Geographical Indicators Research Articles

Geographic and Socioeconomic Inequalities in Delays in COVID-19 Vaccinations: A Cross-Sectional Study in Indonesia.

Previous studies have provided evidence of inequalities in the coverage of COVID-19 vaccination. However, evidence of such inequalities in delays in vaccinations is lacking. Our study examined the socioeconomic and geographic disparities in terms of days to get the first and second dose of COVID-19 vaccinations in Indonesia. We conducted a cross-sectional study using the WhatsApp messaging app and social media platforms during December 2021-February 2022. We distributed the questionnaire through our university network to reach all regions. We included 3592 adults aged 15+ years in our analysis. We used two main dependent variables: days to receive the first dose (after national vaccine rollout) and days to receive the second dose (after receiving the first dose). We examined a range of socioeconomic and geographic indicators, including education level, income level, formal employment, working in health facilities, being a health worker, and region. We controlled for sex, age, religion, and urbanicity. We performed multivariate logistic regressions in STATA 15. Our findings show considerable delays in getting the first dose among participants (160.7 days or about 5.4 months on average) from Indonesia's national COVID-19 vaccination rollout on 13 January 2021. However, we found a shorter period to receive the second dose after receiving the first dose (41.1 days on average). Moreover, we found significant socioeconomic (i.e., education, income, formal employment, working in health facilities, and being a health worker) and geographic (i.e., in and out of the Java region) inequalities in terms of delays in getting the first dose. However, we did not find significant inequalities in getting the second dose for most inequality indicators, except for working in health facilities. By region, we found that participants living in more deprived areas (out of the Java region) received the second dose 4.9 days earlier. One of the study's key limitations is that there may be an inherent bias with respect to socioeconomics factors since it was conducted online (web-based). While there were considerable delays in getting the first dose, especially among those of a lower socioeconomic status and those in more deprived areas, the waiting time for the second dose was relatively similar for everyone once they were in the system. Effective efforts to address inequalities are essential to ensuring the effectiveness of the national COVID-19 vaccination rollout.

ANALYSIS OF RELIGIOUS TOURISM OBJECTS IN JOMBANG REGENCY USING COG METHOD

Jombang Regency is a religious tourism area where many national scholars are buried here so that Jombang becomes a tourist spot for tourists in various regions in Indonesia, with these objects tourists need a map to make it easier when visiting Jombang Regency. The purpose of this study was to analyze the distribution of thematic maps and to observe the supporting facilities for religious tourism infrastructure including (Tomb of KH. Abdur Rahman Wahid, tomb of KH. Bisri Syansuri, tomb of KH. Wahab Hasbullah, tomb of KH.Mustain Romlly and Tomb of Syayid Sulaiman) . This study uses digitized coordinates that produce a map of the distribution of religious tourism objects, for the application of a Geographic Information System (GIS) and questionnaires distributed to six religious tourism objects, using the Center Of Gravity (COG) method to determine the intended route. The results of the study obtained six coordinates of religious tourism objects and resulted in a distributed questionnaire declared valid and reliable with Cronbach's alpha value of 0.809 for the Geographic Information System indicator and 0.933 for the Center of Gravity indicator.

Leverage and Cook distance in regression with geostatistical data: methodology, simulation, and applications related to geographical information

Regression is often conducted assuming independent model errors. The detection of atypical values in regression (leverage and influential points) assumes independent errors. However, such independence could be unrealistic in geostatistics. In this article, we propose a methodology based on least squares and geostatistics to identify such values in spatial regression. Our procedure uses the hat matrix to detect leverage points. A modified Cook distance is employed to confirm whether these points are influential. The methodology is evaluated with stationary and non-stationary geostatistical data. We apply this methodology to real georeferenced data related to depth, dissolved oxygen, and temperature. First, an autoregressive model is fitted to depth data. Second, a regression between oxygen and temperature is estimated. In both models, spatial correlation is assumed to determine the parameters, leverage, and influential observations. Our methodology can be used in regression with geographical information to avoid misinterpreted results. Not considering this information may under- or over-estimate geographical indicators, such as the mean depth, which can affect the circulation of water masses or dissolved oxygen variability. Our results reveal that including spatial dependence to identify high leverage points is relevant and must be considered in any geostatistical analysis.

Spatial heterogeneity and socioeconomic transformation challenge the prevention of illegal wildlife consumption in China

Wildlife can be viewed as a renewable resource at ecologically viable levels, but illicit consumption is a major threat to global biodiversity. Using data from crime cases is an emerging new tool for assessing the motives and drivers of wildlife offenders. This approach can be used with behavior change frameworks to devise more effective conservation strategies. We used data from 20,145 online judgments published between 2014 and 2019 to determine the spatial distribution of different wildlife crime and illegal consumption patterns across China, and used multiscale modeling to test the effects of socioeconomic, geographic, and demographic correlates. The results indicated that geographic indicators and agricultural practices had a broad and positive impact on wildlife consumption, implying wildlife availability was a powerful incentive for wildlife crimes. In addition, urbanization and industrial structure were regionally sensitive in predicting convictions for wild meat, traditional medicine, and human-nature conflicts. Given the socioeconomic transformation in modern China, we predict that functional approaches of wildlife utilization will decrease in the coming years, but the illegal consumption characterized by financial and spiritual demand is unlikely to diminish. As a response, the prevention strategy should strengthen law enforcement on non-functional consumption and enhance nature education campaigns among youths across the country.

Estimation of missing building height in OpenStreetMap data: a French case study using GeoClimate 0.0.1

Abstract. Information describing the elements of urban landscapes is required as input data to study numerous physical processes (e.g., climate, noise, air pollution). However, the accessibility and quality of urban data is heterogeneous across the world. As an example, a major open-source geographical data project (OpenStreetMap) demonstrates incomplete data regarding key urban properties such as building height. The present study implements and evaluates a statistical approach that models the missing values of building height in OpenStreetMap. A random forest method is applied to estimate building height based on a building’s closest environment. A total of 62 geographical indicators are calculated with the GeoClimate tool and used as independent variables. A training dataset of 14 French communes is selected, and the reference building height is provided by the BDTopo IGN. An optimized random forest algorithm is proposed, and outputs are compared with an evaluation dataset. At building scale for all cities, at least 50 % of the buildings have their height estimated with an error of less than 4 m (the cities' median building heights range from 4.5 to 18 m). Two communes (Paris and Meudon) demonstrate building height results that deviate from the main trend due to their specific urban fabrics. Putting aside these two communes, when building height is averaged at a regular grid scale (100 m×100 m), the median absolute error is 1.6 m, and at least 75 % of the cells of any city have an error lower than 3.2 m. This level of magnitude is quite reasonable when compared to the accuracy of the reference data (at least 50 % of the buildings have a height uncertainty equal to 5 m). This work offers insights about the estimation of missing urban data using statistical methods and contributes to the use of open-source datasets based on open-source software. The software used to produce the data is freely available at https://doi.org/10.5281/zenodo.6372337 (Bocher et al., 2021b), and the dataset can be freely accessed at https://doi.org/10.5281/zenodo.6855063 (Bernard et al., 2021).

Evaluation of Heavy Metals in Soil Wastewater Stream.

Environmental pollution is one of the main factors that significantly affect biological systems and human health. Soil pollution with heavy metals is an increasingly pressing problem worldwide. In general, heavy metals are stable and do not decompose, unlike other organic pollutants. The quantity of them is natural components of soil crust, the remaining come from human activities, which may result from the extensive use of sewage. In the present study, a methodology aimed at simultaneous quantification of 16 heavy elements in soil of 3 different regions was developed. The concentration of 16 soil heavy metals (Se, Cd, V, Be, As, Mn, Co, Zn, Fe, Cr, Pb, Ni, Cu, Mo, Hg, and Ti) was measured in 11 sampling along Riyadh, Qassim, and Medina, Kingdom of Saudi Arabia from 3 sites soil treated with sewage water. These chemical minerals were identified in the samples using an ICPE-9000 spectrometer. The assessment of heavy metal contamination was derived using enrichment factors (EF), the pollution load index (PLI), and geoaccumulation index (Igeo). This study revealed that the soil is predominantly polluted by Cd, As, and Mo of Riyadh and Medina and As, Mo, and Cd of Qassim region at site B and site C, respectively. As recorded, the highest concentration value of 5000 mg/kg for Fe at site (B) followed by Cu. The Igeo value of Cd is 1.1520 in Medina region. The Igeo value of Se is 3.2395 in Medina region, while its cumulative geographical index decreased in the regions of Riyadh and Qassim, which amounted to 2.6114 and 2.1699, respectively. The Igeo values of the rest of the minerals in the three regions studied indicated that the soil is unpolluted, while it was slightly to moderately polluted for both Mo and Hg in most regions studied. The minerals in the soil at all sites studied were less than the general average concentration. With the exception of mercury, molybdenum, arsenic, cadmium, and selenium, whose concentration exceeded the permissible and recommended limits. The increasing order of concentration of minerals was Be < V < Cd < Hg < Mo < Co < Zn < Pb < Cr < Se < As < Ni < Ti < Mn < Cu < Fe at all sites, respectively.

The French Covid-19 vaccination policy did not solve vaccination inequities: a nationwide study on 64.5 million people

BackgroundTo encourage Covid-19 vaccination, France introduced during the Summer 2021 a ‘Sanitary Pass’, which morphed into a ‘Vaccine Pass’ in early 2022. While the sanitary pass led to an increase in Covid-19 vaccination rates, spatial heterogeneities in vaccination rates remained. To identify potential determinants of these heterogeneities and evaluate the French sanitary and vaccine passes’ efficacies in reducing them, we used a data-driven approach on exhaustive nationwide data, gathering 141 socio-economic, political and geographic indicators.MethodsWe considered the association between vaccination rates and each indicator at different time points: before the sanitary pass announcement (week 2021-W27), before the sanitary pass came into force (week 2021-W31) and 1 month after (week 2021-W35) and the equivalent dates for the vaccine pass (weeks 2021-W49, 2022-W03 and 2022-W07).ResultsThe indicators most associated with vaccination rates were the share of local income coming from unemployment benefits, overcrowded households rate, immigrants rate and vote for an ‘anti-establishment’ candidate at the 2017 Presidential election. These associations increase over time. Consequently, living in a district below the median of such indicator decreases the probability to be vaccinated by about 30% at the end of the studied period, and this probability gradually decreases by deciles of these indicators.ConclusionsOur analysis reveals that factors related to poverty, immigration and trust in the government are strong determinants of vaccination rate, and that vaccination inequities tended to increase after the introduction of the French sanitary and vaccination passes.

Assessment on the Spatial Distribution Suitability of Ethnic Minority Villages in Fujian Province Based on GeoDetector and AHP Method

Ethnic minority villages are important resources for the economy and social development of ethnic minority areas because they preserve ethnic minorities’ culture. With the rapid development of industrialization and urbanization in China, the factors affecting the development of villages have changed. With the help and guidance of the government, the gap between villages has increased. According to the development conditions of ethnic minority villages at the present stage, the suitability of their spatial distribution has been studied, the existing problems in the current development have been explored, and the development laws and future development trends have been found. To make the evaluation results more scientific and objective, Geographical Detector (Geodetector) and Absorbent Hygiene Product (AHP) methods are used to establish the evaluation model. Taking 567 ethnic minority villages in Fujian Province as the research object, 13 factors are selected from the aspects of natural geographical, socio-economy and cultural life to construct the evaluation indicator system of Fujian ethnic minority villages, and the spatial distribution suitability of Fujian ethnic minority villages is quantitatively evaluated. The findings indicated the following: (1) The per capita income of villages has the most important impact on the suitability of spatial distribution of Fujian minority villages. Through comprehensive evaluation, the impact of cultural life indicators on the suitability of the spatial distribution of the village is greater than that of socio-economic indicators and natural geographical indicators. The intensity relationship is 9:7:10. (2) The high suitability value is concentrated in Fujian Province’s southeast coastal and central areas, gradually decreasing from east to west. In Fujian Province, 82.84%of the land is suitable for the development of ethnic minority villages, with 89% of ethnic minority villages. The unsuitable areas are mostly in Fujian’s north and west. (3) The most suitable cities for the number of ethnic minority villages are Ningde City and Quanzhou City because ethnic minority villages in these two cities are mostly distributed in areas relatively close to the central urban area, with good economic conditions, flat terrain, and easy transportation. The cities of Nanping and Sanming are the least suitable for many ethnic minority villages, which are primarily limited by topographic conditions, have a backward economy, a sparse road network, and have experienced significant population loss. In the context of urbanization, the evaluation results can provide a reference for the precise development and protection of minority villages. Governments at all levels in Fujian Province can adjust and optimize the development strategies of minority villages according to the evaluation results.

Livelihood vulnerability of smallholder farmers to climate change: A comparative analysis based on irrigation access in South Sulawesi, Indonesia

Bulukumba Regency is one of the major rice-producing areas in South Sulawesi, Indonesia and has experienced frequent climate disasters over the past decade. Several downstream villages within the Bettu River irrigation area have been affected by the drought, culminating in reduced lowland rice production and increasing the vulnerability of farmers’ livelihoods. This study aims to evaluate the vulnerability of the livelihood system among rice farmers in the Bettu River irrigation area by classifying the area into two zones based on the distance from the main irrigation canal, namely the upstream area and downstream area. The livelihood vulnerability index (LVI) framework and livelihood vulnerability index-Intergovernmental Panel on Climate Change (LVI-IPCC) approach were applied by selecting geographic and socio-demographic indicators that affected the farmer households, including 8 major components and 26 sup-components. The data for LVI-IPCC estimation were collected by randomly selecting 132 households from villages in the two areas. The empirical results showed that farmers in the downstream area were more vulnerable to climate change than farmers in the upstream area. The major components causing the livelihood vulnerability of the downstream farmers were livelihood strategy, food, water, land, health, as well as natural disasters and climate variability. In particular, the sub-components of agricultural livelihood diversification, consistent water supply for farming, and drought events were important in the downstream area. Farmers in the upstream area were vulnerable to socio-demographic profile and social network components. The LVI-IPCC findings suggested that the government should prioritize farmers in the downstream area to develop resilience strategies, particularly by increasing irrigation infrastructure and the number of reservoirs and drilling holes. Furthermore, to increase their adaptive capacity in terms of diversification of agricultural livelihood systems, the government and donor agencies need to provide trainings on the development of home food industries for poor farmers and vulnerable households that were affected by disasters.

Characterization of soil salinization and its driving factors in a typical irrigation area of Northwest China.

Salinization of irrigation areas is a global environmental challenge. The uncertainty in the distribution of salinization is increased by the complexity of the natural environment. This study adopted Yinchuan Plain as a typical irrigation area to study the relationship between soil salinity and the environment from the perspective of macro-environmental elements and micro-ion composition. A Geographic Weighted Regression model (GWR) was used to predict the risk of salinization in the Yinchuan Plain. The results showed obvious spatial variation in soil salinization in the Yinchuan Plain. Farmland accounted for the largest proportion of salinized land area, followed by woodland and "other" land use categories. The main characteristic ions in the salinized area of the Yinchuan Plain were SO42-, K++Na+and Cl-. The rank of ions in terms of change rate with increasing soil salinity was: SO42- > K+ + Na+ > Cl- > Ca2+ > HCO3- > Mg2+ > CO32-. However, the rank of ions in terms of their sensitivity to salinization was: HCO3- > Ca2+ > Mg2+ > SO42- > Cl- > K+ + Na+. On this basis, the geographical indicators of DEM and NDVI, groundwater indicators of groundwater depth and TDS, climate indicators of SPEI, as well as soil indicators of PH and organic matter were taken as the representative ecological drivers of salinization in irrigation areas. These environmental factors were found to control the distribution of salinization, whereas human activity affected the degree of change in salinization. The enrichment of SO42- in the Yinchuan Plain was mainly related to agricultural activities (such as pesticides application and irrigation evaporation), and followed by phreatic evaporation. The salt ions carried by irrigation and rainfall further polluted phreatic water. In the end, the measures of optimizing drainage, combined irrigation, and improving planting layout were recommended for the effectively and economically controlling of salinization.

HPV Vaccination Coverage Rate in a Rural Area: An Observational, Retrospective, and Cohort Study.

In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organization (WHO) declared the Global Strategy Goal for 2030, advocating for reaching a vaccination coverage rate of >90% against human papillomavirus for girls by the age of 15 years. The main objectives of this study were (1) to determine the papillomavirus vaccination coverage among women 15–40 years old and (2) to identify the at-risk subgroups and possible barriers to achieving WHO’s 2030 goal. Multicentre, observational, retrospective, and community-based cohort studies were conducted on women from a rural area in southern Catalonia until 31 December 2021. A total of 23,136 women were included, with a mean age of 26.6 (SD = 5.6) years. The average dose number was 1.7 (SD = 0.7). The results showed overall vaccination coverage of 17.4% among the target women. This coverage was unequal across regions (16.6–24.5%, p < 0.001), primary healthcare teams (15.5–24.3%, p < 0.001), and age groups (56.7% (15–19-year-olds) vs. 3.8% (35–40-year-olds), p < 0.001), related to accessibility to vaccination and economic–geographical indicators. Clinical practice guidelines on screening individuals at risk in terms of vaccination access and public vaccination protocols should be implemented in order to improve the vaccination coverage rate.

A Study on the Online Attention of Emergency Events of Torrential Rain in Shanxi and Henan

To analyze the differences in the spatial and temporal distribution patterns of online attention to sudden torrential rain public events in Shanxi and Henan provinces in China, and their influencing factors, the Baidu index search platform was used to obtain the online attention of 31 provinces (autonomous regions and municipalities directly under the central government) nationwide for the 20 July 2021 to 9 August 2021 Henan torrential rain and the 5 October 2021 to 25 October 2021 Shanxi torrential rain. The geographical concentration index, the coefficient of variation, the Moran index, and the Pearson correlation were used to analyse the spatial and temporal distribution characteristics of the online attention of the floods in Shanxi and Henan and their influencing factors. The study shows that: (1) from a temporal perspective, the daily internet attention of both the Shanxi and Henan torrential rain reached its highest value on the third day, showing a sharp rise followed by a sharp fall in an inverted “V” pattern, and compared to the prolonged and continuous torrential rain in Shanxi, the short-lived precipitation and broken ring of the Henan torrential rain were seriously urgent, showing a higher internet attention. For example, the highest daily attention in Shanxi was only 73,643, while the highest daily attention in Henan was 56,054, which is 7.6 times higher than the former. The Geographical Concentration (G) index of internet attention for torrential rain in Shanxi increased from 1.55 to 8.25 within three weeks, with attention shifting from scattered to concentrated, while the G-index for torrential rain in Henan showed an inverted “V” shape; the Coefficient of Variation (CV) index for torrential rain in both provinces showed a downward trend within three weeks. (2) In terms of spatial distribution, the regional distribution of the network concern about the torrential rain in Shanxi and Henan is uneven. The provinces and cities with a higher concern about the torrential rain in Shanxi are mainly some eastern provinces and cities, such as Jiangsu, Beijing, Zhejiang, Fujian, Hainan, etc., who have signed coal protection agreements with Shanxi. The provinces and cities with a higher concern about the torrential rain in Henan are mainly the economically developed coastal provinces or provinces adjacent to Henan, such as Beijing, Zhejiang, Shandong, and Shaanxi, etc. The concern of each city for the torrential rain in the two provinces is in line with the law of distance decay. (3) In terms of influencing factors, the level of regional economic development, demographic factors, and Internet penetration and distance all have a certain influence on the level of attention to sudden torrential rain, and the study found that the level of economic development and demographic factors have the most significant influence on the level of internet attention.

Spatiotemporal Variations of Extreme Precipitation in Wuling Mountain Area (China) and Their Connection to Potential Driving Factors

Changes in extreme precipitation have become a significant issue of regional disaster risk assessment and water resources management. Extreme precipitation variability is affected by multiple factors and shows disparities across different regions. Especially in mountain areas, geographic feature and local characteristics put more complexity and uncertainty on the changes of precipitation extremes. In this study, ten extreme precipitation indices of Wuling Mountain Area (WMA) during 1960–2019 have been used to analyzed the spatiotemporal variations of precipitation extremes. The relationships between extreme precipitation and potential driving factors, including geographic factors, global warming, local temperature, and climate indices, were investigated via correlation analysis. The results indicated that extreme precipitation tends to have a shorter duration and stronger intensity in WMA. Decreasing trends in R10mm, R20mm, R25mm, and the consecutive wet days (CWD) series account for 92%, 68%, 52%, and 96% of stations, while most stations in WMA have rising trends in Rx1day (68%), SDII (64%), R95p (72%), and R99p (72%). Significant abrupt changes in extreme precipitation indices mainly occurred in the 1980s–1990s. Geographic factors, local temperature, and climate indices exert different impacts on extreme precipitation. Longitude and elevation instead of latitude significantly affect extreme precipitation indices except for the maximum duration of wet spells. Global warming is likely to increase the intensity and decrease the duration of extreme precipitation, while the influence of local temperature is not exactly the same as that of global warming. The study reveals that summer monsoon indices are the dominant climate factor for variations of precipitation extremes in WMA. The correlation coefficient between extreme precipitation indices (such as Rx1day, R95p, R99p) and the East Asian summer monsoon index is around 0.5 and passed the significant test at the 0.01 level. The weakening of the summer monsoon indices tends to bring extreme precipitation with stronger intensity. The findings provide more understanding of the drivers and reasons of extreme precipitation changes in the mountain area.

New Economic Policy in Documents of the Russian State Archive of the Economy

A fundamental collection of documents has been prepared and published to mark the centenary of the beginning of new economic policy in Soviet Russia. The wide coverage shows processes taking place in the country during the mentioned period, which are reflected in the compromise nature of economic activities in such spheres as taxation of the village, grain procurement and agricultural co-operation, trust and syndication of nationalized industry, use of private capital for its restoration, private mediation between state bodies, development of stock-exchange and fair trade, the role of private trade in wholesale and retail trade, etc. The collection has been prepared on the basis of the documents and materials held in the Russian State Archive of the Economy. The materials for the collection were compiled by archivists who had studied and selected over 12,000 documents. The publication introduces little known and previously unpublished documents, showing the process of change in the economic life of the Soviet state in the difficult conditions of postwar devastation. It is the first time the whole picture of the Soviet economic life in agriculture, industry and trade is presented in a documentary form. The edition includes reference aids, including historical and archeographic preface, notes, name index and geographical index. It is intended for researchers, economists and all those interested in the political and economic history of Soviet Russia of the 1920s.

Data privacy protection in scientific publications: process implementation at a pharmaceutical company

BackgroundSharing anonymized/de-identified clinical trial data and publishing research outcomes in scientific journals, or presenting them at conferences, is key to data-driven scientific exchange. However, when data from scientific publications are linked to other publicly available personal information, the risk of reidentification of trial participants increases, raising privacy concerns. Therefore, we defined a set of criteria allowing us to determine and minimize the risk of data reidentification. We also implemented a review process at Takeda for clinical publications prior to submission for publication in journals or presentation at medical conferences.Methodss, manuscripts, posters, and oral presentations containing study participant information were reviewed and the potential impact on study participant privacy was assessed. Our focus was on direct (participant ID, initials) and indirect identifiers, such as sex, age or geographical indicators in rare disease studies or studies with small sample size treatment groups. Risk minimization was sought using a generalized presentation of identifier-relevant information and decision-making on data sharing for further research. Additional risk identification was performed based on study participant/personnel parameters present in materials destined for the public domain. The potential for participant/personnel identification was then calculated to facilitate presentation of meaningful but de-identified information.ResultsThe potential for reidentification was calculated using a risk ratio of the exposed versus available individuals, with a value above the threshold of 0.09 deemed an unacceptable level of reidentification risk. We found that in 13% of Takeda clinical trial publications reviewed, either individuals could potentially be reidentified (despite the use of anonymized data sets) or inappropriate data sharing plans could pose a data privacy risk to study participants. In 1/110 abstracts, 58/275 manuscripts, 5/87 posters and 3/58 presentations, changes were necessary due to data privacy concerns/rules. Despite the implementation of risk-minimization measures prior to release, direct and indirect identifiers were found in 11% and 34% of the analysed documents, respectively.ConclusionsRisk minimization using de-identification of clinical trial data presented in scientific publications and controlled data sharing conditions improved privacy protection for study participants. Our results also suggest that additional safeguards should be implemented to ensure that higher data privacy standards are met.

Market determinants of commercial prices for intravenous chemotherapy infusions.

1585 Background: Recent price transparency legislation mandated that hospitals across the country report their individually negotiated prices with insurers. Using this data, we sought to characterize the prices paid for standard intravenous (IV) chemotherapy infusions, and determine the hospital, regional, and market factors associated with higher prices. Methods: We utilized a database of U.S. hospital-reported price transparency data to characterize prices for the most commonly billed chemotherapy drug administration Common Procedural Terminology (CPT) codes— 96413 (initial IV chemotherapy infusion) and 96415 (additional hour of IV chemotherapy). We obtained standard charges and commercial prices negotiated with private payers from hospitals that directly administer chemotherapy. To assess variation in prices, we calculated the ratio of the 90th percentile price to the 10th percentile price among private payers in each hospital and among hospitals in each Hospital Referral Region (HRR). We performed multivariable linear regressions to assess hospital, regional, and market factors associated with higher prices. Results: A total of 1,458 hospitals reported at least one price for CPT code 96413 or 96415. Hospitals reported 1 chargemaster and a median of 18 (IQR: 8–35) commercial prices negotiated with different private payers. National median commercial prices for CPT codes 96413 and 96415 were $536.00 (IQR: $326.43-$784.63) and $175.06 (IQR: $98.28-$327.25), respectively. Within each hospital, the 90th percentile commercial price was 2.2 times higher, on average, than the 10th percentile price for CPT code 96413, and 2.8 times higher for 96415. Among different hospitals within each HRR, the median commercial price at the 90th percentile hospital was 1.5 times higher than at the 10th percentile for CPT code 96413, and 2.3 times higher for 96415. On multivariable analysis, higher prices for CPT code 96413 were observed at for-profit hospitals ($215.12 higher than government not-for-profit hospitals, 95% CI: $55.22-$429.61). Higher prices for CPT code 96415 were observed at hospitals with higher predicted practice costs ($35.79 for every 1% increase in the geographical practice cost index, 95% CI: $16.69-$54.87), and a lower disproportionate share percentage ($0.96 for every 1% decrease in DSH patient percentage, 95% CI: $0.08-$19.41). Conclusions: Commercial prices for commonly billed IV chemotherapy infusions demonstrate significant variability. Prices for identical infusions vary by a factor of 2 depending on which hospital or private payer a patient selects. While prices for CPT code 96415 are largely explained by the relative cost of care, prices for the more expensive 96413 appear to be driven by the profit-status of the hospital. Further study is required to characterize the implications of such high levels of price variability on access to care and overall healthcare costs.

COVID-19 susceptibility mapping: a case study for Marinduque Island, Philippines

Small islands are highly susceptible to infectious disease outbreak and other health emergencies because of their remoteness, small physical size, and poorly developed infrastructure. These are true in the case of Marinduque, an island province around 200 km south of the National Capital Region (NCR), which is the “epidemiological epicenter” of the COVID-19 pandemic in the Philippines. This study utilized GIS and Principal Component Analysis (PCA) using demographic, socio-economic, and geographic indicators to map susceptibility of different villages in the island province of Marinduque, the Philippines. Based on the results, the northwestern and northeastern portion of Marinduque has a higher susceptibility score. Also, villages in the town centers have relatively high susceptibility scores compared to other villages in each municipality.

Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria

Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan–Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan–Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360; 95% CI 1.133–1.631), primary education (HR: 1.279; 95% CI 1.056–1.550) and secondary education (HR: 1.204; 95% CI 1.020–1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers’ age ≤ 19 at first birth (HR: 1.144; 95% CI 1.041–1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634; 95% CI 1.238–2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.

Were the socio-economic determinants of municipalities relevant to the increment of COVID-19 related deaths in Brazil in 2020?

The COVID-19 pandemic in Brazil has been showing a pattern of distribution of related deaths associated with individual socioeconomic status (SES). However, little is known about the role of SES in the distribution of the mortality rate in different population, from an ecological perspective. The objective of this study was to evaluate the role of socioeconomic factors in the distribution of the COVID-19-related mortality rate among Brazilian municipalities in 2020. We conducted a retrospective, cross-sectional, observational, population-wide, and ecological study, using data of COVID-19-related deaths from the Influenza Epidemiological Surveillance Information System database (SIVEP-Gripe) and SES from the Social Vulnerability Index (SVI), the Human Development Index (HDI), the Geographic Index of the Socioeconomic Context and Social Studies (GeoSES), and 2010 Demographic Census (IBGE/Brazil). We computed crude, age- and sex-standardized, and the latter offset by the time of exposure to the epidemic mortality rates. To determine socioeconomic factors associated with mortality rates we used log-linear models with state codes as a random effect and Haversine variance-covariance matrix. 191,528 deaths were related to COVID-19 and distributed in 4,928 (88.55%) Brazilian municipalities. Whatever the socioeconomic indexes used, the R2 were very small to explain SMRT. Consistent across all socioeconomic indexes used, high-income, more educated, and well infrastructure municipalities generally had higher mortality rates. Excluding the effect of demographic structure and pandemic timing from mortality rates, the contribution of SES to explain differences in COVID-19-related mortality rates among municipalities in Brazil became very low. The impact of SES on COVID-19-related mortality may vary across levels of aggregation. Urban infrastructure, which includes mobility structures, more complex economic activities and connections, may have influenced the average municipal death rate.

Prevalence and associated factors of double and triple burden of malnutrition among child-mother pairs in Ethiopia: Spatial and survey regression analysis

BackgroundEvidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn’t assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia.MethodsA total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM.ResultsThe overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38–2.24) and 1.2% (95%CI: 0.83–1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24–35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6–12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM.ConclusionThere is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.