the three major public Arizona universities, with an average of 10 staff members per bar (Nstaff = 564). Assessments of individual-level and bar-level outcomes occur at baseline, training completion, and 3-months post-training, with an additional individual-level assessment at 6 months. Community-level effects are assessed using GIS data regarding police dispatches. ConclusionSafer Bars represents a novel, theory-driven approach to promote effective bystander behavior among bar staff working in close proximity to university campuses to reduce rates of alcohol-involved sexual assault.

Determinants of injuries and accidents in Ethiopia: A Multilevel Analysis

Background: Injury is a major health issue worldwide, especially in developingcountries such as Ethiopia, where no comprehensive national injury data exists.There is a need to better define the epidemiology of injury and determinants asa basis for the formulation of violence and injury prevention strategies.Objective: This study aimed to determine individual and community-levelfactors associated with injuries and accidents in Ethiopia.Methods: Using the latest nationally representative data obtained fromEthiopia Demographic and Health Survey (EDHS) 2016, the survey collectedinformation about the occurrence of injuries in the past 12 months among 12,841 members of 16,650 households. Sample from 645 clusters of 12372 un-weighted households and 12841 weighted households were selected from nine regions and two city administrations of Ethiopia using a stratified clustersampling procedure. Multilevel logistic regressions were used to identify thedeterminants of injuries. Four models were built to estimate both fixed effectsof the individual and community-level factors and random effects betweencluster variation on injuries and/or accidents.Results: The current study found that 3.4 % of injuries and accidents occurredin the reference 12-month period. At the final best-fitted model (model IV), asecondary educational level of household members (AOR= 0.54; 95 % CI (0.297,0.987), household members from middle-level wealth index (AOR = 1.72; 95 %CI (1.048, 2.807), and history of smoking within the last 24 hours (AOR = 0.28;95 % CI (0.092, 0.863) were significantly associated with injury and accidents.Conclusion: The study's analysis of injuries that occurred during the study'sreference 12-month period revealed that Ethiopia has low injury prevalence,considering Ethiopian demographic survey data limitations on major injuries.Additionally, having a secondary education, falling into the middle of thewealth index, and having a history of smoking were all significantly associatedwith injuries and accidents.

Aquatic and sediment ecotoxicity data of difenoconazole and its potential environmental risks in ponds bordering rice paddies

Difenoconazole has a widespread agricultural use to control fungal diseases in crops, including rice. In edge-of-field surface waters the residues of this lipophilic fungicide may be toxic to both pelagic and benthic organisms. To allow an effect assessment we mined the regulatory and open literature for aquatic toxicity data. Since published sediment toxicity data were scarce we conducted 28 d sediment-spiked toxicity test with 8 species of benthic macroinvertebrates. Ecotoxicological threshold levels for effects were assessed by applying the species sensitivity distribution approach. Based on short-term L(E)C50’s for aquatic organisms from water-only tests an acute Hazardous Concentration to 5% of the species (HC5) of 100 µg difenoconazole/L was obtained, while the HC5 based on chronic NOEC values was a factor of 104 lower (0.96 µg difenoconazole/L). For benthic macroinvertebrates the chronic HC5, based on 28d-L(E)C10 values, was 0.82 mg difenoconazole/kg dry weight sediment. To allow a risk assessment for water- and sediment-dwelling organisms, exposure concentrations were predicted for the water and sediment compartment of an edge-of-field pond bordering rice paddies treated with difenoconazole using the Chinese Top-Rice modelling approach, the Chinese Nanchang exposure scenario and the Equilibrium Partitioning theory. It appeared that in the vast majority of the 20 climate years simulated, potential risks to aquatic and sediment organisms cannot be excluded. Although the HC5 values based on laboratory toxicity data provide one line of evidence only, our evaluation suggests population- and community-level effects on these organisms due to chronic risks in particular.

Multilevel mixed effects analysis of individual and community factors associated with unmet need for contraception among married women in four East African countries

BackgroundDespite the use of contraceptives being an expression of a woman's reproductive control, the prevalence of unmet need remains high and a public concern among married women in East Africa. However, limited literature has explored the associated factors in the region. We live in age of leaving no one behind unfortunately many women still have unmet for family planning todate. This study therefore intends to examine the individual and community level factors associated with unmet need for contraception among married women in Burundi, Rwanda, Tanzania and Uganda. MethodsThe study utilizes data from the four recent demographic and health surveys for Burundi, Rwanda, Tanzania and Uganda. Analyses were conducted using multilevel mixed effects logistic regressions with random community and country level effects. Results are reported using predictive probabilities and margins. ResultsThis study revealed that: 20%, 22%, 28% and 33% of the married women in Tanzania, Uganda, Rwanda and Burundi respectively had unmet need for contraception. Younger women, and those: without formal education, from the poorest households, had ever experienced child loss, whose husbands desire more children than them, and have no access to family planning messages faced a higher probability of unmet need for contraception. This was also true for women living in communities with low usage of modern contraception and those in communities where there is an increasing number of children per woman. ConclusionsThe findings reiterate the need for family planning efforts to focus on younger women. Additionally, improved education, economic empowerment, calls for spousal involvement in family planning matters, support for those with child loss, and comprehensive awareness initiatives remain vital to tackling unmet need for contraception.

Spatial Visualization: Community-Level Effects of Sport Industry on Community Resilience

Spatial Visualization: Community-Level Effects of Sport Industry on Community Resilience

Eviction as a community health exposure

Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals’ social networks and shaping broader community conditions.In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.

Soil arthropod communities collected from agricultural soils influence wheat growth and modify phytohormone responses to aboveground herbivory in a microcosm experiment

Soil arthropods can affect plant growth and aboveground interactions directly via root herbivory and indirectly through nutrient cycling and interactions with soil microorganisms. Research on these effects of soil arthropods has focused on a few taxa within natural systems, largely neglecting agroecosystems and arthropod community-level effects. This study investigated the effects of soil arthropod communities from cereal-based agroecosystems on wheat plant growth and above-belowground interactions. Nutrient cycling and wheat growth were measured in a greenhouse microcosm experiment using field-collected agricultural soils from two rotational schemes with and without their soil arthropod communities. The effects of soil arthropods on aboveground phytohormones and colony growth of an aphid [Metopolophium festucae cerealium (Stroyan)] infesting the plants were measured. Wheat grown in soils with arthropod communities had significantly greater root (+ Arth mean: 0.15 ± 0.01 g; − Arth mean: 0.06 ± 0.01 g; F1,54 = 72.34, p < 0.001) and shoot biomass (+ Arth mean: 0.39 ± 0.03 g; − Arth mean: 0.24 ± 0.03 g; F1,54 = 17.61, p < 0.001), greater soil nitrate concentrations (+ Arth mean: 62.18 ± 4.76 mg NO3− - N kg−1 soil; − Arth mean: 13.06 ± 0.61 mg NO3− - N kg−1 soil; F1,54 = 99.89, p < 0.001), and altered root architecture compared to controls. Soil arthropod communities collected from the two rotational schemes differed significantly in abundance and diversity, but affected wheat growth similarly. Aphid colony growth (+ Arth mean: 30.50 ± 4.06; − Arth mean: 22.13 ± 3.36; χ21,27 = 21.19, p < 0.001), but not plant damage by aphids (+ Arth mean: 2.72 ± 0.17, − Arth mean: 2.69 ± 0.16; F1,27 = 0.02, p > 0.05), was significantly greater on wheat grown in soils with arthropods. Aphids, in turn, modified the effects of soil arthropods on root architecture and increased the abundance of soil arthropods. Wheat grown in soils with arthropods had increased levels of stress- and defense-related phytohormones in response to aphid herbivory, while phytohormones of wheat plants grown in soils without arthropods did not differ with aphid presence. Soil arthropod communities may help plants defend against herbivores aboveground by facilitating phytohormone induction while offsetting costs by increasing soil nutrients and modifying plant growth. By using taxonomically diverse field-collected soil arthropod communities from agroecosystems, this study showed that community-level effects on plant growth are more complex and dynamic than the effects of any single taxon, such as Collembola, illustrating that interactions within communities can produce emergent properties that alter the net effect of soil arthropods on plant growth. The results indicate that community-level effects of soil organisms should be considered as part of sustainable plant production and protection strategies.

Violence in childhood and community contexts: a multi-level model of factors associated with women's intimate partner violence experience in Samoa

Intimate partner violence (IPV) affects approximately 26% of women worldwide and is driven by a complex interplay of factors across individual, relationship/household, community and societal levels. Individual and relationship/household factors are well studied however little empirical evidence exists on factors at the community level that drive IPV which are needed to inform prevention interventions. We conducted a cross-sectional, multi-level analysis of factors associated with women's IPV experience in Samoa using the 2019-20 Demographic and Health Multiple Indicator Cluster Survey. We used hierarchical multivariable logistic regression to assess individual, relationship/household and community level effects on women's risk of physical, sexual and/or emotional IPV. The past year prevalence of physical, sexual and/or emotional IPV among women in Samoa was 31.4%. At the individual and relationship/household level, women's employment, witnessing IPV between parents, experiencing physical abuse from a parent, and partner's alcohol use and controlling behaviours were associated with higher risk of IPV. At the community level, higher levels of women with higher education and involved in household decision-making, and higher levels of men in employment were protective against IPV. A complex interplay of factors across individual, relationship/household and community levels are associated with women's experience of IPV in Samoa. Experiences of IPV are embedded within a broader context of violence against children and harmful alcohol use. Community contexts, including women's empowerment and men's employment, are also associated with women's IPV experience in Samoa. These findings not only demonstrate that public health issues such as IPV, violence against children and harmful alcohol use should be addressed together as part of multi-pronged approaches, but they point towards the importance of community-level analyses for designing and delivering community-based interventions. Greater knowledge of community dynamics will enable community-based interventions to create environments at the community level that support meaningful and sustainable change towards IPV prevention. Funding for this study was provided by UKRI (ref. MR/S033629/1).

Light pollution in complex ecological systems.

Light pollution has emerged as a burgeoning area of scientific interest, receiving increasing attention in recent years. The resulting body of literature has revealed a diverse array of species-specific and context-dependent responses to artificial light at night (ALAN). Because predicting and generalizing community-level effects is difficult, our current comprehension of the ecological impacts of light pollution on complex ecological systems remains notably limited. It is critical to better understand ALAN's effects at higher levels of ecological organization in order to comprehend and mitigate the repercussions of ALAN on ecosystem functioning and stability amidst ongoing global change. This theme issue seeks to explore the effects of light pollution on complex ecological systems, by bridging various realms and scaling up from individual processes and functions to communities and networks. Through this integrated approach, this collection aims to shed light on the intricate interplay between light pollution, ecological dynamics and humans in a world increasingly impacted by anthropogenic lighting. This article is part of the theme issue 'Light pollution in complex ecological systems'.

Changes in the acoustic structure of Australian bird communities along a habitat complexity gradient

Abstract Avian vocalizations have evolved in response to a variety of abiotic and biotic selective pressures. While there is some support for signal convergence in similar habitats that are attributed to adaptation to the acoustic properties of the environment (the “acoustic adaptation hypothesis,” AAH), there is also evidence for character displacement as a result of competition for signal space among coexisting species (the “acoustic niche partitioning hypothesis”). We explored the acoustic space of avian assemblages distributed along six different habitat types (from herbaceous habitats to warm rainforests) in southeastern Queensland, Australia. We employed three acoustic diversity indices (acoustic richness, evenness, and divergence) to characterize the signal space. In addition, we quantified the phylogenetic and morphological structure (in terms of both body mass and beak size) of each community. Acoustic parameters showed a moderately low phylogenetic signal, indicating labile evolution. Although we did not find meaningful differences in acoustic diversity indices among habitat categories, there was a significant relationship between the regularity component (evenness) and vegetation height, indicating that acoustic signals are more evenly distributed in dense habitats. After accounting for differences in species richness, the volume of acoustic space (i.e., acoustic richness) decreased as the level of phylogenetic and morphological resemblance among species in a given community increased. Additionally, we found a significantly negative relationship between acoustic divergence and divergence in body mass indicating that the less different species are in their body mass, the more different their songs are likely to be. This implies the existence of acoustic niche partitioning at a community level. Overall, while we found mixed support for the AAH, our results suggest that community-level effects may play a role in structuring acoustic signals within avian communities in this region. This study shows that signal diversity estimated by diversity metrics of community ecology based on basic acoustic parameters can provide additional insight into the structure of animal vocalizations.

An Analysis of Community-Level Socioeconomic Status Effects on Pricing Transparency and Variability of Hand Surgery Procedures.

The hospital price transparency final rule requires hospitals to publish pricing information about provided items and services by means of 2 methods: (1) a comprehensive machine-readable file and (2) a display tool of selected shoppable services. Using machine-readable files on hospital websites, the authors examined trends in pricing transparency and variation in association with community-level socioeconomic factors for 3 common hand surgery procedures among Association of American Medical Colleges-affiliated hospitals. Available discount cash prices and payer-specific negotiated prices for CPT codes 64721, 26615, and 25111 were recorded. Multivariate analysis was used to stratify hospitals into 2 groups based on their area's median household income, percentage uninsured, and geographic practice cost index practice expense scores. Generalized linear mixed effects modeling was used to evaluate price variability against community-level financial characteristics of the patient population. Of hospitals that met selection criteria, a majority did not display discount cash prices and payer-specific negotiated prices for the 3 procedures. Hospitals in lower-income areas and areas with a higher percentage of the uninsured tended to charge a higher average payer-specific negotiated price for CPT code 25111. They also tended to have greater variation in payer-specific negotiated prices than hospitals found in higher-income and lower-percentage-uninsured areas. This study demonstrates that considerable pricing variation and incomplete transparency exists for CPT codes 64721, 26615, and 25111 among Association of American Medical Colleges-affiliated hospitals. Patients in lower-income and higher-percentage-uninsured areas are more exposed to a higher variability and average of negotiated prices than those in higher-income areas, which may translate to higher out-of-pocket costs for those with higher coinsurance and less socioeconomic prowess.