Demographic Disparities Research Articles

Socioeconomic and Demographic Disparities in Immunotherapy Utilization for Advanced Kidney and Bladder Cancer

ObjectivesImmunotherapy (IO) drugs have been increasingly utilized in locally advanced or metastatic clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma of the bladder (UC). Multiple trials have demonstrated clear survival benefit, however, there are often barriers to access for these advanced therapies which has been demonstrated in other non-urologic malignancies. The goal of this study was to assess socioeconomic and demographic factors associated with the receipt of IO for advanced ccRCC and UC. Materials and methodsWe queried the National Cancer Database (NCDB) for patients with stage IV ccRCC and UC. The study period was 2015 to 2020 for ccRCC (FDA approval date of IO) and 2017 to 2020 for UC (FDA approval date of broadened indication for IO, initial limited approval in 2016). The primary outcome of interest was receipt of IO therapy using multivariable logistic regression, adjusting for relevant socioeconomic and demographic variables. ResultsWe identified 15,926 patients with stage IV ccRCC and 10,380 patients with stage IV UC of which 5,419 (34.0%) and 2,231 (21.5%) received IO therapy, respectively. IO utilization increased with each successive year. In both malignancies, treatment at a non-academic facility, education level, income, and insurance were independently associated with IO utilization. For ccRCC, black (OR = 0.77, 95% CI, 0.64–0.93, P = 0.009) and Hispanic race (OR = 0.73, 95% CI, 0.61–0.86, P = 0.006) were each associated with decreased IO utilization but there were no independent associations between race and receipt of IO in patients with UC. ConclusionsIn the era of FDA-approved IO therapy for advanced ccRCC and UC, this national cohort analysis suggests that IO utilization is increasing over time, but significant disparities exist based on income, education, and insurance status in both malignancies. Additionally, patients treated at non-academic facilities were less likely to receive IO therapy for these specific genitourinary malignancies. In ccRCC, additional disparities were seen black and Hispanic races which each were associated with lower odds of IO receipt. Identifying strategies to mitigate these differences and provide equitable access to IO therapy is of imperative need.

Social media use and mental health among older adults with multimorbidity: the role of self-care efficacy.

To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity. Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses. Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health. Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education). Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.

Unravelling factors influencing demand for modern contraception and evaluating coverage progress since 2015 in Ethiopia, Kenya, and Nigeria: insights from multilevel and geostatistical modelling

IntroductionThe United Nations established the Sustainable Development Goals (SDGs) in 2015 to enhance global development. In this study, we examine an SDG indicator: the percentage of women aged 15–49 whose family planning needs are met by modern contraception (mDFPS). We evaluate both the factors influencing its coverage and its progress since 2015.MethodsWe used nationally representative surveys data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period, using a Bayesian model-based geostatistical approach. We assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%.ResultsVaried individual and community-level determinants emerged, highlighting the countries’ uniqueness. Factors such as being part of a female-headed household, and low household wealth, lowered the odds of mDFPS, while rural-residence had low odds only in Ethiopia and Nigeria. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. The predicted posterior proportion of mDFPS and exceedance probability (EP) for WHO target for Ethiopia was 39.85% (95% CI: [4.51, 83.01], EP = 0.08) in 2016 and 46.28% (95% CI: [7.15, 85.99], EP = 0.13) in 2019. In Kenya, the adjusted predicted proportion for 2014 was 30.19% (95% CI: [2.59, 80.24], EP = 0.06) and 44.16% (95%CI: [9.35, 80.24], EP = 0.13) in 2022. In Nigeria, the predicted posterior proportion of mDFPS was 17.91% (95% CI: [1.24, 61.29], EP = 0.00) in 2013, and it was 23.08% (95% CI: [1.80, 56.24], EP = 0.00) in 2018. None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO target. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS target.ConclusionThe study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.

Patterns and trends in melanoma mortality in the United States, 1999–2020

IntroductionMelanoma, a deadly form of skin cancer, has witnessed a notable increase in incidence over the past decades. Despite advancements in treatment, it remains a significant cause of cancer mortality. Understanding demographic trends and variations in melanoma mortality is crucial for addressing disparities and implementing effective interventions.MethodsUsing the Centers for Disease Control Wide Ranging Online Data for Epidemiologic Research (CDC WONDER) database, we analyzed melanoma mortality data in the United States from 1999 to 2020. Data were stratified by demographic and regional variables, and age-adjusted mortality rates were calculated. Descriptive analysis was performed and Joinpoint regression analysis was employed to identify temporal trends.ResultsBetween 1999 and 2020, there were 184,416 melanoma-related deaths in the United States Overall, the age-adjusted mortality rate declined from 2.7 to 2.0 per 100,000 people at a rate of -1.3% annually, with significant variations across demographic groups and regions. Men, non-Hispanic White individuals, and those aged > 65 experienced higher mortality rates. Non-Hispanic White individuals noted the steepest decrease in AAMR after 2013 at a rate of -6.1% annually. Disparities were seen by geographic density, with rural populations exhibiting higher mortality compared to their urban and suburban counterparts.ConclusionThe study highlights a significant reduction in melanoma mortality in the U.S. since 2013, potentially attributed to advancements in diagnostic techniques such as dermoscopy and the introduction of immune checkpoint inhibitors. Disparities persist, particularly among rural populations. Targeted interventions focusing on increased screening and education are warranted to further mitigate melanoma mortality and address demographic disparities.

Investigating racial and gender disparities in virtual randomized clinical trial enrollment: Insights from the BE ACTIVE study

Randomized clinical trials (RCTs) often suffer from a lack of representation from historically marginalized populations, and it is uncertain whether virtual RCTs (vRCTs) enhance representativeness or if elements of their consent and enrollment processes may instead contribute to underrepresentation of these groups. In this study, we aimed to identify disparities in enrollment demographics in a vRCT, the BE ACTIVE study, which recruited patients within a single health system. We discovered that the proportions of eligible patients who were randomized differed significantly by gender and race/ethnicity (men 1.2%, women 2.0%, P < .001; White 1.8%, Black 1.3%, Hispanic 0.7%, Asian 0.9%; P < .001), and compared with White patients, non-White patients were less likely to have a valid email address on file and were less likely to click on the email link to the study webpage and begin enrollment.

PP01.39 Demographic and Socioeconomic Disparities in Lung Cancer Screening Uptake: A Quantitative Analysis in the State of Indiana

PP01.39 Demographic and Socioeconomic Disparities in Lung Cancer Screening Uptake: A Quantitative Analysis in the State of Indiana

Perceptions and outcomes of a nationwide remote pharmacy mentorship program

AbstractIntroductionMentorship is crucial for professional development in health care. However, the outcomes of national remote mentorship programs in pharmacy remain largely unexplored. This study evaluates the perceptions and experiences of student pharmacists, residents, fellows, and nontrainee pharmacists in such a program.ObjectivesThis study aimed to assess the perceptions and outcomes of a nationwide remote pharmacy mentorship program designed for student pharmacists, residents, and fellows. It explores the efficacy, benefits, and barriers within a national pharmacy professional organization mentorship program.MethodsThe mentor and mentee experiences in the American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice and Research Network (PRN) from program years 2019–2022 were assessed using an anonymous online survey, employing a mixed‐methods approach. The survey featured quantitative Likert scale and qualitative free‐response questions. In addition, publicly available online sources provided data for postprogram placement outcomes of learner participants in the program. Summary statistics were computed from the quantitative data, and content analysis was applied to the qualitative data.ResultsOf the 356 invited program participants, 48 mentors (32.7%) and 18 mentees (8.6%) responded to the survey. Most respondents agreed or strongly agreed on the program's effectiveness, contributing to a high postprogram placement rate in residencies and ambulatory care positions, emphasizing the program's success in supporting career progression. Respondents recognized significant benefits like career development and professional satisfaction. Notable demographic disparities, especially in age, gender, and race, were observed among participants. The study also identified logistical challenges that impeded the program's full potential.ConclusionDespite limitations, including a low number of responses, the study revealed that remote mentorship may positively affect professional development and well‐being. The data supports the program‐impacted respondent involvement and professional growth. Moreover, these findings suggest the need for further research to address the program barriers and disparities in participation.

Dissecting bias of ChatGPT in college major recommendations

AbstractLarge language models (LLMs) such as ChatGPT play a crucial role in guiding critical decisions nowadays, such as in choosing a college major. Therefore, it is essential to assess the limitations of these models’ recommendations and understand any potential biases that may mislead human decisions. In this study, I investigate bias in terms of GPT-3.5 Turbo’s college major recommendations for students with various profiles, looking at demographic disparities in factors such as race, gender, and socioeconomic status, as well as educational disparities such as score percentiles. To conduct this analysis, I sourced public data for California seniors who have taken standardized tests like the California Standard Test (CAST) in 2023. By constructing prompts for the ChatGPT API, allowing the model to recommend majors based on high school student profiles, I evaluate bias using various metrics, including the Jaccard Coefficient, Wasserstein Metric, and STEM Disparity Score. The results of this study reveal a significant disparity in the set of recommended college majors, irrespective of the bias metric applied. Notably, the most pronounced disparities are observed for students who fall into minority categories, such as LGBTQ + , Hispanic, or the socioeconomically disadvantaged. Within these groups, ChatGPT demonstrates a lower likelihood of recommending STEM majors compared to a baseline scenario where these criteria are unspecified. For example, when employing the STEM Disparity Score metric, an LGBTQ + student scoring at the 50th percentile faces a 50% reduced chance of receiving a STEM major recommendation in comparison to a male student, with all other factors held constant. Additionally, an average Asian student is three times more likely to receive a STEM major recommendation than an African-American student. Meanwhile, students facing socioeconomic disadvantages have a 30% lower chance of being recommended a STEM major compared to their more privileged counterparts. These findings highlight the pressing need to acknowledge and rectify biases within language models, especially when they play a critical role in shaping personalized decisions. Addressing these disparities is essential to foster a more equitable educational and career environment for all students.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity. Keywords: Runny nose, nasal obstractions , nasal pruritis, stuffy nose

What is fair? Proxy discrimination vs. demographic disparities in insurance pricing

Discrimination and fairness are major concerns in algorithmic models. This is particularly true in insurance, where protected policyholder attributes are not allowed to be used for insurance pricing. Simply disregarding protected policyholder attributes is not an appropriate solution as this still allows for the possibility of inferring protected attributes from non-protected covariates, leading to the phenomenon of proxy discrimination. Although proxy discrimination is qualitatively different from the group fairness concepts discussed in the machine learning and actuarial literature, group fairness criteria have been proposed to control the impact of protected attributes on the calculation of insurance prices. The purpose of this paper is to discuss the relationship between direct and proxy discrimination in insurance and the most popular group fairness axioms. We provide a technical definition of proxy discrimination and derive incompatibility results, showing that avoiding proxy discrimination does not imply satisfying group fairness and vice versa. This shows that the two concepts are materially different. Furthermore, we discuss input data pre-processing and model post-processing methods that achieve group fairness in the sense of demographic parity. As these methods induce transformations that explicitly depend on policyholders' protected attributes, it becomes ambiguous whether direct and proxy discrimination is, in fact, avoided.

Dependable approaches to hypertension management: A review.

Hypertension, a prevalent chronic condition characterized by elevated blood pressure, is a significant global health burden, contributing to approximately 7.5 million premature deaths annually. While existing literature predominantly focuses on conventional treatment modalities, this paper offers unique insights into dependable approaches to hypertension management. Drawing upon epidemiological data, it highlights the increasing prevalence of hypertension across diverse populations, emphasizing demographic disparities and regional variations. This article underscores the need for tailored interventions considering individual risk profiles and socioeconomic determinants. Beyond conventional lifestyle modifications and pharmacological therapies, it explores emerging trends such as mindfulness-based interventions and integrative medicine in hypertension management. Additionally, it discusses the role of digital health technologies and telemedicine in enhancing patient engagement and remote monitoring, optimizing treatment outcomes. Furthermore, the paper addresses the evolving landscape of personalized medicine and genomic advancements in predicting individual responses to antihypertensive therapies, advocating for precision medicine approaches. This paper advocates for a holistic and patient-centered approach to hypertension management by offering a comprehensive overview of established and emerging strategies. It underscores the importance of interdisciplinary collaboration, continuous education, and innovative research endeavors to address the multifaceted challenges posed by hypertension and improve global cardiovascular health outcomes.

"Isolation by Gentes with Asymmetric Migration" shapes the genetic structure of the common cuckoo in China.

Amid coevolutionary arms races between brood parasitic birds and their diverse host species, the formation of host-specific races, or gentes, has drawn significant research focus. Nevertheless, numerous questions about gentes evolutionary patterns persist. Here, we investigated the potential for gentes evolution across multiple common cuckoo (Cuculus canorus) populations parasitizing diverse host species in China. Using maternal (mitochondrial and W-linked DNA) and biparental (autosomal and Z-linked DNA) markers, we found consistent clustering of cuckoo gentes (rather than geographical populations) into distinct clades in matrilineal gene trees, indicating robust differentiation. In contrast, biparental markers indicated intermixing of all gentes, suggesting asymmetric gene flow regardless of geography. Unlike the mitonuclear discordance commonly resulting from incomplete lineage sorting, adaptive introgression, or demographic disparities, the observed pattern in brood parasitic cuckoos might reflect biased host preferences between sexes. We hereby present the "Isolation by Gentes with Asymmetric Migration" model. According to this model, the maternal line differentiation of the common cuckoo in China is potentially driven by host preferences in females, whereas males maintained the integrity of the cuckoo species through random mating. To achieve this, cuckoo males could perform flexible migration among gentes or engage in early copulation with females before reaching the breeding sites, allowing female cuckoos to store sperm from various gentes. Future studies collecting additional samples from diverse cuckoo gentes with overlapping distribution and investigating the migratory and copulation patterns of each sex would enhance our understanding of sex-biased differentiation among cuckoo populations in China.

HIV and Syphilis Co-Screening Rates Among Patients Tested for Gonorrhea and Chlamydia at a Large, Urban Hospital

Abstract Background Current guidelines recommend concurrent screening for HIV and syphilis with gonorrhea and chlamydia testing. Despite this, many patients are still not screened. This study describes trends in demographics and encounter locations associated with missed opportunities for HIV and syphilis screening among patients tested for gonorrhea or chlamydia. Methods This is a retrospective review of all encounters with gonorrhea or chlamydia testing in a large, urban hospital from November 1, 2018, to July 31, 2021. Demographic information and encounter location were extracted from the medical record. Encounters were categorized as including both HIV and syphilis (complete) screening, HIV screening only, or neither. Logistic regression was used to examine associations between demographics and encounter location and likelihood of complete screening. Results There were 42,791 patient encounters, of which 40.2% had complete screening, 6.2% had concurrent HIV screening only, and 53.6% had no concurrent screening. Increasing age, female sex (aOR 0.58, 95% CI 0.55-0.61, p &lt; 0.01), non-Hispanic Black race (aOR 0.52, 95% CI 0.49-0.55, p &lt; 0.01), and public insurance (aOR 0.72, 95% CI 0.69-0.75, p &lt; 0.01) were associated with lower odds of complete screening. Emergency department (ED) encounters were most likely to include complete screening (aOR 3.11, 95% CI 2.96-3.26, p &lt; 0.01). Conclusions This study found a large proportion of patients tested for gonorrhea and chlamydia had missed opportunities for HIV and syphilis screening. Significant demographic disparities were found. The ED was most likely to screen for both HIV and syphilis. Decreasing disparities in screening could have profound effects on the HIV and syphilis epidemics.

Reconsidering Household Food Insecurity: Assessing the Impact of Neighborhood and Household Characteristics

ABSTRACT Motivated by substantial public health implications of food insecurity, this study systematically reexamined its determinants beyond household disadvantages. Utilizing data from the Panel Study of Income Dynamics and American Community Survey, hierarchical linear modeling was employed. The findings underscored notable between-neighborhood variations in food insecurity after adjusting for household-specific characteristics, revealing residing in high-poverty or nonmetropolitan areas heightened the risk. Demographic disparities were evident, with Black and Hispanic households experiencing elevated food insecurity, despite neighborhood racial composition. Additional household factors exacerbating food insecurity included financial constraints, limited education, vehicle inaccessibility, and single-living arrangements. These findings inform interventions in similar contexts.

Nurturing care assets for food security: a community asset mapping approach

BackgroundZip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk.MethodsFour steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist.ResultsWe identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk.ConclusionsThe quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets.

Demographic Disparities in Lung Cancer Mortality and Trends in the United States From 1999 Through 2020: A Population-Based CDC Database Analysis.

Lung cancer is the leading cause of cancer-related mortality in the United States and is projected to account for 127,070 deaths in 2023. Although the lung cancer mortality rate has been decreasing over the last decade, demographic disparities in mortality still exist. We sought to determine the impact of demographic factors on lung cancer mortality and trends in the United States. We queried the Centers for Disease Control and Prevention (CDC) database for mortality statistics with an underlying cause of death of lung and bronchus cancer from 1999 through 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 people. We assessed the AAMR by demographic variables, including race, geographic density, sex, age, and US census region. Temporal trends were evaluated using Joinpoint regression software, and average annual percent change (APC) was calculated. From 1999 through 2020, lung cancer led to 3,380,830 deaths. The AAMR decreased by 55.1 to 31.8, with an associated average APC of -2.6%. In 1999, men had an AAMR almost twice as high as women, but these differences became less pronounced over time. Rural populations experienced the highest AAMR and the slowest rate of decrease compared with urban populations, who experienced the lowest AAMR and fastest decrease. Non-Hispanic Black individuals experienced the highest AAMR, with an annual decrease of -3.0%. The West experienced the fastest decrease at -3.1% annually, whereas the Midwest experienced the slowest decrease at -2.0% annually. Although the mortality rate of lung cancer has been decreasing since 1999, not all demographic groups have experienced the same rates of decrease, and disparities in outcomes are still prevalent. Vulnerable subgroups need targeted interventions, such as the incorporation of patient navigators, improved screening chest CT scan access and follow-up, and telehealth expansion, which will improve the likelihood of earlier-stage diagnoses and the potential for curative treatments.

An examination of health care efficiency in Canada: a two-stage semi-parametric approach.

Using data envelopment analysis, we examine the efficiency of Canada's universal health care system by considering a set of labour (physicians) and capital (beds) inputs, which produce a level of care (measured in terms of health quality and quantity) in a given region. Data from 2013-2015 were collected from the Canadian Institute for Health Information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that variation in efficiency scores across Canada is the result of regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health care production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust their transfer payments to reflect these disparities, thereby potentially reducing inequality in regional efficiency.

Increasing cancer-related mortality and demographic disparities in young adults in the United States between 1999 and 2020.

10569 Background: The global rise in cancer incidence in the young adult population (≤ 45 years), particularly in obesity-related cancers, is of growing concern. As the demographic afflicted by cancer expands beyond traditional boundaries, a nuanced understanding of the unique characteristics and challenges specific to young adults is imperative for developing interventions that address their distinct needs. In this study, we characterize cancer mortality rates in the young adult population to assess for emerging trends and cancer burden in the United States. Methods: The Centers for Disease Control database was queried for all underlying causes of death due to cancer (ICD 10 codes C00-C97) between 1999 and 2020. Malignancies that primarily affect the elderly, such as prostate and multiple myeloma, were excluded. Age-adjusted mortality (AAMR) rates per 100,000 people were extracted for adult patients between 25 and 44 years of age. AAMR was assessed by demographic and clinical variables, including race, geographic density, sex, and primary site. Joinpoint trend analysis was used to identify the presence of statistically significant temporal trends. Average annual percent change (AAPC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, 366,478 cancer-related deaths occurred in young adults in the United States. The overall AAMR was 20.7, decreasing from 24.8 in 1999 to 17.5 in 2020 at a rate of -1.6% annually (p&lt;0.05). However, increasing mortality was seen in a number of primary sites, including uterine cancer with an increase of 2.6% annually (p&lt;0.05) and colorectal cancer with an increase of 0.8% annually (p&lt;0.05). Overall AAMR was highest for non-Hispanic Black individuals at 28.3, 29% higher than the next highest group (non-Hispanic White) at 21.2 and almost double that of non-Hispanic Asians at 14.7. Individuals residing in rural populations experienced the highest AAMRs at 24.3 and the slowest rates of decrease at -1.6% annually (p&lt;0.05), compared with urban individuals whose AAMR was 19.8 with a decrease of -1.9% annually (p&lt;0.05). Primary sites with the highest AAMRs included breast (3.1), lung (2.1), and colorectal (1.8) cancers. Conclusions: The current study sheds light on the evolving landscape of cancer mortality among young adults in the United States. The overall decrease in age-adjusted mortality rates is promising, reflecting advancements in cancer care and prevention strategies. However, the alarming increase in mortality rates for specific cancer types, such as uterine and colorectal cancers, underscores the need for targeted interventions and heightened awareness, especially in at-risk populations. The identified racial and geographic disparities further emphasize the importance of implementing tailored approaches to address the unique challenges faced by diverse populations.

The Venezuelan Humanitarian Crisis, Out-Migration, and Household Change Among Venezuelans in Venezuela and Abroad

International migration is increasingly characterized by the need to evade threats to survival. Nevertheless, demographic understandings of how families—rather than individuals alone—decide to migrate or separate in response to threats remain limited. Focusing on the recent humanitarian crisis in Venezuela, we analyze 2012–2016 data on Venezuelans in Venezuela and 2018–2020 data on UNHCR (United Nations High Commissioner for Refugees)-registered Venezuelans in nine receiving countries to illuminate the evolution of threats Venezuelans sought to evade, how threat evasion transformed households away from previous norms, the selection of migrants into different receiving countries and household structures, and demographic disparities in migrants’ odds of reporting changes to their household because of specific migration-related processes (e.g., leaving someone in Venezuela, leaving someone in another country). Results underscore a simultaneous escalation of economic, safety, and political concerns that informed Venezuelans’ increasing intentions to out-migrate. Where Venezuelans migrated and who ended up in their households abroad varied by demographic background and migration experiences. Among UNHCR-registered Venezuelans, 43% left family members in Venezuela, and more than 10% left or were left behind by members in another country. Such household separations, however, were unevenly distributed across factors such as age, gender, and country of reception.