Geographic Disparities Research Articles

TCT-782 Geographic Disparities in Non–ST-Segment-Elevation Myocardial Infarction Management and Outcomes: A Decade of Insights From National Data

TCT-782 Geographic Disparities in Non–ST-Segment-Elevation Myocardial Infarction Management and Outcomes: A Decade of Insights From National Data

Service Access and Supportive Care Experiences among Urban and Rural Cancer Survivors: Informing Social Work Practice.

Access to medical and supportive care services is important for the health and quality of life of cancer survivors; however, services are not always available or accessible to all survivors equally. This study aims to explore the experiences of cancer services among cancer survivors in urban and rural settings to inform social work practice. Authors conducted interviews with 25 cancer survivors (colorectal, n = 13; hematological, n = 12) in the West of Ireland, using a narrative inquiry approach. Thematic analysis was used to analyze the data. Authors found variations in the availability of supportive care services for urban and rural cancer survivors. Often, services designed to maximize survivors' individualized choices and needs in community care were limited in rural communities, preventing some survivors from having their physical and psychological needs met. Additionally, access to services proved to be a barrier for rural cancer survivors. Rural survivors stated that traveling to appointments required time and planning, and the implications of travel costs were an increased burden. When rural survivors had good social support, access to services became less of an issue. The study confirms geographical disparities and recommends a review of supports that better meet survivors' needs and informs social work practice.

Patient- and Areal-Level Risk Factors Associated With Lung Cancer Mortality in Victoria, Australia: A Bayesian Spatial Survival Analysis.

In Australia, lung cancer is the leading cause of cancer-related deaths. In Victoria, the mortality risk is assumed to vary across Local Government Areas (LGAs) due to variations in socioeconomic advantage, remoteness, and healthcare accessibility. Thus, we applied Bayesian spatial survival models to examine the geographic variation in lung cancer survival in Victoria. Data on lung cancer cases were extracted from the Victorian Lung Cancer Registry (VLCR). To account for spatial dependence and risk factors of survival in lung cancer patients, we employed a Bayesian spatial survival model. Conditional Autoregressive (CAR) prior was assigned to model the spatial dependence. Deviance Information Criterion (DIC), Watanabe Akaike Information Criterion (WAIC), and Log Pseudo Marginal Likelihood (LPML) were used for model comparison. In the final best-fitted model, the Adjusted Hazard Ratio (AHR) with the 95% Credible Interval (CrI) was reported. The outcome variable was the survival status of lung cancer patients, defined as whether they survived or died during the follow-up period (death was our interest). Our study revealed substantial variations in lung cancer mortality in Victoria. Poor Eastern Cooperative Oncology Group (ECOG) performance status, diagnosed at a regional hospital, Small Cell Lung Cancer (SCLC), advanced age, and advanced clinical stage were associated with a higher risk of mortality, whereas being female, presented at Multidisciplinary Team (MDT) meeting, and diagnosed at a metropolitan private hospital were significantly associated with a lower risk of mortality. Identifying geographical disparities in lung cancer survival may help shape healthcare policy to implement more targeted and effective lung cancer care services.

S1496 Geographic Disparity in Access to Specialist Care for Ulcerative Colitis and Crohn’s Disease in the US

S1496 Geographic Disparity in Access to Specialist Care for Ulcerative Colitis and Crohn’s Disease in the US

Navigating OpenDOAR Distribution: A Deep Dive into Predictive Modeling and Trend Forecasting

Effective navigation and strategic foresight are imperative in the dynamic realm of academic repositories. This study aims to comprehensively understand global scholarly communication dynamics by analyzing repository distribution and forecasting future trends using predictive modeling methodologies. Employing a mixed-methods approach, this research blends quantitative analysis and predictive modeling techniques. It encompasses phases such as distribution analysis of repositories across continents, examination of repository counts across countries using GeoPandas and Matplotlib, optimization of Long short-term memory (LSTM) networks, application of Random Forest Regressor models, and time series analysis using Autoregressive Integrated Moving Average (ARIMA) models. The study reveals profound disparities in repository counts across continents, reflecting variations in research infrastructure. Visualizations vividly depict geographical patterns and disparities in repository distribution. Predictive modeling techniques offer insights into future trends in repository development, empowering decision-makers with strategic insights. While this study provides valuable insights, limitations exist, such as the scope limited to OpenDOAR repositories and the need for further refinement in predictive modeling techniques; future research should explore additional factors influencing repository development.

State Schooling Policies and Cognitive Performance Trajectories: A Natural Experiment in a National US Cohort of Black and White Adults.

Education is strongly associated with cognitive outcomes at older ages, yet the extent to which these associations reflect causal effects remains uncertain due to potential confounding. Leveraging changes in historical measures of state-level education policies as natural experiments, we estimated the effects of educational attainment on cognitive performance over 10 years in 20,248 non-Hispanic Black and non-Hispanic White participants, aged 45+ in the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort (2003-2020) by (1) using state- and year- specific compulsory schooling laws, school-term length, attendance rate, and student-teacher ratio policies to predict educational attainment for US Census microsample data from 1980 and 1990, and (2) applying policy-predicted years of education (PPYEd) to predict memory, verbal fluency, and a cognitive composite. We estimated overall and race- and sex-specific effects of PPYEd on level and change in each cognitive outcome using random intercept and slope models, adjusting for age, year of first cognitive assessment, and indicators for state of residence at age 6. Each year of PPYEd was associated with higher baseline cognition (0.11 standard deviation [SD] increase in composite measure for each year of PPYEd, 95% confidence interval [CI]: 0.07, 0.15). Subanalyses focusing on individual cognitive domains estimate the largest effects of PPYEd on memory. PPYEd was not associated with rate of change in cognitive scores. Estimates were similar across Black and White participants and across sex. Historical policies shaping educational attainment are associated with better later life memory, a major determinant of dementia risk.

Trends in Cerebrovascular Disease-related mortality among Older Adults in the United States from 1999 to 2020: an analysis of gender, race/ethnicity, and geographical disparities

One of the most prevalent causes of morbidity and death is cerebrovascular disease in the US. The manifestations and pathophysiology of cerebrovascular disease are significantly impacted by aging and determine the quality of one's late life. However, contemporary mortality trends in cerebrovascular disease and comparison to older adults of different gender, race, and geographic disparities have not been fully examined. A thorough comprehension of these correlations and current cerebrovascular disease death patterns can impact medical treatment and strategies. We examined the mortality trends according to gender, race, and geographical disparities in cerebrovascular disease among older adults, using mortality data (1999 - 2020) from the Centers for Disease Control and Prevention WONDER database METHODS: This research study aims to analyze disparities in cerebrovascular disease among senior citizens in the United States. The analysis has considered factors such as gender, race, and geographical variations over 21 years from 1999 to 2020. Mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database has been utilized for this retrospective cohort analysis, focusing on individuals aged 75 and above. From 1999 to 2020, there were 3,813,729 deaths related to Cerebrovascular disease in older adults, demonstrating a declining trend (AAPC=). Males (880.6) had slightly higher AAMRs than females (866.7). Non-Hispanic (NH) Black (1050) had higher AAMRs than NH whites (880.8) followed by NH American Indians (699.7), Hispanic (673.2), and NH Asians (669.3). AAMRs also varied by region with the Midwest (922) having the highest AAMRs followed by the South (918.2), West (884.3), and Northeast (744). Among states, Tennessee had the highest AAMRs (1076.3), whereas New York had the lowest (609.7). These results indicate a significant decline in cerebrovascular disease-related mortality among older adults from 1999 to 2020, highlighting improvements in healthcare and preventive measures over the two decades. Despite the overall decrease, elderly females had more deaths, elderly males had a higher AAMR, non-Hispanic blacks had the highest AAMR, and the Midwest and non-metropolitan areas had higher mortality burdens. The recent uptick in mortality rates from 2018 to 2020 underscores the need for ongoing public health efforts to address cerebrovascular diseases, particularly targeting vulnerable populations and high-risk regions.

Geographical disparities in fibromyalgia severity: An Italian study.

Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro-regions. This retrospective, cross-sectional study involved patients included in the Italian Fibromyalgia Registry. Three geographical macro-regions were identified, comprising patients from Northern Italy, Central Italy and Southern Italy. Clinical differences (evaluated through PolySymptomatic Distress Scale [PSD], revised Fibromyalgia Impact Questionnaire [FIQR] and modified Fibromyalgia Assessment Status [FASmod]) among the geographical macro-regions were studied using one-way analysis of variance (ANOVA) and the Scheffé's test. A total of 6095 patients (5719 females and 376 males) were included, with 1957 from Northern Italy, 2979 from Central Italy and 1159 from Southern Italy. All studied clinical indices showed a trend indicative of greater disease severity in Southern Italy, followed by Northern Italy and then Central Italy (mean values for PSD: 19.97 ± 6.20 in Northern Italy, 18.61 ± 7.12 in Central Italy, 23.01 ± 5.66 in Souther Italy). These differences were statistically significant for the overall scores of all studied indices, evaluated with ANOVA (all p < 0.001) and in the head to head comparisons, evaluted with Scheffé's test. Geographic background is significantly associated with variations in the severity of fibromyalgia in Italian patients. This is the first study to demonstrate geographical origin-dependent intra-national differences in the severity of fibromyalgia. The results confirm the necessity of considering fibromyalgia within the context of the biopsychosocial model and of implementing healthcare policies targeted towards the most underserved regions.

PRIME: A CyberGIS Platform for Resilience Inference Measurement and Enhancement

In an era of increased climatic disasters, there is an urgent need to develop reliable frameworks and tools for evaluating and improving community resilience to climatic hazards at multiple geographical and temporal scales. Defining and quantifying resilience in the social domain is relatively subjective due to the intricate interplay of socioeconomic factors with disaster resilience. To broaden upon it, the choice of indicators and their subsequent ranking for the aggregation into an index is subjective in nature. This aggregation is not empirically validated and is prone to omit the nuances of localized resilience changes and causal factors affecting it, while leading to oversimplified conclusions. Meanwhile, there is a lack of scientifically and computationally rigorous, user-friendly tools that can support customized resilience assessment with consideration of local conditions. This study addresses these gaps through the power of CyberGIS with three objectives: 1) To develop an empirically validated disaster resilience model - Customizable Resilience Inference Measurement (RIM), designed for multi-scale community resilience assessment and influential socioeconomic factors identification; 2) To implement a Platform for Resilience Inference Measurement and Enhancement (PRIME) module in the CyberGISX platform backed by high-performance computing, enabling users to apply and customize RIM to compute and visualize disaster resilience; 3) To demonstrate the utility of PRIME through a representative study to understand the geographical disparities of county-level community resilience to natural hazards in the United States and identifying the driving factors of resilience in the social domain. Customizable RIM generates vulnerability, adaptability, and overall resilience scores derived from empirical parameters—hazard threat, damage, and recovery. Computationally intensive Machine Learning (ML) methods are employed to explain the intricate relationships between these scores and socioeconomic driving factors. PRIME provides a web-based notebook interface guiding users to select study areas, configure parameters, calculate and geo-visualize resilience scores, and interpret socioeconomic factors shaping resilience capacities. A representative study showcases the efficiency of the platform while explaining how the visual results obtained may be interpreted. The essence of this work lies in its comprehensive architecture that encapsulates the requisite data, analytical and geo-visualization functions, and ML models for resilience assessment. This setup provides a foundation for assessing resilience and strategizing enhancement interventions.

Geographic inequality in funding by National Institutes of Health negatively impacts almost one-half of the states in the United States.

The National Institutes of Health (NIH) is the primary federal agency in the United States (US) that supports biomedical research, training, and clinical trials. NIH funding creates patents and jobs and thus helps the regional and national economy grow. Therefore, NIH funding would be expected to flow equitably to all 50 US states. However, there is a significant geographic disparity in the level of NIH funding received by various states. To that end, in 1993, authorized by Congress, NIH initiated a funding program called the Institutional Development Award (IDeA) to support states, called IDeA states, which received low levels of NIH funding. However, whether this approach has helped reduce the geographic disparity in NIH funding is unclear. In the current study, we analyzed data on various NIH funding mechanisms awarded to 23 IDeA states vs. 27 non-IDeA states, as identified by NIH. We compared these data to the population size, federal taxes paid, and the number of PhDs and Post-doctoral Fellows(PDFs) trained in IDeA vs. non-IDeA states. The non-IDeA states received 93.6% of the total NIH funding, whereas IDeA states received only 6.4%. On average, one Institutional Training Grant was received for every 24 PhDs trained in non-IDeA states, while IDeA states received one such grant for every 46 PhDs trained. The non-IDeA states comprised 84.3% of the US population, whereas IDeA states comprised 15.7%. Thus, on a per capita basis, non-IDeA states received $120 from NIH, whereas IDeA states received $45 per person. For every million dollars contributed by the non-IDeA states toward federal taxes, they received $7,903 in NIH funding, while the IDeA States received only $4,617. For FY 2022, the NIH funding created an economic activity of $90.6 Billion in non-IDeA states and only $6.3 billion in IDeA states. When total NIH funding to the states was analyzed for the years 1992, 2002, 2012, and 2022, IDeA states received 4.7% of the total NIH funding in 1992, which increased to 7.2% in 2002 but dropped to 6.8% in 2012 and 6.5% in 2022. This demonstrated that IDeA states' share of NIH funding remained relatively unchanged for the past 20 years. Eliminating the geographic disparity in NIH funding is crucial for achieving equitable health outcomes across the US, and for the IDeA states to successfully train future generations of physicians and scientists, as well as grow the regional economy. Although the NIH IDeA programs have helped enhance the research capacity in IDeA states, the funding currently constitutes less than 1% of the total NIH budget. Thus, it is critical to increase NIH funding to IDeA states to improve health outcomes for all Americans.

The Role of Complementary Feeding Practices in Addressing the Double Burden of Malnutrition among Children Aged 6-23 Months: Insight from the Vietnamese General Nutrition Survey 2020.

Background/Objectives: Optimal infant and young child feeding (IYCF) practices are crucial to addressing the double burden of malnutrition (DBM), encompassing undernutrition (including micronutrient deficiencies) and overnutrition. This study examined the demographic and socioeconomic determinants of IYCF practices, and their impacts on the DBM among 2039 Vietnamese children aged 6-23 months from the General Nutrition Survey 2020. Methods: Thirteen IYCF indicators recommended by the WHO/UNICEF were evaluated. Associations between IYCF indicators and outcome variables were assessed using logistic regressions. Results: The prevalence of stunting, underweight, and overweight subjects was 10.9%, 5.6%, and 3.1%, respectively. Low serum zinc affected 56.7% of children, while 14.3% had low serum retinol, 31.2% had anemia, and 34.6% had iron deficiency (ID). Only 36.7% of children achieved minimum dietary diversity (MDD), and 29.0% achieved the minimum acceptable diet (MAD). Children from the younger age group (6-11 months), ethnic minorities, those living in rural/mountainous regions, and poorer wealth quintiles had reduced odds of meeting IYCF criteria, including MDD and MAD. Infants meeting MDD had reduced odds of stunting [adjusted odds ratio (95% confidence intervals): 0.61 (0.41, 0.92)], and ID [0.69 (0.54, 0.88)]. Children meeting MAD had reduced odds of anemia [0.72 (0.57, 0.91)], ID [0.66 (0.52, 0.84)], and low serum retinol [0.63 (0.41, 0.99)]. Continued breastfeeding (12-23 months) reduced the odds of being underweight [0.50 (0.27, 0.92)] and of having low serum zinc [0.70 (0.52, 0.96)]. Adequate minimum milk feeding frequency had increased odds of being overweight [3.33 (1.01, 11.09)]. Conclusions: Suboptimal IYCF practices were significant predictors of the DBM among Vietnamese children, with evident age-specific, geographical, and socioeconomic disparities.

Global, regional, and national burden of retinoblastoma in infants and young children: findings from the global burden of disease study 1990–2021

Retinoblastoma is considered a lethal but curable malignancy often presenting in childhood. We investigated its global, regional, and national burden among infants and young children from 1990 to2021. We obtained data on retinoblastoma incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Trends were analysed using joinpoint regression to calculate annual percentage changes. Spearman's rank correlation and locally estimated scatterplot smoothing regression were used to assess the relationship between retinoblastoma burden and sociodemographic index. In 2021, the global incidence, prevalence, mortality, and DALYs of retinoblastoma were 0.82 (95% uncertainty interval [UI], 0.48-1.10), 7.46 (95% UI, 4.42-10.08), 0.37 (95% UI, 0.22-0.51), and 32.81 (95% UI, 19.9-45.21), respectively. From 1990 to 2021, the global incidence and prevalence rates of retinoblastoma increased, with average annual percentage changes (AAPCs) of 0.67 (95% confidence interval [CI], 0.49-0.85] and 0.68 (95% CI, 0.50-0.86), respectively. Conversely, those of related mortality and DALYs decreased, with AAPCs of-0.64 (95% CI,-0.79 to-0.49) and-0.63 (95% CI,-0.78 to-0.48), respectively. Children aged 2-4 years and those in low-income regions exhibited the highest burden. Negative correlations were found between sociodemographic index and retinoblastoma burden. Advancements in retinoblastoma detection and treatment have increased its reported incidence and prevalence while reducing its mortality and DALYs. Nonetheless, substantial socioeconomic and geographic disparities persist. In low-income countries, the incidence has decreased, possibly reflecting challenges such as limited healthcare access and underreporting, necessitating targeted interventions and improved healthcare access. National Key R&D Project of China (2020YFA0112701), Natural Science Foundation of Guangdong Province (2024A1515013058), and Science and Technology Program of Guangzhou, China (202206080005).

Evaluating Equity in Clinical Trial Accessibility: An Analysis of Demographic, Socioeconomic, and Educational Disparities in Irritable Bowel Syndrome Drug Trials.

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, imposes a significant economic burden because of its high prevalence and the chronic nature of its symptoms. IBS currently has 7 United States Food and Drug Administration-approved treatments. Despite efforts to improve diversity in randomized controlled trials' participation, significant disparities remain in various medical fields; yet, these have not been thoroughly examined within the context of IBS. We aimed to investigate the demographic, socioeconomic, educational, and geographic disparities in IBS drug trials. We conducted a systematic review of phase 3 randomized controlled trials on United States Food and Drug Administration-approved drugs for the treatment of IBS with constipation and IBS with diarrhea in the United States. Data on participant demographics and trial site locations were extracted and analyzed to identify disparities. Our analysis included 17 studies encompassing 21 trials with 17,428 participants. Approximately 77.3% of participants were female, with a mean age of 45.4 years. Race was reported in 95% of the trials, but only 35% disclosed ethnicity. White participants constituted the majority at 79.3%. Hispanics accounted for only 5.9%. Counties without trial sites had smaller average population sizes compared with trial and trial-adjacent counties. Socioeconomic indicators such as poverty rates, median household income, educational attainment, and broadband internet access were lower in counties without trial sites, with higher average Area Deprivation Index scores indicating greater deprivation. The findings highlight significant disparities in IBS trial participation across race, ethnicity, gender, and socioeconomic backgrounds. This raises potential concerns about generalizability of trial outcomes and underscores the need for strategies to enhance inclusivity in clinical research.

THE IMPACT OF LIBERALIZATION, PRIVATIZATION, AND GLOBALIZATION (LPG) ON INDIAN AGRICULTURE

The study examines the influence of Liberalization, Privatisation and Globalization (LPG) reforms on agricultural sector in India since their initiatives in 1991. The study explores evolving disputes and government measures in providing solution for the problem faced by the marginal and small-scale agriculturists. The research objective is to examine the influence of LPG on export of agricultural items, Technological innovations, Geographical disparities along with ecofriendly practices. The study examined the strengths such as enhancement in export of agricultural products and diversification of harvests, weaknesses are identified as geographical differentiation and reduction in public funding these aspects are analysed through SWOT analysis. Encouragement or opportunities on LPG reforms includes combination of technological innovations and ecofriendly procedures whereas, threats are identified as financial disparities among farmers and environmental depletion. This complete analysis offers a mixed view of varied influence of LPG on agriculture in India, Proposing the requirement for sustainable approach and higher inclusiveness for agriculture expansion. KEYWORDS: Liberalization, Privatization, Globalization, SWOT analysis, Indian agriculture, regional disparities, Environmental sustainability, Technological advancements, Government policies

Abstract B166: Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States

Abstract BACKGROUND: While overall colorectal cancer (CRC) rates have stabilized or declined in the United States (U.S.), early-onset CRC (EO-CRC), diagnoses before age 50, has increased. Rural U.S. residents face a higher CRC incidence (43.9 vs. 40.1 per 100,000) than urban residents. CRC mortality, once highest in the Northeast, is now most prevalent in the South and Midwest, particularly among Non-Hispanic Black populations. This geographic shift is also evident in EO-CRC. Existing literature lacks comprehensive analysis on the influence of rurality and age at CRC diagnosis. In this study, we sought to elucidate the relationships between age at diagnosis with CRC outcomes, while examining the moderating role of rurality. Methods: We used data from the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program. Rurality was defined using census tract level U.S. Department of Agriculture (USDA)’s 2010 Rural Urban Commuting Area (RUCA) codes: rural (codes 8, 9, 10) and urban (all other listed codes). We conducted multilevel regression modeling (logistic and Cox proportional hazards) to examine the associations between age at diagnosis, rurality, and CRC outcomes (late-stage diagnosis and survival), adjusting for race, marital status, sex, and year of diagnosis. Results: We identified 835,907 patients aged 20-79 from the 2006-2020 SEER program. Most patients lived in urban areas (86%), were non-Hispanic white (66%), and married (41%). After adjusting for marital status, race, sex, and diagnosis year, we found that patients aged 30-39 (aOR: 1.49, 95% CI: 1.44–1.55) and 40-49 (aOR: 1.43, 95% CI: 1.39–1.46) had over a 40% increased likelihood of late-stage CRC compared to patients aged 50-59. Urban patients aged 30-39 had a 52% higher likelihood of late-stage CRC (aOR: 1.52, 95% CI: 1.46–1.58). Patients aged 20-29 (aOR: 0.81, 95% CI: 0.77–0.86) had a reduced risk of CRC death compared to those aged 50-59. Conversely, patients aged 40-49 (aOR: 1.09, 95% CI: 1.07–1.11), 60-69 (aOR: 1.16, 95% CI: 1.14–1.17), and 70-79 (aOR: 1.39, 95% CI: 1.28–1.36) had increased risks of CRC death compared to patients aged 50-59. Rural patients aged 20-29 (aOR: 0.79, 95% CI: 0.68–0.94) and 30-39 (aOR: 0.95, 95% CI: 0.87–1.03) had a reduced risk of CRC death compared to rural patients aged 50-59. Conclusion: We observed that patients aged 30-49 were more likely to be diagnosed with late- stage CRC compared to those aged 50-59, particularly in urban areas. To reduce the burden of EO-CRC and prevent advanced-stage diagnoses in young adults, it is essential to enhance access to care and raise awareness of CRC symptoms among younger Americans. Future research should explore urban -rural barriers to healthcare access, including the role of healthcare infrastructure, transportation, and provider availability, to develop strategies for improving EO-CRC early detection and treatment outcomes. Citation Format: Meng-Han Tsai, Justin X. Moore, Caitlyn Grunert. Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States [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 B166.

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

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

Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening

Abstract Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with &amp;lt;10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations. Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [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 A135.

Trends in pre-biopsy MRI usage for prostate cancer detection, 2007-2022.

Clinical guidelines favor MRI before prostate biopsy due to proven benefits. However, adoption patterns across the US are unclear. This study used the Merative™ Marketscan® Commercial & Medicare Databases to analyze 872,829 prostate biopsies in 726,663 men from 2007-2022. Pre-biopsy pelvic MRI within 90 days was the primary outcome. Descriptive statistics and generalized estimating equations assessed changes over time, urban-rural differences, and state-level variation. Pre-biopsy MRI utilization increased significantly from 0.5% in 2007 to 35.5% in 2022, with faster adoption in urban areas (36.1% in 2022) versus rural areas (28.3% in 2022). Geographic disparities were notable, with higher utilization in California, New York, and Minnesota, and lower rates in the Southeast and Mountain West. The study reveals a paradigm shift in prostate cancer diagnostics towards MRI-guided approaches, influenced by evolving guidelines and clinical evidence. Disparities in access, particularly in rural areas and specific regions, highlight the need for targeted interventions to ensure equitable access to advanced diagnostic techniques.

Abstract C157: Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas

Abstract Background: Colorectal cancer (CRC) remains a significant public health concern in the United States, with substantial disparities observed in survival rates and age at diagnosis among different racial and ethnic groups. In Texas counties bordering Mexico, which have predominantly Hispanic populations, show higher CRC diagnoses. Hispanic patients generally exhibit lower screening rates, higher mortality, and late-stage diagnosis compared to non- Hispanic counterparts. Understanding the factors behind these disparities is crucial for developing targeted interventions to improve outcomes and reduce the burden of CRC. Methods: Using data from the Texas Cancer Registry, a retrospective study examined CRC survival rates and age at diagnosis among 235,076 patients of various racial and ethnic groups in Texas from 1995 to 2016. The association between Race and ethnicity and survival time over two periods (1995-2005 and 2006-2016) was analyzed using Kaplan-Meier survival analysis and pairwise comparisons. Additionally, the effects of Race and ethnicity on age at diagnosis were examined for the same periods using Welch ANOVA and posthoc comparisons. Results: Persistent survival disparities were observed, with Black patients facing the lowest median survival times across both periods (1995-2005 and 2006-2016). Hispanic patients showed significantly lower median survival rates compared to their non-Hispanic counterparts. Comparisons between races showed significant differences in median survival time between the two periods (1995-2005 and 2006-2016). Black: Hispanic patients showed no significant improvement in survival time between the periods. Significant improvements in survival time were observed in Black: non-Hispanic, White: Hispanic, and White: non-Hispanic patients. Lastly, the mean age at diagnosis depended on the ethnicity of the patient, with Hispanic patients displaying an earlier onset of CRC compared to non-Hispanic equivalents. Hispanic ethnicity was associated with an earlier onset of CRC compared to non-Hispanic counterparts. Conclusion: Geographic and ethnic disparities significantly influence CRC outcomes in Texas. Hispanic populations in border counties face increased risks due to lower screening and socioeconomic challenges. The rising incidence of early-onset CRC, particularly among younger, socioeconomically disadvantaged, and minority populations, necessitates targeted public health interventions to improve screening, early detection, and treatment access. Addressing these disparities is crucial to enhancing CRC survival rates and reducing mortality across diverse demographic groups. Citation Format: Tyler J Torres, Elias Arellano Villanueva, Yossef Alsabawi, Manish Tripathi. Unraveling Early Onset Disparities and Determinants: A Two-decade Analysis of Colorectal Cancer Trends in Texas [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 C157.

The geography of healthcare: Mapping patient flow and medical resource allocation in China

The misallocation of medical resources leads to interregional patient flow in search of better healthcare. Using out-of-pocket medical expenditure data and a delineating method, this paper identifies spatial clusters of medical services in China based on patient flow across cities. Our findings indicate that healthcare resources are more concentrated in northern China, while southern China is divided into several large healthcare clusters at the same threshold. The provincial capital and economically significant cities are more likely to serve as medical cluster centers. We further apply the gravity model to examine the effects of healthcare disparity on cross-city medical expenditure. The results reveal that geographic disparities in high-quality medical resources encourage remote healthcare-seeking behavior, and the shorter the distance between locations, the higher the level of medical consumption. Patients are inclined to seek medical services within their own province and within specific medical clusters identified through delineation methods. This effect is more pronounced among patients from non-central cities. This study highlights healthcare inequality by examining cross-regional medical expenditure, providing valuable insights for future healthcare policy.