Geographic Disparities Research Articles

Mortality trends and racial disparities in hepatocellular carcinoma associated with metabolic syndrome in the United States and Texas: A 21-year analysis (1999-2020) using CDC WONDER database.

525 Background: The prevalence of hepatocellular carcinoma(HCC) and metabolic syndrome (MetS) is increasing globally. This study aims to examine annual trends of mortality in MetS-associated HCC in the United States and its state of Texas, from 1999 to 2020, to evaluate public health initiatives and identify socioeconomic factors. Methods: Mortality trends for adults aged ≥25 years with MetS-associated HCC were analyzed using CDC WONDER database, identifying deaths through ICD-10 codes C22.9 “Liver Malignant neoplasms” and E88.9 “Metabolic Syndrome”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, with 95% confidence intervals, were determined across various demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2020, 271,046 documented deaths were attributed to HCC due to metabolic syndrome. The AAMR for MetS-related HCC mortality increased in the US from an adjusted rate (AR) (3.7) in 1999 to (4.5) in 2009 (APC:2.10%; 95% CI: -0.13% to 3.10%), after which it increased to (7.6) in 2018 (APC:5.83%; 95% CI:4.25% to 6.99%) and increased to 9.9 in 2020 (APC:13.19%; 95% CI:8.78% to 15.7%). In Texas, AAMR for MetS-related HCC mortality increased from AR (4.9) in 1999 to (8.9) in 2015 (APC:3.95%; 95% CI:3.11% to 4.69%) after which it increased to (15.3) in 2020 (APC:10.64%; 95% CI:8.18% to 17.33%). Men had consistently higher AAMRs than women (12.4 vs. 8). The AAMR in U.S. men increased from (5.1) in 1999 to (12.4) in 2020. The AAMR in U.S. women increased from (2.7) in 1999 to (8) in 2020. The non-Hispanic (NH) American Indian or Alaska Native population has the greatest AAMR (13.4), followed by the NH Black or African American(AA) (12.7) and the Hispanic or Latino population with AAMR (10.9). The low-risk population was NH White with AAMR (9.6) and NH Asian or Pacific Islander (6.6). The AAMR also varied by region (South:11.5; Midwest:9.9; West:9.4; Northeast:7.4) and non-metropolitan areas had higher AAMR (small metro:12.1; non-core areas:11; micropolitan areas:11.7) than metropolitan areas (large central metropolitan: 8.8; large fringe areas: 8.7). The states in the upper 90th percentile of MetS-related HCC AAMRs were Texas, Louisiana, Arkansas, Michigan, Nevada exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile Nebraska, Wisconsin, Washington, Maine. Conclusions: Mortality rates from hepatocellular carcinoma associated with metabolic syndrome have risen in the United States and Texas over the past two decades. However, significant demographic and geographic disparities in MetS-related HCC mortality continue, emphasizing the need for further investigation and the development of targeted treatment strategies.

Survival feature and trend of female breast cancer: A comprehensive review of survival analysis from cancer registration data.

To better understand global patterns, chronological changes, and international comparisons of female breast cancer survival, we reviewed published data from population-based cancer registries worldwide. Using PubMed, Embase, Web of Science, SEER, and SinoMed, a comprehensive literature search was conducted for female breast cancer survival from the population-based cancer registries through 31 December 2023. Observed, relative, and net survival rates and their corresponding age-standardized survival rates since the 1990s were collected and further stratified by prognostic factors. The prognosis of female breast cancer patients was favorable, with 5-year relative survival rates above 80% in most regions. The trend in breast cancer survival showed annual increases in most countries but was accompanied by geographical disparities. The highest age-standardized 5-year relative survival rate was identified in the USA (2010-2014) at 90.2%, while the lowest was in India (2010-2014) at 66.1%. Overall, North America and Oceania had the best survival, and, for Europe, survival was worst in Eastern Europe. The survival in some Asian countries was disturbing. Younger age groups had a better prognosis than those aged 75 years and over. The lowest survival rates were observed in patients with distant metastatic and triple-negative breast cancer. Worldwide, there has been a steady improvement in female breast cancer survival. However, the survival gap between developed and developing countries has remained wide over the past 30 years. Differences in age, stage at diagnosis, and molecular subtype may explain some of the disparities, providing evidence for targeted management strategies.

Understanding factors contributing to vaccination underutilization among Jewish ultra-orthodox communities in Israel: A cross-sectional study.

This study aims to investigate the factors contributing to the underutilization of childhood and school-age immunizations among parents within the Jewish Ultra-Orthodox community in Israel. It identifies socio-demographic, attitudinal, and belief-related risk factors that affect vaccination decisions. A cross-sectional study was conducted involving 369 Jewish Orthodox parents in Israel, using structured questionnaires distributed through various community channels. Data on socio-demographic variables, vaccination status, and intentions were collected. Attitudinal assessments included the VAX Scale and the Multidimensional Health Locus of Control Scale. The proportion of fully vaccinated children was 46.3% for childhood diseases and 64.2% for school-age vaccinations. Flu vaccination rates were significantly lower, with only 19.2% of parents and 15.2% of children receiving flu shots. Key factors contributing to vaccine underutilization include large family size, lower socioeconomic and educational levels, reliance on the internet for health information, and the absence of media technology at home. Geographical disparities were notable, especially in the Jerusalem District, which demonstrated lower vaccination uptake, and among different Orthodox streams, with the Modern stream showing higher vaccination rates compared to the Lithuanian, Sephardic, and Hasidic streams. The VAX scale and Health-Related Locus of Control measures revealed that attitudinal factors significantly impacted vaccination decisions, such as mistrust in vaccine benefits, preference for natural immunity, and reliance on religious beliefs. To address vaccination disparities, targeted interventions should consider cultural and logistical barriers, engaging community leaders and offering culturally sensitive education to improve uptake within the Jewish ultra-Orthodox community.

Survival disparities in small intestine carcinoid tumors: A SEER-based analysis.

653 Background: Small intestine carcinoid tumors (SI-carcinoids) are rare neuroendocrine neoplasms with variable survival outcomes. This study examines the impact of age, sex, race, income, and geographic location on overall survival (OS) in patients with SI-carcinoid tumors. Methods: A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) registry 22 to identify patients aged 20 and above with SI-carcinoid tumors from 2000 to 2021. Kaplan-Meier survival analysis and log-rank tests were used to assess differences in survival. Cox proportional hazards models estimated hazard ratios (HR) for Overall Survival (OS). Results: 20,777 patients were included, with 7,029 deaths recorded. Median OS varied significantly by age, sex, race, income, and tumor site. Patients aged 60-85 had a median OS of 10 months (95% CI: 9.75-10.42), while those over 85 had 2.92 months (95% CI: 2.67-3.33). Females had better OS (13.92 months; 95% CI: 13.42-14.42) than males (12.83 months; 95% CI: 12.42-13.25). Non-Hispanic Black patients had worse OS (12.33 months; 95% CI: 11.50-13.33) compared to Non-Hispanic Whites (13.25 months; 95% CI: 12.92-13.67). Patients earning less than $50,000 had worse OS (11.42 months; 95% CI: 10.67-12.42) than those earning $100,000–$120,000 (15.42 months; 95% CI: 14.25-17.83). Geographic disparities were noted, with nonmetropolitan areas showing worse OS (11.42 months; 95% CI: 10.83-12.92) compared to large metropolitan areas (14.00 months; 95% CI: 13.50-14.42). Cox models confirmed age (HR for 85+ years: 21.99; 95% CI: 17.40-27.81), male sex (HR: 1.12; 95% CI: 1.07-1.17), and Black race (HR: 1.29; 95% CI: 1.18-1.42) were linked to worse OS. Tumor site also affected OS, with ileal tumors showing better survival compared to duodenal tumors (HR: 0.89; 95% CI: 0.84-0.94). Conclusions: Age, sex, race, income, and geographic location significantly affect OS in patients with small intestine carcinoid tumors, highlighting the need for tailored interventions for vulnerable groups.

WCN25-3569 Global Geographic and Socio-Economic Disparities in COVID-Associated Acute Kidney Injury: A Systematic Review and Meta-analysis

WCN25-3569 Global Geographic and Socio-Economic Disparities in COVID-Associated Acute Kidney Injury: A Systematic Review and Meta-analysis

Global, regional, and national burden of male breast cancer in 204 countries and territories: a systematic analysis from the global burden of disease study, 1990-2021.

Male breast cancer (MBC) is a rare malignancy that has been under-investigated, with limited global epidemiological research dedicated to it. A comprehensive estimate of the global, regional, and national burden of MBC is valuable for policy planning. This study aims to evaluate the burden of MBC across 204 countries and territories. MBC data were collected from the 2021 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates spanning from 1990 to 2021. The global incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) attributed to MBC, as well as corresponding age-standardized rates, were calculated. Temporal trends, projections of incidence and mortality to 2050, lifetime risk, and risk factors of MBC were also estimated according to regions and countries. In 2021, there were 38,827 (95% uncertainty interval [UI], 24,650-47,846) new cases, 320,459 (95% UI, 220,533-384,317) prevalent cases, 13,274 (95% UI, 9074-16,240) deaths, and 380,917 (95% UI, 252,922-476,417) DALYs attributed to MBC worldwide, with the highest disease burden observed in the Eastern Sub-Saharan Africa region. From 1990 to 2021, the age-standardized incidence and mortality rates of MBC significantly increased, but they are projected to decrease over the next 30 years. High-middle Socio-demographic Index (SDI) quintile had the highest lifetime risk of developing MBC, while the low SDI quintile had the highest lifetime risk of dying from MBC. Dietary risk and alcohol use were identified as important risk factors for MBC deaths and DALYs globally. The global burden of MBC significantly increased from 1990 to 2021, with notable geographic disparities. Efforts aimed at MBC prevention and control strategies should take into account the inequities in its global distribution. This study was supported by the National Natural Science Foundation of China (grant numbers 82372996 and 82202913) and the Chongqing Natural Science Foundation (grant number CSTB2023NSCQ-MSX0480).

Racial, biological sex, and geographic disparities of venous thromboembolism in the United States, 2016 to 2019

Racial, biological sex, and geographic disparities of venous thromboembolism in the United States, 2016 to 2019

The case for value-based care in kidney transplantation: insights into geography, growth, and financial models.

Kidney transplantation (KT) is the preferred treatment for end-stage renal disease (ESRD), yet systemic challenges, including geographic disparities, impede equitable access. This review evaluates transplant center activity and regional disparities using recent trends and discusses the potential of value-based care (VBC) models like the proposed Increasing Organ Transplant Access (IOTA) model to address these challenges. Analysis of Organ Procurement and Transplantation Network (OPTN) data from 2021 to 2023 identified 185 of 322 transplant centers as potentially eligible for VBC inclusion. High ESRD prevalence states like Texas, California, and New York have the largest number of centers, while states like Wyoming and Vermont lack operational centers, creating access barriers. Growth in KT rates following the 2014 Kidney Allocation System (KAS) reforms has stabilized at 3-5% since 2023. Geographic disparities persist, with regions like the South Atlantic and Pacific showing high transplant activity but unmet demand relative to ESRD prevalence. The proposed IOTA model could mitigate disparities by incentivizing infrastructure investment and prioritizing equitable access. Tailored VBC strategies are essential to addressing regional needs and improving KT equity and outcomes nationwide.

Assessing the Equitable Renewable Energy Access and Environmental Justice for Sustainable Development in China

ABSTRACTThe pursuit of sustainable development in China necessitates a comprehensive evaluation of renewable energy access and environmental justice. As China experiences rapid economic growth and shifts towards cleaner energy sources, it is crucial to examine the fairness of renewable energy distribution and the equitable allocation of environmental benefits and burdens. This study explores the complexities involved in balancing renewable energy, social equity, and environmental factors. A twofold methodological approach was employed such as the fuzzy analytic hierarchy process (AHP) was first used to systematically assess the equity of renewable energy distribution, identifying six key factors and 24 sub‐factors that influence renewable energy access and environmental justice. The results from fuzzy AHP show that the distribution of environmental burdens and socio‐economic equity are the most critical factors shaping renewable energy access and environmental justice. To further refine strategic insights, the fuzzy complex proportional assessment (COPRAS) method was applied, ranking six strategic approaches for advancing renewable energy access and environmental justice. The top‐ranked strategy was expanding renewable energy infrastructure in underserved regions which emerged as the most impactful, emphasising the importance of addressing geographic disparities. Following closely were strategies aimed at strengthening financial mechanisms for low‐income households and promoting community‐led renewable energy projects, emphasising the importance of economic support and local empowerment in achieving energy justice.

Trends and Insights in Financial Inclusion and Mobile Money: A Decade of Bibliometric Analysis (2014–2023)

This study conducts a comprehensive bibliometric analysis to explore research trends in financial inclusion and mobile money over the last decade (2014–2023), using data from the Scopus database. Analyzing 439 publications, this study identifies key trends, influential authors, and leading countries in the field. The analysis, supported by tools such as VOS Viewer, reveals dominant themes such as “financial inclusion,” “mobile money,” and “financial system,” with a particular focus on technological advancements and their regional impacts, especially in developing countries. The findings highlight the growing academic interest in mobile money’s role in promoting economic development and poverty alleviation. Moreover, this study underscores the significant geographical disparities in research output, with developed economies producing the most research. Insights from this analysis provide guidance for policymakers and researchers to support future financial inclusion initiatives. The study concludes by recommending further exploration of under-researched regions and the qualitative impact of mobile money on socio-economic outcomes.

Absolute risk prediction for esophageal squamous cell carcinoma adaptable to regional disease burden across diverse regions.

Esophageal squamous cell carcinoma (ESCC) exhibits a long latency period and has a significant geographical disparity in incidence, which underscores the need for models predicting the long-term absolute risk adaptable to regional disease burden. 31,883 participants in a large-scale population-based screening trial (Hua County, China) were enrolled to develop the model. Severe dysplasia and above (SDA) identified at screening or follow-up were defined as the outcome. We calculated the absolute risk in three steps: 1) constructing a relative risk model using logistic regression, 2) calculating the age-specific baseline hazard, and 3) adjusting for the competing risk of all-cause death excluding ESCC. Flexible incidence rate parameters were integrated into the model to ensure its relevance across diverse regions worldwide. A total of 295 SDAs were detected. The relative risk model consisted of old age, male gender, irregular meal pattern, preference for hot or hard food, BMI of less than 22 kg/m2, and ESCC family history. The area under the receiver operating characteristic curve was 0.753 (95% CI: 0.749-0.757). The averaged 5-year and 10-year absolute risk were 0.53% and 1.30% among participants. Based on our model, we developed an online calculator incorporated flexible incidence rate parameters, demonstrating ideal risk stratification tailored to regions with varying disease burdens (https://pkugenetics.shinyapps.io/escc_risk_prediction/). We developed an absolute risk model to predict individualized long-term risk of ESCC, accounting for local disease burden. This model has the potential to mitigate the global burden of ESCC by enabling targeted screening and personalized prevention strategies.

Time until operation for elective endovascular aortic aneurysm repair in Canadian Vascular Centers using the Canadian Vascular Quality Initiative Registry.

Optimal timing for intervention for abdominal aortic aneurysms remains unclear. Given the increased rupture risk with larger aneurysms, timely intervention is critical. This study sought to examine endovascular aortic aneurysm repairs (EVAR) delays across Canadian centers, focusing on potential differences related to geography, sex and race. The Vascular Quality Initiative (VQI) dataset was obtained for all patients who underwent elective EVAR for asymptomatic AAAs between January 11th, 2016 and October 30th, 2020 in 6 participating Canadian vascular centers. Delay was defined as the time between the date of preoperative imaging and the operative date. Univariate and multivariable analysis were performed to evaluate predictors of long delay. A total of 659 patients were included in the analysis. Geographic disparities were significant, with patients in Quebec more likely to experience delays exceeding 8 weeks compared to Ontario (OR = 4.5, 95% CI: 2.8-7.1, p < 0.001). Patients with shorter delays (≤ 8 weeks) were more likely to have an unrestricted functional status (88.0% vs. 81.9% for delay > 8 weeks, p = 0.030) and larger aneurysms (83.1% vs. 67.0% for delay > 8 weeks, p < 0.001). Perioperative and postoperative complications were similar across both groups. Our study reveals significant disparities in the timing of elective EVAR cross Canadian centers, likely due to multifactorial causes. These findings highlight the need for targeted strategies to reduce delays and ensure equitable access to timely care. Future efforts should focus on improving healthcare system preparedness and addressing regional and demographic disparities.

Geographic and Demographic Disparity in Firearm Injury: A 33-Year Retrospective Cohort Analysis of Florida Communities.

Firearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use. The open-access FLHealthCHARTS was searched for firearm injuries from 1989-2022. Intentional firearm injury rates (IFIR) and unintentional firearm injury rates (UFIR) were collected as the number of injuries per 100,000 citizens, race and ethnicity. They were then stratified by severity of injury across county-level characteristic categories such as ruralness, Distressed Communities Index (DCI), and Concealed Carry Weapons (CCW) permit rates. Of 123,484 firearm injuries reported, 109,745 were intentional and 13,739 unintentional. Since the late 1990s intentional firearm related deaths and hospitalizations have increased over time, with higher rates in socioeconomically at-risk and larger counties. Unintentional non-fatal hospitalizations have increased exponentially, with higher rates in distressed counties, but no effects of county size or ruralness. Unintentional deaths declined over time, with no significant county-level effects. Based on heatmap patterns, white citizens appear to be victims of more intentional firearm injuries in rural areas, while Black citizens were victims of more intentional firearm injuries in urban areas. The rate of CCW permit holders did not correlate to changes in UFIR or IFIR but patterns can be identified on a county-by-county basis. These results suggest that deaths remain a problem in all Florida county communities while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level one trauma hospitals to implement tailored education for high risk surrounding communities.

DOP106 Geographic disparities in Healthcare Utilisation in people with inflammatory bowel disease, Crohn’s Colitis Cure Data Insights Program

Abstract Background Inflammatory bowel disease (IBD) is a lifelong illness, increasing in prevalence, with Australia (AUS) and New Zealand (NZ) amongst the highest in the world. Long-term management poses significant economic burden on people with IBD and the healthcare system. We aim to describe the healthcare utilisation (HCU) across 18 sites using Crohn’s Colitis Care (CCCare) as their IBD electronic management record (EMR). Methods CCCare is a cloud based EMR used in Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September 2024 to examine HCU over a 12-month period (September 2023 to 2024). People under active care, with a clinical assessment during the last 14 months were included. Descriptive statistics and a negative binomial regression model were used to examine for possible relationships amongst disease and demographic characteristics. Results There were 7506 eligible people, with a median age of 42 years (IQR 31 – 56). There was an even gender distribution (49.0%, n=3679, male) and more than half had Crohn’s disease (CD) (55.8%, n=4187), 41.4% (n=3107) ulcerative colitis (UC), and 2.8% (n=212) IBD-Unclassified. The median disease duration was 10.7 years (IQR 5.1 – 19.2). Most resided in AUS (73.1%, n=5487) and 26.9% (n=2019) in NZ. The majority of people resided in a metropolitan area (75.2%, n=4973), with 26.9% (n=1643) in non-metropolitan areas. Patient demographics are presented in table 1. Ambulatory HCU is presented in table 1. Over the past 12 months, there were 10,705 helpline contacts (1.4 pp) and 11,439 (1.5 pp) clinical assessments either in-person or via telehealth. There were notably fewer endoscopic (0.2 pp) and radiology (0.3 pp) events. People with UC received endoscopies at a higher rate, but radiological events at a lower rate than those with CD (both p&amp;lt;0.001). Helpline contacts were also less frequent from people with UC compared to those with CD (p&amp;lt;0.01). Those residing in NZ consistently show lower HCU than in AUS in all HCU measures (p&amp;lt;0.01). Residing in non-metropolitan area is associated with lower use rate of radiology (p&amp;lt;0.05) and clinical assessments (p&amp;lt;0.01), but higher rates of helpline contacts compared to those in metropolitan areas (p&amp;lt;0.001). Conclusion The disparity in HCU suggests unwarranted variation in care or disparities in resource allocation creating inequities in health outcomes and access to care. The significant difference in HCU between countries and regions requires further correlation with healthcare outcomes. Identifying the most cost-effective approach to care that also improves patient outcomes will ultimately optimise health outcomes and advance value-based healthcare models for IBD management.

Spatiotemporal dynamics and prevention strategies of cervical cancer incidence in Addis Ababa, Ethiopia: an ecological study

ObjectiveThis study analysed the spatial and temporal patterns of cervical cancer incidence in Addis Ababa from 2012 to 2021.DesignAn ecological study was conducted from 1 September to 30 November 2023...

Prediction of tissue and clinical thrombectomy outcome in acute ischaemic stroke using deep learning.

The advent of endovascular thrombectomy has significantly improved outcomes for stroke patients with intracranial large vessel occlusion, yet individual benefits can vary widely. As demand for thrombectomy rises and geographic disparities in stroke care access persist, there is a growing need for predictive models that quantify individual benefits. However, current imaging methods for estimating outcomes may not fully capture the dynamic nature of cerebral ischemia and lack a patient-specific assessment of thrombectomy benefits. Our study introduces a deep learning approach to predict individual responses to thrombectomy in acute ischemic stroke patients. The proposed models provide predictions for both tissue and clinical outcomes under two scenarios: one assuming successful reperfusion and another assuming unsuccessful reperfusion. The resulting simulations of penumbral salvage and difference in NIHSS at discharge quantify the potential individual benefits of the intervention. Our models were developed on an extensive dataset from routine stroke care, which included 405 ischemic stroke patients who underwent thrombectomy. We used acute data for training (n = 304), including multimodal CT imaging and clinical characteristics, along with post hoc markers like thrombectomy success, final infarct localization, and NIHSS at discharge. We benchmarked our tissue outcome predictions under the observed reperfusion scenario against a thresholding-based clinical method and a generalised linear model. Our deep-learning model showed significant superiority, with a mean Dice score of 0.48 on internal (n = 50) and 0.52 on external (n = 51) test data, versus 0.26/0.36 and 0.34/0.35 for the baselines, respectively. The NIHSS sum score prediction achieved median absolute errors of 1.5 NIHSS points on the internal test dataset and 3.0 NIHSS points on the external test dataset, outperforming other machine learning models. By predicting the patient-specific response to thrombectomy for both tissue and clinical outcomes, our approach offers an innovative biomarker that captures the dynamics of cerebral ischemia. We believe this method holds significant potential to enhance personalised therapeutic strategies and to facilitate efficient resource allocation in acute stroke care.

Trends and disparities in the surgical management of spinal fractures in Sweden during 2008–2023

BackgroundSpinal fractures are a group of complex injuries whose management varies according to a number of factors. The aim of this study was to analyze trends in the management of spinal fracture surgery in Sweden from 2008 to 2023 with a focus on disparities based on gender, surgery method, age and geographical location. A secondary aim was to predict future incidence of spinal fracture surgeries.MethodsComprehensive open source data was obtained from the Swedish National Board of Health and Welfare. The data was stratified based on gender, surgery method, age and geographical location per year and analyzed for trends. Future trends were projected using regression modeling. The student’s T-test was used to compare means.ResultsThe incidence of spinal fracture surgery decreased overall from 2008 to 2023 while maintaining an increased incidence for males compared to females. The highest incidence for osteosynthesis was 2.7 per 100 000 inhabitants in 2008 and 1 in 2023. This trend is projected to be reversed in 2030. Several surgery methods have decreased in usage and are projected to reach close to 0 in 2030. The patient group that underwent spinal fracture surgery had a higher mean age in 2023 compared to 2008. The incidence of spinal fracture surgery varied significantly across Sweden where region Östergötland performed 6.3 surgeries per 100 000 inhabitants and region Örebro performed 1.4.ConclusionsWe found several trends where males may undergo spinal fractures surgery more commonly than females. Probable influencing factors may be increased life-spans and osteoporosis. This may also explain the observed shift towards older age groups in spinal fracture surgery. The decreased use of several surgery methods may reflect changes in operational techniques, demographics, and more standardized care. Geographical disparities may indicate different local health care protocols and uneven healthcare utilization and access.Trial registrationNot applicable.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

Non-physician practitioners, including nurse practitioners and physician assistants, increasingly practice in emergency departments, especially in rural areas, where they help mitigate physician shortages. However, little is known about non-physician practitioner durability and demographic trends in emergency departments. Our objective was to examine attrition rates and ages among non-physician practitioners in emergency medicine. We conducted a repeated cross-sectional analysis using the Medicare Data on Provider Practice and Specialty and Medicare Provider Utilization and Payment Data. The study included non-physician practitioners providing at least 25 independent evaluation and management services annually for Medicare beneficiaries between 2014 and 2021. Attrition rates, defined as the absence of emergency medicine clinical services in subsequent years, were stratified by gender, clinician type, and practice urbanicity. The emergency medicine non-physician practitioner workforce grew from 14,559 to 17,679 between 2014 and 2021. Women non-physician practitioners comprised 64.6% of the workforce, and rural non-physician practitioners accounted for 15.7%. Across study years, the weighted annual attrition rate was 13.8%, rising from 12.1% in 2014 to 17.6% in 2019. Attrition rates were higher among physician assistants as well as women and rural non-physician practitioners, with median ages at attrition of 40.2 years for women and 45.9 years for men, and 38.6 years for urban non-physician practitioners versus 43.6 years for rural non-physician practitioners. The rate of non-physician practitioner attrition from the emergency medicine workforce is considerably higher and occurs at younger ages than prior work evaluating emergency physician attrition, with similar identified gender and geographic disparities. Targeted retention strategies are needed to support a more durable emergency medicine workforce and reduce disparities.

Virtual Mental Health Counselling

What Is the Issue? The rate of mental illnesses, such as major depressive disorder and generalized anxiety disorder, has significantly increased among people aged 15 and older living in Canada. In Canada, more than 1 in 3f those with mental illnesses do not receive adequate mental health (MH) services, with notable geographic disparities in the availability and quality of services. Specialized MH services remain particularly scarce in remote and rural areas. Providing MH counselling through virtual platforms has the potential to enhance the accessibility of MH services and reduce the stigma associated with in-person services. A review of the clinical effectiveness and evidence-based guidelines is required to help understand the potential role of virtual MH counselling in clinical practice. What Did We Do? To inform decisions regarding the use of virtual MH counselling for people with depression, anxiety, obsessive-compulsive disorder (OCD) or posttraumatic stress disorder (PTSD), we conducted a rapid review and summarized evidence that compared the clinical effectiveness of MH counselling provided in a virtual setting versus in person. We also sought to identify evidence-based guidelines regarding the use of virtual MH counselling for these populations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2019. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found 6 systematic reviews (SRs) relevant to the present review that evaluated the clinical effectiveness of MH counselling provided through virtual versus in-person settings. Most SRs and their included randomized controlled trials (RCTs) reported results on the reduction of depression and anxiety, followed by PTSD and OCD. For depression, PTSD and specific anxiety outcomes (generalized anxiety disorder, social anxiety disorder, and panic disorder), the effectiveness of virtual MH counselling in improving these outcomes was comparable to in-person settings. For OCD, results were inconsistent, suggesting virtual MH counselling can be an alternative treatment where in-person MH counselling is not readily available. We found 5 evidence-based guidelines that provide recommendations on the use of virtual MH counselling for adults with depression, anxiety, and PTSD, based mostly on low-quality evidence or expert opinion. We did not find any evidence-based guidelines or relevant recommendations regarding the use of virtual MH counselling for people of any age with OCD nor children and youth with depression, anxiety, and PTSD. Virtual MH counselling is recommended as a first-line intervention for adults with mild depression and for reducing symptoms of anxiety in older adults. Virtual MH counselling is recommended as second-line adjunctive or alternative intervention for adults with moderate-severe depression, certain anxiety disorders, and PTSD. What Does This Mean? Virtual MH counselling may improve clinical outcomes for people with depression, anxiety, OCD, or PTSD and can be used as a comparable or alternative treatment to in-person MH counselling. Virtual MH counselling may address equity issues regarding access to evidence-based MH services where in-person MH counselling is not readily available. Clinicians and health care decision-makers can use the evidence summarized in this review to inform decisions regarding the implementation of virtual MH counselling for adults with depression, anxiety, OCD, or PTSD.

Geographical Disparities in Cardiac Rehabilitation Usage by Race and Dual-Eligibility.

Geographical Disparities in Cardiac Rehabilitation Usage by Race and Dual-Eligibility.