County Of Residence Research Articles

Awareness of community-led total sanitation and its impact on sanitation among residents of Kilifi and Marsabit Counties, Kenya

Background: Community-based strategy known as community-led total sanitation (CLTS) is frequently employed to address open defecation and the health issues it causes. Inadequate sanitation is one of the biggest health and environmental problems in the world, contributing to approximately 775,000 deaths per year. This study aimed to assess the level of awareness of community-led total sanitation (CLTS) and its impact on sanitation among communities in Kilifi and Marsabit Counties in Kenya. Methods: The study adopted a comparative study design. Purposive and multistage sampling were used to recruit study respondents in this study. Fischer's formula was used to determine the sample size for this investigation where 811 study participants were enlisted for the research. Propensity score matching (PSM) was used to estimate the impact of CLTS intervention on sanitation status. A significance level of 0.05 was employed as the threshold for all tests conducted in this study. Results: From this study, Among those fully conversant with CLTS, 98% resided in Kilifi County; 77% in Marsabit were fully aware of CLTS. The majority(87.7%) of the study respondents were fully aware of CLTS. Despite CLTS intervention resulting in a 42% increase in households owning a sanitation facility, There was no significant statistical association between CLTS intervention and sanitation status (t=0.42, p=0.0835). Conclusion: The study established that the level of awareness of CLTS in both counties was high. The results from this study demonstrated that CLTS intervention programs had an impact on sanitation levels in Kilifi and Marsabit counties.

Risk of Major Adverse Cardiovascular Outcomes in Families With MASLD: A Population-Based Multigenerational Cohort Study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a risk factor for cardiovascular disease. However, whether family members of individuals with MASLD also share an increased cardiovascular risk is unknown. We created a nationwide multigenerational cohort study identifying all family members of Swedish adults diagnosed with biopsy-proven MASLD (1969-2017) and of matched general population comparators (by age, sex, calendar year, and county of residence). We calculated incidence rates and used Cox models to calculate adjusted hazard ratios (aHRs) and 95% CIs for incident major adverse cardiovascular events (MACE), including acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox models were adjusted for education, country of birth, diabetes, hypertension, obesity, dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease, and the Charlson comorbidity index. We identified 22 267 MASLD first-degree relatives (FDRs; parents, siblings, and offspring) and 5687 MASLD spouses, as well as 118 056 comparator FDRs and 29 389 comparator spouses without earlier cardiovascular disease. Overall, the mean age was 41.8 years (SD, 18.0), and 51.5% were females. Over a median of 24.6 years, the incidence rate for MACE was higher in MASLD FDRs than in comparator FDRs (65.0 versus 62.5/10 000 person-years; aHR, 1.06 [95% CI, 1.01-1.11]). MASLD FDRs had higher rates of acute myocardial infarction (23.0 versus 20.9/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]) and cardiovascular death (aHR, 1.09 [95% CI, 1.01-1.18]). Across generations of FDRs, the risk of MACE was uniformly increased with no differences by relationship (ie, parents, siblings, and offspring; Pinteraction>0.05). MASLD spouses were also at an increased risk of MACE (117.6 versus 103.5/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]). First-degree relatives of individuals with biopsy-proven MASLD are at slightly higher risk of incident MACE, but absolute risks do not support early screening for cardiovascular disease. Shared lifestyle factors may be the main contributors, as spouses of MASLD patients also had higher risks of MACE.

Does perceived neighbourhood social cohesion moderate the effects of demographic changes on health?

Abstract Small-area characteristics changes over time may be associated with health. Various theories have been proposed to explain small-area effects on health, including those concerning social capital. The effect of small-area demographic changes on health are very little researched and hardly anything is known about their relationship with social cohesion. We use longitudinal data from the German Socio-Economic Panel linked to demographic measures at county level. We explore the association between 5-year changes in the proportion of over 65 and of 18-24 years-old and physical and mental health and the moderating effect of perceived neighbourhood social cohesion (SC) using random intercept models. Control variables include education, income, and relevant baseline measures. Included are all participants with a 6-year continuous exposure to their county of residence. The main outcomes are the physical and mental health components (PCS, MCS) of the SF-12. We included 21,239 persons up to 6 times in 399 counties. 5-year changes in the over 65, of 18-24 and measure of SC are associated to MCS and PCS. Significant interactions between the changes in over 65 and social cohesion are seen for MCS only in rural areas and some interactions are significant for PCS. For MCS there are no interactions between social cohesion and the changes in 18-24. Important interaction effects for PCS: for those exposed to a small decrease in 18-24, an increase in one unit of SC is associated with an increase of 1.71 (95% CI[1.38, 2.03]) PCS units. For those exposed to a large decrease this effect is lower by 0.88 PCS units. Exposition to some demographic changes have the effect to reduce the positive effects of perceived social cohesion on health. Thus, demographic changes appear to be health stressors. The evidence shown by this work need to be further developed by considering smaller scales but the evidence opens up a new range of possible intervention targets to reduce health inequalities. Key messages • County level demographic changes are associated with physical and mental health and certain exposition to changes reduce the positive effects of perceived neighbourhood social cohesion. • Social cohesion can be an intervention target to reduce small-area health inequalities, population changes can annulate positive effects. This must be accounted for in public health interventions.

Association between surgery treatment delays and survival outcomes in patients with esophageal cancer in Hebei, China.

The delays in cancer therapies have the potential to impact disease progression by allowing the unchecked growth and spread of cancer cells. However, the understanding of the association between treatment waiting time and survival outcomes in patients with esophageal cancer (EC) is limited. This study aims to assess the impact of waiting time on survival outcomes among EC patients in Hebei province, which is recognized as one of the high-risk areas for EC in China. A total of 9,977 non-metastatic EC patients who underwent surgical treatment were identified between 2000 and 2020. The survival outcomes of overall survival (OS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier methodology. Univariate and multivariate Cox regression analysis was employed to evaluate the impact of treatment delays on OS and CSS. The average delay time for initiating EC surgical treatment after diagnosis was 1.31 months (95%CI=1.29-1.34). Patients with a long delay (≥ 3 months) intreatment, comprising 9977 EC patients, exhibited significantly lower rates of 3-, 5-, and 10-year OS and CSS compared to those without any delay in treatment initiation. A long delay in EC treatment independently associated with an elevated risk of all-cause and cancer-cause mortality among various patient subgroups, including males, older individuals, single individuals, low-income patients, residents of nonmetropolitan counties, as well as those diagnosed with poorly differentiated and stage IV EC. The long delay of treatment initiation impacts the outcomes of OS and CSS in EC patients. Optimizing treatment timing may enhance life expectancy for individuals diagnosed with EC.

“Tweet of the town”: Synthesizing Local and Social Media Discourse on Book Bans

This project explores the intersection of local and online discourse around book bannings. I use the McMinn County School Board’s decision in 2022 to remove Art Spiegelman’s graphic memoir, Maus, as a case study for this discourse. Through a combination of interviews with McMinn County residents and data collected from Twitter, I argue that social media has altered local community discourse and responses to book bannings. Interviews with local residents asked them to discuss their experiences when Maus was removed by the school board and to reflect on how the local community responded amidst worldwide scrutiny once the event reached digital spaces via social media. Online discourse on Twitter involved collecting tweets mentioning the McMinn County Schools Twitter account along with tweets discussing Maus to understand the broader online response to the board’s decision. I use Danielle Allen’s discourse flow model as the theoretical framework for this project and in my initial findings, discourse around the Maus ban has traveled as described by Allen. In the age of social media, discourse frequently begins at the local level before traveling online and then back into local spaces. Ongoing data analysis has shown that locally, residents were concerned with not only the board’s decision, but also the perception of their community once news of the banning spread. This is supported by online discourse on Twitter, where initial analysis shows frequent characterization of the McMinn County community in a negative light based on the school board’s actions.

Characteristics associated with adult non-fatal opioid and stimulant overdose and substance use disorder emergency department visits in Michigan

BackgroundUnderstanding risk factors for emergency department (ED) visits for overdose and substance use disorder (SUD) can inform prevention efforts. Few studies have considered non-fatal opioid overdoses, stimulant overdoses and SUD, and limited data exists by overdose intentionality and by sex. MethodsWe conducted a serial cross-sectional study with Healthcare Cost and Utilization Project Michigan (MI) 2019–2020 ED discharge data (n=5,716,716). Primary outcomes included non-fatal opioid overdoses, non-fatal stimulant overdoses, and SUD primary diagnoses in a single ED visit. We examined demographic and socioeconomic factors associated with study outcomes using binary and multinomial logistic regression (for overdose intentionality) models, which estimated adjusted odds ratios (AOR) and 95 % confidence intervals (CI). ResultsAmong all MI discharges, 13,908, 1,379, and 23,462 were nonfatal opioid, stimulant, or SUD overdose visits, respectively. Lower median household income (vs. higher income), male sex (vs. female), metropolitan county of residence (vs. small urban/rural), and Medicaid (vs. private insurance) were associated with increased odds of all outcomes. For example, ORs(95 % CIs) for Medicaid were 4.41(4.18,4.65), 2.25(1.95,2.60), and 2.80(2.70,2.91) for opioid overdoses, stimulant overdoses, and SUD, respectively. All outcomes had the highest increased odds in ages 28–32 years compared to 18–22 years. Stratification by sex and non-fatal overdose intentionality modified some associations, with the strongest associations observed for non-fatal opioid overdoses. ConclusionsMale sex, Medicaid, and race/ethnicity were consistently associated with all outcomes similarly, but other characteristics varied in patterns, strengths of association, and statistical significance by outcome groups, sex, and non-fatal opioid or stimulant overdose intentionality.

Community-Level Social Vulnerability and Hip and Knee Joint Replacement Surgery Receipt Among Medicare Enrollees With Arthritis.

(1) Explore associations between county minority health social vulnerability index (MH-SVI) and total joint replacement (TJR), and (2) assess associations by individual-level race/ethnicity. An expanded understanding of relevant social determinants of health is essential to inform policies and practices that promote equitable access to hip and knee TJR. Retrospective cohort study of Medicare enrollees. Centers for Medicare and Medicaid Services claims data were linked with MH-SVI. Multivariable logistic regression models were used to evaluate the odds of TJR according to the MH-SVI quartile in which enrollees resided. A total of 10,471,413 traditional Medicare enrollees in 2018 aged 67 years or older with arthritis. The main outcome was enrollee primary TJR during hospitalization. The main exposure was the MH-SVI (composite and 6 themes) for the county of enrollee residence. Results were stratified by enrollee race/ethnicity. Asian American, Native Hawaiian, or Pacific Islander (AANHPI), Black or African American (Black), and Hispanic enrollees comparatively had 26%-41% lower odds of receiving TJR than White enrollees. Residing in counties within the highest quartile of composite and socioeconomic status vulnerability measures were associated with lower TJR overall and by race/ethnicity. Residing in counties with increased medical vulnerability for Black and White enrollees, housing type and transportation vulnerability for AANHPI and Hispanic enrollees, minority status and language theme for AANHPI enrollees, and household composition vulnerability for White enrollees were also associated with lower TJR. Higher levels of social vulnerability were associated with lower TJR. However, the association varied by individual race/ethnicity. Implementing multisectoral strategies is crucial for ensuring equitable access to care.

Self-Stigma vs. Perceived Public Stigma Toward Mental Illness in Rural Adults

Introduction: Mental illness is a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. Stigma toward mental health comes in two primary forms: Self-stigma and perceived public stigma. Purpose: The objective of this study is to quantify the amount of stigma toward mental illness in rural adults and analyze differences in stigma across demographic groups. Methods: Adults were offered a 14-item questionnaire at five different sites from January 2023 to April 2023. Rural distinctions were made based on participants' reported county of residence following the Indiana Office of Community and Rural Affairs (OCRA) definition of rurality. Demographic information such as age, gender, marital status, total household income, and highest level of education were also obtained. Results: Rural adults experience mild amounts of self-stigma (14.52 +/- 5.0) and moderate amounts of perceived public stigma (18.4 +/- 4.3). Adults aged 46-65 experience more significant levels of perceived public stigma when compared to those of younger participants. An inverse relationship exists between the highest level of education and self-stigma towards mental illness. Seventy two percent of respondents agreed or strongly agreed with the statement, “In general, others believe that having a mental illness is a sign of personal weakness or inadequacy.” Conclusions: This study demonstrates that perceived public stigma toward mental illness presents a significant barrier to care for mental illness. Adults aged 46-65 are especially vulnerable to the perceived public stigma toward mental illness. To provide the largest benefit to rural populations, anti-stigma campaigns should focus on perceived public stigma among adults aged 46-65.

Association of rurality and health professional shortages with the clinicopathologic characteristics of melanoma in North Carolina.

To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina. We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0mm) and thicker (>1.0mm) tumors. The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P =.008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P =.013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001). Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.

“All Eyes on McMinn:” Book Banning Discourse in the Age of Social Media

ABSTRACTThis project explores the intersection of local and online discourse around book bannings using the McMinn County School Board's decision in 2022 to remove Art Spiegelman's graphic memoir, Maus, from their school curriculum as a case study. Through interviews with McMinn County residents and data collected from Twitter, I argue that social media has altered book banning discourse. I interviewed 10 residents and asked them to discuss their experiences when Maus was removed by the school board and to reflect on how the local community responded amidst worldwide scrutiny online. Discourse on Twitter involved collecting over 2000 tweets mentioning the @McMinnCountySch account and tweets discussing Maus to understand online responses to the board's decision. I use Danielle Allen's discourse flow model as the theoretical framework for this project. In my initial findings, discourse began at the local level before traveling online and then back into the local space. Ongoing data analysis has shown that locally, residents were concerned with the board's decision along with the perception of their community once news of the banning spread. This is supported by Twitter discourse, where many tweets cast the McMinn County community in a negative light based on the school board's actions.

Association between pyrrolizidine alkaloids exposure and risk of abnormal serum indices—Insights from a descriptive cross-sectional study in Yunnan Province

The hazard of pyrrolizidine alkaloids (PAs) has been widely reported in animal studies but rarely in population-based research, especially reports about daily exposure. A single-centre descriptive cross-sectional study was conducted on 552 Lahu Autonomous County residents recruited in 2021. Blood PAs exposure biomarker (pyrrole- protein adduct, PPA) and serum biochemical indices were measured. The prevalence of abnormal serum indices and PAs exposure in this region were elucidated using descriptive analyses. 75% of Lahu Autonomous County participants were exposed to PAs. PAs exposure risk in males was lower than in females (OR=0.357, 95% CI: 0.222- 0.574), and varied with the ethnicity of Lahu Autonomous County. PPA concentration was positively correlated with serum alanine transaminase (ALT) activity (r=0.6263, P<0.01) and triglyceride level (r=0.2327, P<0.01); PAs exposure was positively associated with anbormal serum ALT activity (x2=99.629, P<0.001; OR=1.428, 95% CI: 1.293-2.319) and hypertriglyceridemia (x2=15.376, P<0.001; OR=1.629, 95% CI: 1.229-2.251). These results suggest that PAs exposure might be a risk factor for serum ALT abnormality and hypertriglyceridemia in the local population. This study conducted the first epidemiological study on PAs exposure in China and established the etiological hypotheses for health issues in Lahu Autonomous County.

Barriers to the Uptake of Tickborne Disease Prevention Measures: Connecticut, Maryland 2016-2017.

Public health programs promote numerous tickborne disease (TBD) prevention measures. However, measures are not frequently or consistently performed. Describe barriers to consistent use of 4 commonly promoted TBD prevention measures. We conducted an online survey (n=1883) evaluating behaviors regarding TBD prevention measures including conducting tick checks, applying insect repellents, showering/bathing, and applying chemical or natural pesticides to residential yards. Respondents could select reasons for never, rarely, or sometimes performing these measures. Descriptive analysis and logistic regression modeling evaluated associations between the 3 most cited barriers for each measure and select demographic variables. The survey was administered to residents in high Lyme disease incidence counties of Connecticut and Maryland, 2016-2017. For tick checks (n=800), the most cited barriers were forgetting (63%), not spending time in tick habitat (28%), and too much trouble (11%). For applying insect repellents (n=1303), the most cited barriers were forgetting (38%), personal safety concerns (24%), and too much trouble (19%). For showering/bathing 2 hours after outdoor activity in tick habitat (n=1080), the most cited barriers were being unaware of the prevention measure (51%), too much trouble (18%), and forgetting (18%). For applying chemical pesticides to yards (n=1320), the most cited barriers were having environmental (45%), pet safety (31%), and personal safety concerns (28%). Lastly, for applying natural pesticides to yards (n=1357), the most cited barriers were being unaware of natural pesticides (31%), having cost concerns (23%), and not being concerned about ticks on property (16%). Forgetting, too much trouble, unawareness, and safety concerns were primary barriers to using several TBD prevention measures. Education regarding effectiveness, safety, and timing may increase uptake of certain measures. These challenges can be difficult to address, highlighting the need for passive TBD prevention measures, such as a Lyme disease vaccine.

Abstract A104: EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics

Abstract There are known disparities in cancer death rates in the U.S. by demographic, geographic and socioeconomic factors. While there are several widely available webtools to visualize U.S. cancer death rates, none allow for direct comparison of cancer death rates across county-level measures of social determinants of health. The National Cancer Institute has developed a new webtool, EpiTracker Cancer (https://episphere.github.io/epitracker), to allow for customizable visualization of cancer death rates across geography, demographics and county-level characteristics. Cancer death data and decedent race (i.e., American Indian and Alaska Native, Asian, Black, Native Hawaiian and Pacific Islander, White), ethnicity (Hispanic, non-Hispanic), sex, age and county of residence were ascertained from the National Center for Health Statistics (NCHS) death certificate data for 2018-2022. Counts and rates based on &amp;lt;10 deaths are suppressed per NCHS policy. Population data were abstracted from the U.S. Census. County-level characteristics were derived from multiple sources, and include metrics of socioeconomic status (e.g., median income, proportion with a college degree), health status (e.g., proportion who smoke, proportion who are obese), and healthcare access and utilization (e.g., proportion uninsured, proportion of women who have had a mammogram). EpiTracker Cancer is comprised of three main pages, each featuring a different type of visualization. The first page displays bar charts of age-standardized or crude death rates by cancer type, sex, race, ethnicity and age group. The second displays maps of cancer death rates at the county, state and national level. Users can generate national, state and county-level maps for each cause of cancer death that can be compared by race, ethnicity and sex, and can control how outlying rates are handled. The final visualization plots cancer death rates across quartiles, quintiles or deciles of county- level characteristics. The user can choose to display rate ratios comparing to either the highest or lowest quantile of the county-level metric. As an example, a user could visualize the association between county-level education, measured by the fraction of adults with at least some college education, and lung cancer mortality. Compared to counties in the highest quintile of educational attainment, those in the lowest quintile have lung cancer age-adjusted death rates that are 1.77- times (95%CI 1.72-1.82) higher among men and 1.56-times (95%CI 1.51-1.61) higher in women. Future iterations will include more county-level variables, death rates over time and additional visualizations, as well as user suggested improvements and innovations. Citation Format: Meredith Shiels, Lee Mason, Jonas Almeida, Sahar Behpour, Neal Freedman, Peter Kraft, Wayne Lawrence. EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics [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 A104.

Abstract C065: Stage-specific cancer survival in Black and White individuals by urbanicity of county of residence

Abstract Cancer survival rates are generally lower in Black than White individuals. We examined stage-specific cancer survival in non-Hispanic Black (Black) and non-Hispanic White (White) individuals by urbanicity of county of residence. Data on 5-year stage-specific cancer survival for all, lung, female breast, prostate, and colorectal cancers diagnosed in 2014-2020 were obtained from the Surveillance, Epidemiology, and End Results Program 22 registries. Urbanicity, based on the 2013 Rural-Urban Continuum Codes, was consolidated into four categories: county of residence in a large metropolitan (population ≥1 million), medium metropolitan (250,000-&amp;lt;1 million), small metropolitan (&amp;lt;250,000), and non-metropolitan area. The overall 5-year cancer survival for each stage was lower in Black than White individuals and in non-metropolitan than metropolitan areas. After stratification by both race and urbanicity, the 5-year survival for localized-stage cancers in Black and White individuals was comparable across categories of urbanicity, except in large metropolitan areas, where it was slightly lower in Black (90.2%, 95%CI=90.0%-90.4%) than White (91.0%, 90.9%-91.1%) individuals. The Black-White difference was larger for regional-stage cancers, for which the 5-year survival was about 5% lower in Black individuals than White individuals across all four categories of urbanicity, e.g., 65.8% (65.3%-66.3%) vs. 70.8% (70.6%-71.1%) in large metropolitan areas. For distant-stage cancers, the Black-White difference in 5-year survival was also about 5% (33.9%, 33.5%-34.4% vs. 38.6%, 38.4%-38.9%) in large metropolitan areas, but the difference in other areas was smaller. After stratification by age group, the Black-White differences were larger in ages &amp;lt;65 years. For example, the Black-White difference in 5-year survival for localized-, regional-, and distant-stage cancer in ages &amp;lt;65 years in large metropolitan areas was 2.1%, 8.6%, and 8.4%, respectively. The Black-White differences in survival also varied by cancer type. The stage-specific survival was lower in Black than White individuals across most categories of urbanicity, especially in large metropolitan areas in ages &amp;lt;65 years, for breast and colorectal cancer, localized-stage lung cancer, and localized- and regional-stage prostate cancer (&amp;lt;65 years only), with little differences in other evaluated stages. Notably, the 5-year survival for distant-stage breast cancer in ages &amp;lt;65 years in large metropolitan areas was about 16% lower in Black females (26.7%, 95%CI=24.3%-29.2%) than White females (43.1%, 41.3%-44.9%); the corresponding difference in ages ≥65 years was about 4% (23.1%, 19.9%-26.5% vs. 26.7, 25.0%-28.4%, respectively). Black-White differences in stage-specific cancer survival vary by cancer type, urbanicity, and age, and generally are larger in metropolitan areas and younger ages. These differences may largely reflect disparities in receipt of quality care, especially in large metropolitan areas and younger ages, due to inequities in social determinants of health, including health insurance coverage. Citation Format: Farhad Islami, Daniel Wiese, Elizabeth Schafer, Hyuna Sung, Ahmedin Jemal. Stage-specific cancer survival in Black and White individuals by urbanicity of county of residence [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 C065.

Risk factors for Lyme disease among residents of rural, suburban, and urban areas in the United States: A Case-Control Study

Abstract lyme disease (LD) is the most common vector-borne disease in the United States, with 476,000 cases estimated each year. It is unclear how LD risk factors vary by residential setting. We conducted a case-control study on LD risk by rural, urban, and suburban residential settings. Individuals from 15 high-incidence states and the District of Columbia in the Optum Research Database were identified as cases (LD medical claim) or controls (no LD medical claim, matched by county of residence and census block group population density). Participants were surveyed about LD history, outdoor activities, and residential characteristics. The final analytic dataset had 750 LD cases and 965 controls. Residence in a rural setting had increased LD risk (OR 1.41, 95% CI 1.16, 1.72). In multivariable analyses, activities associated with LD were hiking/walking/running or having an occupation in forests, wooded areas, or areas of tall grass (all respondents), and spending time in a yard (rural and urban residents only). Public health interventions can help prevent LD in high-incidence jurisdictions by reinforcing the nearuniversal LD risk for rural residents, and highlighting activities that lead to increased LD risk for those in areas with less ubiquitous tick exposure like in urban and suburban settings.

Impact of urban form on carbon emissions of residents in counties: evidence from Yangtze River Delta, China.

Urban form is a key factor affecting carbon emissions. Accurately estimating the impact of urban form on the carbon emissions of residents (CER) is an important prerequisite for China to adopt effective low-carbon spatial planning strategies and respond to climate change. However, counties mainly account for China's energy consumption, and the relationship between their urban form and the CER remains unclear, limiting their low-carbon development. Therefore, in this study, the PLS-SEM model and data from 90 counties in the Yangtze River Delta are used to determine the extent and ways that urban form affects the CER. The model considers the impact of both geometric-aspect urban form factors (urban scale, compactness, spatial structure, and urban shape) and built environment-aspect urban form factors (public service facilities, urban greening, road traffic, public transportation, and urban energy infrastructure) on the CER. The results indicate that urban form factors related to the built environment (public service facilities, urban greening, road systems, and municipal infrastructure) have a direct impact on the CER. Geometric-aspect urban form factors (size, compactness, spatial structure, and shape) not only directly affect the CER but also indirectly affect the CER by altering built environment-aspect urban form factors. This study identifies the complex relationship between urban form and the CER, facilitating the coordinated integration of multiple elements and providing a basis for the formulation of low-carbon spatial planning strategies for counties.

Group sex and behavior change associated with the 2022 Mpox outbreak among men who have sex with men in Southern California.

The Monkeypox (Mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California. Participants were recruited between October 2022 to April 2023, using palm cards, and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male, ≥18 years, reported sex with men, residents of San Bernardino or Riverside counties, California, Human Immunodeficiency Virus (HIV)-negative, currently not taking pre-exposure prophylaxis (PrEP). Descriptive analyses were performed. Chi-square, Fisher's exact, and Student's T-tests examined the association between group sex behaviors and demographics. We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent Mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent Mpox infection, participants that engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about Mpox symptoms before sex (9.5%). Survey participants reported modest sexual behavior changes in response to the Mpox outbreak. Group sex may increase the risk for Mpox, HIV, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.

COVID-19 immunization status in children compared to their parents: a retrospective review at an upstate NY medicine/pediatrics practice

BackgroundThis study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records.MethodsA cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5–11 years and 6 months-4 years cohorts. Chi square or Fisher’s exact test was used where appropriate.ResultsAcross both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child’s race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5–11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038).ConclusionsThis study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker.

Diverticular disease and risk of incident major adverse cardiovascular events: A nationwide matched cohort study.

An increased risk of cardiovascular disease (CVD) has been reported in patients with diverticular disease (DD). However, there are knowledge gaps about specific risks of each major adverse cardiovascular event (MACE) component. This nationwide cohort study included Swedish adults with DD (1987-2017, N=52,468) without previous CVD. DD was defined through ICD codes in the National Patient Register and colorectal histopathology reports from the ESPRESSO study. DD cases were matched by age, sex, calendar year and county of residence to ≤5 population reference individuals (N=194,525). Multivariable-adjusted hazard ratios (aHRs) for MACE up until December 2021 were calculated using stratified Cox proportional hazard models. Median age at DD diagnosis was 62 years and 61% were females. During a median follow-up of 8.6 years, 16,147 incident MACE occurred in individuals with DD, and 48,134 in reference individuals (incidence rates (IRs)=61.4 vs. 43.8/1,000 person-years) corresponding to an aHR of 1.24 (95%CI=1.22-1.27), equivalent to one extra case of MACE for every 6 DD patients followed for 10 years. The risk was increased for ischemic heart disease (IR=27.9 vs. 18.6; aHR=1.36, 95%CI=1.32-1.40), congestive heart failure (IR=23.2 vs. 15.8; aHR=1.26, 95%CI=1.22-1.31), and stroke (IR=18.0 vs. 13.7; aHR=1.15, 95%CI=1.11-1.19). DD was not associated with cardiovascular mortality (IR=18.9 vs. 15.3; aHR=1.01, 95%CI=0.98-1.05). Results remained robust in sibling-controlled analyses. Patients with DD had a 24% increased risk of MACE compared with reference individuals, but no increased cardiovascular mortality. Future research should confirm these data and examine underlying mechanisms and shared risk factors between DD and CVD.

The Association of Socio-Environmental Inequality and Outcomes Among Patients Undergoing Major Surgery

IntroductionEnvironmental hazards may influence health outcomes and be a driver of health inequalities. We sought to characterize the extent to which social–environmental inequalities were associated with surgical outcomes following a complex operation. MethodsIn this cross-sectional study, patients who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy, pneumonectomy, or pancreatectomy between 2016 and 2021 were identified from Medicare claims data. Patient data were linked with social–environmental data sourced from Centers for Disease Control and Agency for Toxic Substances and Disease Registry data based on county of residence. The Environmental Justice Index social–environmental ranking (SER) was used as a measure of environmental injustice. Multivariable regression analysis was performed to assess the relationship between SER and surgical outcomes. ResultsAmong 1,052,040 Medicare beneficiaries, 346,410 (32.9%) individuals lived in counties with low SER, while 357,564 (33.9%) lived in counties with high SER. Patients experiencing greater social–environmental injustice were less likely to achieve textbook outcome (odds ratio 0.95, 95% confidence interval 0.94-0.96, P < 0.001) and to be discharged to an intermediate care facility or home with a health agency (odds ratio 0.97, 95% confidence interval 0.96-0.98, P < 0.001). ConclusionsCumulative social and environmental inequalities, as captured by the Environmental Justice Index SER, were associated with postoperative outcomes among Medicare beneficiaries undergoing a range of surgical procedures. Policy makers should focus on environmental, as well as socioeconomic injustice to address preventable health disparities.