Geographic Variation Research Articles

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Retinopathy of Prematurity in Neonatal Intensive Care Unit at King Fahd University Hospital, Eastern Province: Prevalence, Risk Factors, and pattern of severity Seven years’ experience.

Background Premature newborns are susceptible to retinopathy of prematurity (ROP), a vasoproliferative disease of the developing retinal vessels, which is a major cause of potentially avoidable blindness. Due to geographical variations in newborn care, geographic variations in the epidemiology of ROP have been observed internationally during the last several decades. There was a correlation between the severity of the condition and the number of prenatal, postnatal, and other risk factors. This study aimed to examine the incidence and risk factors associated with retinopathy of prematurity in preterm infants. Methods A retrospective review of preterm newborns evaluated for retinopathy of prematurity between January 2016 and December 2022 was carried out at King Fahd Hospital of the University (KFHU), Khobar, Saudi Arabia. Infants who fulfilled the screening criteria (GA < 34 or Birth Weight (WT) ≤ 1500 g) underwent the screening test, and the International Classification of Retinopathy of Prematurity was used to classify retinopathy of prematurity. Risk factors and demographic information regarding ROP were assessed. Statistical analysis was performed using SPSS (version 20) with a 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results Among the 200 preterm neonates that were evaluated and admitted to neonatal critical care units, 37% exhibited premature retinopathy, with 46.7% of those cases being in stage 1. The development of ROP was linked to gestational age, length of mechanical ventilation, septicemia, intraventricular hemorrhage, bronchopulmonary dysplasia, respiratory distress syndrome, and septicemia, according to univariate and multivariate logistic regression analyses. Conclusion The incidence of total retinopathy in premature infants in this population was 37%. Evaluating these risk factors during the screening of high-risk premature infants will help determine the appropriate timing of examinations and treatment.

Geographical and temporal variations in the provision of registered older people long-term care home places in Wales

Deep-seated problems facing the residential and nursing care home sector have been compounded by the impacts of the pandemic, underfunding and the cost-of-living crisis. This study aims to investigate how patterns of access to registered residential and nursing care places changed in the period spanning lockdowns and demonstrate how spatial analytical techniques can be used to examine the potential impacts of ongoing pressures on geographical patterns of access. Findings identify variations in access to provision hidden within aggregate figures that can help stakeholders monitor the current and projected availability of places as part of an overall package of care provision.

Aetiology of vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa: A systematic review and meta-regression.

Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. CRD42022348045.

Combining species distribution models and big datasets may provide finer assessments of snakebite impacts.

Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country.

SOLAR AND WIND LEADS THE CHARGE: ANALYZING INDIA'S DYNAMIC GROWTH IN RENEWABLE ENERGY CAPACITY FROM 2016 TO 2023

With a focus on significant advancements in solar, wind, and hydropower capacity, this report offers a thorough analysis of the growth trajectory of India's renewable energy industry from 2016 to 2023. The analysis highlights the exponential increase in solar installations, especially in regions like Rajasthan, which will account for over half of the nation's renewable energy mix by 2023. Solar energy emerged as the dominating force in this regard. Even if solar energy was rising faster, wind energy continued to expand steadily, highlighting its crucial place in the renewable portfolio. The report also explores the hydropower industry, highlighting the minor differences in growth patterns between small- and large-scale projects. The study's thorough data analysis shows a significant increase in the production of renewable energy, particularly in 2023, demonstrating the industry's strong reaction to India's challenging clean energy targets. The study of solar capacity at the state level reveals notable regional differences that may be ascribed to policy, geographic, and infrastructure variations. These findings indicate potential areas for focused policy interventions. The results support a multifaceted strategy for developing renewable energy, highlighting the significance of balanced growth from many sources. To maintain the sector's pace, recommendations include improving legislative frameworks, making infrastructural investments, and encouraging innovation. To support strategic choices and propel India's transition to a sustainable energy future, this research offers insightful information to stakeholders, investors, and policymakers.

Crop Recommendation System Using Machine Learning Algorithm

This study aims to develop an intelligent agricultural yield recommendation framework leveraging the capabilities of AI algorithms. The proposed framework takes yield efficiency and optimal growing seasons as crucial factors in generating appropriate crop recommendations. We have put forth four widely used models, namely Linear Regression (LR) and Multi-Layer Perceptron (MLP), which were trained and evaluated on a comprehensive dataset comprising historical agricultural data encompassing various features such as climatic factors, soil properties, and geographical variables. Furthermore, the data was segmented based on seasonal patterns to provide crop suggestions tailored to specific time periods. The performance of these models was assessed using standard metrics, and an ensemble approach was considered to enhance the system's robustness. Ultimately, the developed framework offers farmers and agricultural professionals a valuable tool for making informed decisions, optimizing crop selection, and enhancing overall agricultural productivity.

The Impact of School Desegregation on White Individuals’ Racial Attitudes and Politics in Adulthood

Abstract In this paper I study how school desegregation by race following Brown v. Board of Education affected White individuals’ racial attitudes and politics in adulthood. I use geocoded nationwide data from the General Social Survey and difference-in-differences to identify causal impacts. Integration significantly reduced White individuals’ political conservatism as adults in the U.S. South but not elsewhere. I observe similar effect heterogeneity for attitudes towards Black individuals and policies promoting racial equity, but (positive) impacts and geographic variation are smaller in magnitude relative to those observed for conservatism. Investigations into mechanisms suggest that this heterogeneity may depend on the effectiveness of integration policies. In the south, White–Black exposure was greater following desegregation, and White disenrollment was lower. Finally, I demonstrate that results are robust to concerns of bias resulting from potential non-random in- and out-mobility of individuals into integrating contexts. My study provides the first causal evidence on how theories concerning intergroup contact and racial attitudes (i.e., the contact hypothesis) may have applied to school contexts following historical court mandates to desegregate.

Spatial variation of zero fruits/vegetables consumption and associated factors among children aged 6–23 months in Ethiopia: geographical weighted regression analysis

BackgroundAfter 6 months, nutrient-dense, varied diets containing fruits and vegetables are crucial to supplement breastfeeding. Like many other low-income countries, Ethiopia has very low FV consumption. Zero vegetable or fruit (ZVF) consumption has been shown to significantly raise the risk of non-communicable diseases and has been ranked among the top 10 risk factors for mortality. And it is associated with poor health, an increased risk of obesity, and a higher risk of non-communicable diseases. Thus, this study’s goal was to investigate the spatial distribution of ZVF consumption and its spatial determinants among children aged 6–23 months in Ethiopia.MethodsA cross-sectional study design was employed. A total of 1,489 weighted samples were included from kids’ datasets from the 2019 Ethiopian mini-demographic and health survey. STATA version 16, ArcGIS version 10.8, Kuldorff’s SaTScan version 9.6, and MGWR version 2.0 software were used for analysis. Spatial regression analyses (geographical weighted regression and ordinary least squares analysis) were conducted. Models were compared using AICc and adjusted R2. A p-value of less than 0.05 was used to declare statistically significant spatial predictors, and the corresponding local coefficients were mapped.ResultsThe spatial distribution of ZVF consumption among children aged 6–23 months was non-random in Ethiopia. Spatial scan analysis revealed a total of 120 significant clusters. Maternal education, wealth status, age of the child, place of delivery, number of under-five children in the house, and current pregnancy status were significant predictors of the spatial variation of ZVF consumption.ConclusionSignificant geographic variation in ZVF consumption was found in this study throughout Ethiopia’s regions. Significant predictors of the spatial variation in ZVF consumption were maternal education, wealth status, child age, place of delivery, number of under-five children in the home, and status as a pregnant woman at the time of birth. Therefore, in order to improve children’s adequate consumption of fruit and vegetables, area-based interventions that can consider these significant factors into account are needed.

Impact of Environmental Conditions on Predicting Condition Rating of Concrete Bridge Decks

Highway agencies prioritize maintaining bridge infrastructure through bridge management systems amid budget constraints. The premature deterioration of reinforced concrete (RC) bridge decks caused by more frequent and increasingly heavy truck load spectra coupled with aggressive environmental conditions has become a critical concern. Despite the prevalence of conventional models and the emerging popularity of machine learning (ML) models in bridge deterioration predictions, they fall short in feature selection and handling of climate conditions, leading to suboptimal accuracy. To address these gaps, this study presents a data-driven framework utilizing ML-based techniques to predict the condition rating of RC bridge decks with a focus on identifying the influencing factors that affect the deck condition. The framework employs the XGBoost algorithm for model development, encompassing comprehensive datasets that include structural, geographical, and climate variables from across the U.S. Furthermore, the Shapley additive explanations approach is applied to identify the explanatory variables with the most impact. Age emerged as the most crucial factor, followed by freeze-thaw cycles and truck traffic, as indicated by the average daily truck traffic. Rainfall also plays a substantial role in deck deterioration. Based on feature importance and monotonicity, this study recommends a series of bridge classifications for transportation agencies to incorporate into their deterioration models. Overall, this research enhances understanding of the primary causes of bridge deck deterioration, enabling more informed decisions about funding allocation and bolstering bridge performance against environmental challenges.

Landscape drives zoonotic malaria prevalence in non-human primates.

Zoonotic disease dynamics in wildlife hosts are rarely quantified at macroecological scales due to the lack of systematic surveys. Non-human primates (NHPs) host Plasmodium knowlesi, a zoonotic malaria of public health concern and the main barrier to malaria elimination in Southeast Asia. Understanding of regional P. knowlesi infection dynamics in wildlife is limited. Here, we systematically assemble reports of NHP P. knowlesi and investigate geographic determinants of prevalence in reservoir species. Meta-analysis of 6322 NHPs from 148 sites reveals that prevalence is heterogeneous across Southeast Asia, with low overall prevalence and high estimates for Malaysian Borneo. We find that regions exhibiting higher prevalence in NHPs overlap with human infection hotspots. In wildlife and humans, parasite transmission is linked to land conversion and fragmentation. By assembling remote sensing data and fitting statistical models to prevalence at multiple spatial scales, we identify novel relationships between P. knowlesi in NHPs and forest fragmentation. This suggests that higher prevalence may be contingent on habitat complexity, which would begin to explain observed geographic variation in parasite burden. These findings address critical gaps in understanding regional P. knowlesi epidemiology and indicate that prevalence in simian reservoirs may be a key spatial driver of human spillover risk.

Landscape drives zoonotic malaria prevalence in non-human primates

Zoonotic disease dynamics in wildlife hosts are rarely quantified at macroecological scales due to the lack of systematic surveys. Non-human primates (NHPs) host Plasmodium knowlesi, a zoonotic malaria of public health concern and the main barrier to malaria elimination in Southeast Asia. Understanding of regional P. knowlesi infection dynamics in wildlife is limited. Here, we systematically assemble reports of NHP P. knowlesi and investigate geographic determinants of prevalence in reservoir species. Meta-analysis of 6322 NHPs from 148 sites reveals that prevalence is heterogeneous across Southeast Asia, with low overall prevalence and high estimates for Malaysian Borneo. We find that regions exhibiting higher prevalence in NHPs overlap with human infection hotspots. In wildlife and humans, parasite transmission is linked to land conversion and fragmentation. By assembling remote sensing data and fitting statistical models to prevalence at multiple spatial scales, we identify novel relationships between P. knowlesi in NHPs and forest fragmentation. This suggests that higher prevalence may be contingent on habitat complexity, which would begin to explain observed geographic variation in parasite burden. These findings address critical gaps in understanding regional P. knowlesi epidemiology and indicate that prevalence in simian reservoirs may be a key spatial driver of human spillover risk.

Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar

It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing emergency, near famine-like conditions (IPC4). Although Madagascar is generally considered among the most undernourished of countries, empirical data in the form of biological samples to validate these claims are extremely limited. Our research drew data from three studies conducted between 2013–2020 and provided comprehensive biomarker profile information for 4,710 individuals from 30 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for both sexes and across all ages, with 66.5% of the population estimated to be deficient in zinc, 15.6% depleted in vitamin B12 (3.6% deficient), 11.6% deficient in retinol, and lower levels of iron deficiency (as indicated by 11.7% deficient in ferritin and 2.3% deficient assessed by soluble transferrin receptors). Beyond nutrient status biomarkers, nearly one quarter of the population (24.0%) exhibited chronic inflammation based on high values of α-1-acid glycoprotein, and 12.3% exhibited acute inflammation based on high values of C-reactive protein. There is an 8-fold difference between the lowest and highest regional observed prevalence of vitamin B12 deficiency, a 10-fold difference in vitamin A deficiency (based on retinol), and a 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on ferritin), highlighting strong geographical variations in micronutrient deficiencies across Madagascar.

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

Role of environmental factors in the genetic structure of a highly mobile seabird

AbstractAimEnvironmental features can act as selection pressures and barriers to gene flow between populations. The genetic structuring of highly mobile but philopatric seabirds creates a paradox, and the role of oceanographic and geographic variables is still poorly understood. In this study, we investigate the influence of environmental and geographic variables in the genetic and phenotypic diversity of a pantropical seabird breeding in islands and archipelagos separated by different geographic distances, up to thousand kilometres, and which differ in environmental characteristics.LocationIslands and archipelagos in the southwestern (SW) Atlantic Ocean.TaxonSula dactylatra, Lesson, 1831 (masked booby).MethodsThe population structure of the species was accessed through mitochondrial and nuclear DNA. To test Isolation by Environment (IBE) versus by Distance (IBD), sea surface temperature, primary productivity and salinity, as well as isotopic niche based on carbon and nitrogen, and distances between colonies and from the continent, were used. We also tested the correlation between the genetic structure and the morphometry of individuals in each colony.ResultsWe uncover the presence of low genetic structure between populations. Nevertheless, differences were identified between inshore and offshore colonies, with the influence of landscape characteristics of these two types of environment. The morphometric and isotopic niche variations are consistent with this segregation.Main ConclusionsEnvironmental variables of coastal and oceanic environments seem to influence the genetic structure of masked boobies, even though it is low in the SW Atlantic Ocean, highlighting the role of environmental heterogeneity in shaping biodiversity.

Comparative analysis of bacterial diversity in accumulated snow and exposed sediments across Antarctic Islands.

The Antarctic continent hosts exceptional niches, making it an ideal environment for studying polyextremophilic microorganisms. These organisms are uniquely shaped by the geographic niches and variations in soil types. Here we present, a culture-independent approach using DNA metabarcoding to assess the bacterial communities associated with accumulated snow and exposed sediments across different Antarctic islands situated in the Larsemann Hills, Antarctica. The exposed sediments (ES) were found to be more diverse than the accumulated snow (AS) sediments as represented by the alpha diversity metrics. Out of the total 303 amplicon sequence variants (ASVs) found at the genus level, 93 were unique to accumulated snow sediments and 97 were unique to exposed sediments. The bacterial community composition in accumulated snow was dominated by the phylum Actinobacteriota (24.7%). However, Pseudonocardia (11.9%), Crossiella (11%), and Rhodanobacter (9.1%) were the predominant genera. In contrast, in the exposed sediments, Bacteroidota (24.6%) was the most prevalent phylum, with Crossiella (17.1%), Rhodanobacter (11.1%), and Blastocatella (10%) as the most abundant genera. Metagenomic imputations revealed the abundance of gene families responsible for carbon metabolism, coping with environmental stresses through DNA repair mechanisms, and carbon fixation.

Global variation in ecoregion flammability thresholds

Anthropogenic climate change is altering the state of worldwide fire regimes, including by increasing the number of days per year when vegetation is dry enough to burn. Indices representing the percent moisture content of dead fine fuels as derived from meteorological data have been used to assess geographic patterns and temporal trends in vegetation flammability. To date, this approach has assumed a single flammability threshold, typically between 8 and 12%, controlling fire potential regardless of the vegetation type or climate domain. Here we use remotely sensed burnt area products and a common fire weather index calculated from global meteorological reanalysis data to identify and describe geographic variation in fuel moisture as a flammability threshold. This geospatial analysis identified a wide range of flammability thresholds associated with fire activity across 772 ecoregions, often well above or below the commonly used range of values. Many boreal and temperate forests, for example, can ignite and sustain wildfires with higher estimated fuel moisture than previously identified; Mediterranean forests, in contrast, tend to sustain fires with consistently low estimated fuel moisture. Statistical modelling showed that flammability thresholds derived from burnt area are primarily driven by climatological variables, particularly precipitation and temperature. Our analysis also identified complex associations between vegetation structure, fuel types, and climatic conditions highlighting the complexity in vegetation–climate–fire relationships globally. Our study provides a critical, necessary step in understanding and describing global pyrogeography and tracking changes in spatial and temporal fire activity.

Epidemiology of SLE in Italy: an observational study using a primary care database

ObjectivesTo estimate the incidence and prevalence of SLE in Italy, and to describe the demographic and clinical characteristics of patients with newly diagnosed SLE.MethodsA retrospective cohort study was conducted using...

Impact of the First-Wave COVID-19 Pandemic on Medical Expenditure for Older Adults in China: Lessons from a Natural Experiment

ABSTRACT Older adults’ access to healthcare services may have been affected by the COVID-19 pandemic. This study explored the effect of the first wave pandemic on the medical expenditure of older adults in China. Difference-in-Difference models captured both temporal and geographical variation in COVID-19 exposure to estimate the impacts of the pandemic on medical expenditure through a quasi-natural experiment. Data derived from the China Family Panel Studies. Results indicate that exposure to the pandemic significantly decreased total medical expenditures, hospital expenditures, and non-hospital medical expenditures of Chinese older adults by 15% (95% CI 12%–17%), 5% (95% CI 2%–7%), and 15% (95% CI 13%–16%), respectively, for each standardized severity increment. Females, less well-educated people, and individuals without internet access were most susceptible to experiencing these reductions. This study revealed that COVID-19 exerted a detrimental influence on the medical expenditure of older adults in mainland China. The “hidden epidemic” of non-COVID-19 medical needs of older adults deserves more attention on the part of policymakers.

Burn Care Funding in the Era of Price Transparency-Does Verification Signal Bargaining Power?

The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related Diagnosis Related Groups (DRG) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission) a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of three for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (p<0.001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.