High-income Areas Research Articles

Exploring Outcomes Related to Residential Determinants in Acute Mesenteric Ischemia Patients

IntroductionTo access the relationship between residential status and outcomes in surgical acute mesenteric ischemia (AMI) patients. MethodsRetrospective chart review of 153 AMI patients admitted to our institution between 2007 and 2021. Residential median income and Rural-Urban Commuting Area (RUCA) code were used as residential proxies. ResultsBeing of the female sex (odds ratio [OR] = 3.116 [1.276-7.609] P = 0.013) and having a vascular intervention performed (OR = 2.927 [1.087-7.883] P = 0.034) were both associated with a threefold increase in the risk of mortality. Increased age (OR = 1.037 [1.002-1.073] P = 0.039), elevated blood urea nitrogen (OR = 1.032 [1.012-1.051] P = 0.001), and living in higher residential income area (OR = 1.049 [1.009-1.091] P = 0.017) had a small, but statistically significant, increased risk of mortality. Patients in higher median income areas were less likely to undergo colonic resection (OR = 0.953 [0.911-0.997] P = 0.038) and tended to have a lower likelihood of receiving an ostomy (OR = 0.963 [0.927-1] P = 0.051). Being from urban or rural areas was not associated with mortality (OR = 1.565 [0.647-3.790] P = 0.321, although rural patients were more likely to undergo colon resection (OR = 2.183 [0.938-5.079] P = 0.070). Furthermore, rural patients were much more likely to be readmitted than urban dwellers (OR = 4.700 [1.022-21.618] P = 0.047). ConclusionsAMI patients living in rural or small-town areas were more likely to be readmitted and tended to undergo colonic resection. Patients residing in higher income areas had a slightly higher risk of mortality but tended to be less likely to require ostomy or colonic resection. These findings suggest a potential need for postoperative care initiatives focused on AMI patients living in rural and lower income areas.

Real-time sewage surveillance for SARS-CoV-2 in Dhaka, Bangladesh versus clinical COVID-19 surveillance: a longitudinal environmental surveillance study (December, 2019–December, 2021)

Clinical surveillance for COVID-19 has typically been challenging in low-income and middle-income settings. From December, 2019, to December, 2021, we implemented environmental surveillance in a converging informal sewage network in Dhaka, Bangladesh, to investigate SARS-CoV-2 transmission across different income levels of the city compared with clinical surveillance. All sewage lines were mapped, and sites were selected with estimated catchment populations of more than 1000 individuals. We analysed 2073 sewage samples, collected weekly from 37 sites, and 648 days of case data from eight wards with varying socioeconomic statuses. We assessed the correlations between the viral load in sewage samples and clinical cases. SARS-CoV-2 was consistently detected across all wards (low, middle, and high income) despite large differences in reported clinical cases and periods of no cases. The majority of COVID-19 cases (26 256 [55·1%] of 47 683) were reported from Ward 19, a high-income area with high levels of clinical testing (123 times the number of tests per 100 000 individuals compared with Ward 9 [middle-income] in November, 2020, and 70 times the number of tests per 100 000 individuals compared with Ward 5 [low-income] in November, 2021), despite containing only 19·4% of the study population (142 413 of 734 755 individuals). Conversely, a similar quantity of SARS-CoV-2 was detected in sewage across different income levels (median difference in high-income vs low-income areas: 0·23 log10 viral copies + 1). The correlation between the mean sewage viral load (log10 viral copies + 1) and the log10 clinical cases increased with time (r = 0·90 in July-December, 2021 and r=0·59 in July-December, 2020). Before major waves of infection, viral load quantity in sewage samples increased 1-2 weeks before the clinical cases. This study demonstrates the utility and importance of environmental surveillance for SARS-CoV-2 in a lower-middle-income country. We show that environmental surveillance provides an early warning of increases in transmission and reveals evidence of persistent circulation in poorer areas where access to clinical testing is limited. Bill & Melinda Gates Foundation.

PD20-07 ASSOCIATIONS BETWEEN PATIENT SOCIODEMOGRAPHIC FACTORS AND RISK-APPROPRIATE PROSTATE CANCER MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023PD20-07 ASSOCIATIONS BETWEEN PATIENT SOCIODEMOGRAPHIC FACTORS AND RISK-APPROPRIATE PROSTATE CANCER MANAGEMENT Madison Novosel, Shayan Smani, Victoria Marks, Farah Jeong, Preston Sprenkle, and Michael Leapman Madison NovoselMadison Novosel More articles by this author , Shayan SmaniShayan Smani More articles by this author , Victoria MarksVictoria Marks More articles by this author , Farah JeongFarah Jeong More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , and Michael LeapmanMichael Leapman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although definitive treatment is associated with improved survival for aggressive prostate cancer, a significant number of patients do not receive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with non-treatment by clinical risk strata in the contemporary era. METHODS: We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 954,591 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2020 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-treatment, stratifying analyses by D’Amico clinical risk criteria. RESULTS: The mean patient age at diagnosis was 65 years. Overall, 26.0% were diagnosed with low, 43.4% with intermediate, and 30.6% with high-risk prostate cancer. There were 131,122 (13.7%) who did not undergo initial treatment, including 82,318 (62.8%) with low, 35,499 (27.1%) with intermediate, and 13,305 (10.2%) with high-risk disease. The proportion of patients not receiving treatment increased over time in all risk groups between 2010 and 2010, including among low (11.7% versus 59.5%), intermediate (4.5% versus 12.5%) and high risk (3.6% versus 5.1%) disease. Compared with White patients, Black patients had lower odds of definitive treatment. This effect was more pronounced for patients with high (OR 0.61, 95% CI 0.58-0.64) rather than intermediate (OR 0.76, 95% CI 0.73-0.78) risk prostate cancer. Asian patients had lower odds of treatment compared with White patients across all disease risk strata (OR 0.84, 95% CI 0.80-0.88) but not high-risk disease (OR 0.90, 95% CI 0.80-1.00). There were lower odds of treatment among American Native/Alaskan Native versus White patients but not for high-risk disease (OR 0.79, 95% CI 0.57-1.10) Uninsured (OR 0.45, 95% CI 0.42-0.47, p<0.001), and Medicaid-insured (OR 0.68, 95% CI 0.66-0.71, p<0.001) patients were less likely to be treated overall. Patients residing in higher income areas had lower odds of over-treatment for low-risk prostate cancer (OR 0.84, 95% CI 0.81-0.87) and higher odds of treatment for high-risk prostate cancer (OR 1.34, 95% CI 1.25-1.44). CONCLUSIONS: Among patients diagnosed with prostate cancer in the contemporary era race and insurance are significantly associated with non-treatment for aggressive prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e586 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madison Novosel More articles by this author Shayan Smani More articles by this author Victoria Marks More articles by this author Farah Jeong More articles by this author Preston Sprenkle More articles by this author Michael Leapman More articles by this author Expand All Advertisement PDF downloadLoading ...

Breast biopsy techniques in a global setting-clinical practice review.

Breast cancer is a disease of global concern, regardless of economic status. A significant disparity in breast cancer care between low- and high-income countries is not unexpected, but consideration can be given to particular aspects of therapy to allow as much equitability as possible. One of these aspects involves biopsy of breast lesions. With available resources, management in developed countries focuses on dealing with screening and image-detected lesions. In such circumstances, advanced percutaneous biopsy techniques are utilized liberally. However, where resources are less forthcoming for mammographic screening, women frequently present with symptomatic, palpable and larger tumours. This scenario behooves the clinician to modify treatment approaches and yet use cost-effective management strategies. It is essential that thought is applied to breast biopsy technique used where there is cost-consciousness as it significantly influences subsequent therapy. Less expensive strategies like fine needle aspiration cytology (FNAC) and core needle biopsy (CNB), when performed with particular attention to technique, handling, transportation and preparation of biopsy specimens allows a high level of accuracy and provides adequate information for the next steps in treatment. This mini-review discusses the variation in biopsy approaches among lower and higher income areas and offers suggestions for appropriate breast biopsy strategies in resource-limited countries.

Comparing the clinical and cost-effectiveness of remote (telehealth and online) cognitive behavioral therapy-based treatments for high-impact chronic pain relative to usual care: study protocol for the RESOLVE multisite randomized control trial

BackgroundCognitive behavioral therapy for chronic pain (CBT-CP) is an effective but underused treatment for high-impact chronic pain. Increased access to CBT-CP services for pain is of critical public health importance, particularly for rural and medically underserved populations who have limited access due to these services being concentrated in urban and high income areas. Making CBT-CP widely available and more affordable could reduce barriers to CBT-CP use.MethodsAs part of the National Institutes of Health Helping to End Addiction Long-term® (NIH HEAL) initiative, we designed and implemented a comparative effectiveness, 3-arm randomized control trial comparing remotely delivered telephonic/video and online CBT-CP-based services to usual care for patients with high-impact chronic pain. The RESOLVE trial is being conducted in 4 large integrated healthcare systems located in Minnesota, Georgia, Oregon, and Washington state and includes demographically diverse populations residing in urban and rural areas. The trial compares (1) an 8-session, one-on-one, professionally delivered telephonic/video CBT-CP program; and (2) a previously developed and tested 8-session online CBT-CP-based program (painTRAINER) to (3) usual care augmented by a written guide for chronic pain management. Participants are followed for 1 year post-allocation and are assessed at baseline, and 3, 6, and 12 months post-allocation. The primary outcome is minimal clinically important difference (MCID; ≥ 30% reduction) in pain severity (composite of pain intensity and pain-related interference) assessed by a modified 11-item version of the Brief Pain Inventory-Short Form at 3 months. Secondary outcomes include pain severity, pain intensity, and pain-related interference scores, quality of life measures, and patient global impression of change at 3, 6, and 12 months. Cost-effectiveness is assessed by incremental cost per additional patient with MCID in primary outcome and by cost per quality-adjusted life year achieved. Outcome assessment is blinded to group assignment.DiscussionThis large-scale trial provides a unique opportunity to rigorously evaluate and compare the clinical and cost-effectiveness of 2 relatively low-cost and scalable modalities for providing CBT-CP-based treatments to persons with high-impact chronic pain, including those residing in rural and other medically underserved areas with limited access to these services.Trial registrationClinicalTrials.gov NCT04523714. This trial was registered on 24 August 2020.

Using neighborhood characteristics to predict vacancy types: Comparing multi-scale conditions surrounding existing vacant lots.

Vacant and abandoned land can be public eyesores that can potentially result in neighborhood distress in the long term. In some cases, the contextual conditions of a neighborhood have been shown to have more of a negative effect on communities than the vacant property itself. Maximum opportunities to actually reuse vacant and abandoned land is known to primarily exist in cases where the surrounding area has locational benefits or when local economic conditions are hopeful. This study examines and compares neighborhood socioeconomic characteristics around vacant lots in Minneapolis, Minnesota, USA, to identify spatial heterogeneity within vacancy types and neighborhood characteristics. Specifically, we examine 1) if the socioeconomic characteristics of a neighborhood can predict existing vacant lots and 2) what neighborhood characteristics are associated with certain vacant lot types. Three logistic regressions were tested with different buffers around each vacant lot, and a total of eighteen regressions were performed to capture the effects on six vacancy types. Results suggest that there are various types of vacancies interacting differently at the neighborhood scale, and that a large-scale neighborhood context matters when predicting vacancy types. The results also indicate three salient points. First, minority populations are a strong predictor of residential and commercial vacancies. Second, high-income areas tend to predict vacancies with potential investment opportunities or vacancies as a part of an existing park or recreational system. Third, vacant properties designated for institutional land uses tend to be found in lower-income areas, yet, not necessarily in areas with high minority populations. Managing and repurposing vacant and abandoned land should be handled more progressively with a better understanding of the socioeconomic characteristics of neighborhoods. Further, examining vacancy types by community can be a way to diagnose potential neighborhood risks associated with vacant and abandoned land.

Neighborhood-Built Environment and Ageism in Later Life.

Ageism is a global challenge and a public health concern that the recent COVID-19 pandemic has further exacerbated. Existing research has mainly focused on individual factors, overlooking the association between the neighborhood-built environment and ageism. This study examined this association and whether its effect varied among areas possessing different socioeconomic characteristics. We conducted a cross-sectional survey of 1278 older people in Hong Kong and merged this with the built environment factors derived from geographical information system data. We used multivariable linear regression to examine the association. Findings revealed that more parks were significantly associated with a lower level of ageism, an impact that remained significant in low-income or low-education areas. Conversely, more libraries in high-income areas were associated with a lower level of ageism. Our findings provide urban planners and policymakers insight into planning for the built environment that reduces ageism enabling older people to achieve a better life.

Content and Area Income Disparities in Recreation Center Website Promotion of Physical Activity

Physical activity (PA) is associated with numerous health benefits; however, both children and adults in the U.S. fall short of national PA recommendations. Diverse agencies have identified the importance of recreation professionals playing an ac-tive role in providing and promoting PA, including via recreation centers. Few studies have examined the contributions public recreation centers make in pro-viding residents with opportunities for PA, and those that exist offer mixed results concerning the influence of neighborhood family income levels.Recreation center websites are a popular, cost-efficient, and flexible me-dium for providing information about PA and center programs. We completed a line-by-line analysis of the content of the websites of all public recreation centers (N = 58) in the city of San Diego, California. We extracted the days and hours the centers operated as well as PA facil-ity types and programs they provided. Program details were identified, includ-ing content, frequency/duration for classes, participants targeted, and enrollment costs. Additionally, we generated information about local neighborhoods, includ-ing family median income levels. Diverse statistical analyses were conducted, overall, and by a median split for neighborhood income status. On average, centers had 4.5 PA facilities and were open 59 hours/week, with no differences by neighborhood income. Meanwhile, centers in higher-income areas provided significantly more programs (5.3 vs 2.3). Overall, 33 distinct facility types were identified, but only gymnasia and outdoor basketball courts were listed by over 50% of centers. Fifty distinct programs were identified, with dance, teen center, basketball, and volleyball mentioned most frequently.

Evaluation of the Spirituality of Village Committees on Integrated Risk Governance of Agricultural Drought: A Case Study in Xindu District, Hebei Province, China

The spirituality of stakeholders in cases of drought has gained significant attention in the field of integrated risk governance of agricultural drought. In this paper, based on a field survey and 30 drought response actions in China, we established an indicator system and quantitative model based on concentration and willpower (spirituality, abbreviated as S), considering the aspects of responsibility (R), enterprise (E), and devotion (D) to evaluate the spirituality of the village committee of Xindu District, Hebei Province. We aimed to develop a new method for the quantitative research of multi-stakeholders’ concentration and willpower and to provide a more scientific reference for the formation of consilience in the process of improving risk governance capability. The main conclusions are as follows: (1) Condensed connotations of spirituality focus on expressing the spirit state of each stakeholder, which is the embodiment of the stakeholder’s concentration and willpower in the consilience system. (2) An evaluation framework of “deeds information excavating → stakeholder-oriented survey → grading and classification” is formed. Based on Chinese traditional cultural backgrounds and administrative system characteristics, the evaluation indicator system and model of spirituality are constructed and will further promote the visualization and quantification of spirituality research. (3) The spirituality index (S) of village committees on integrated risk governance of drought presents a trend of normal distribution, and the average value of all secondary indices is R &gt; E &gt; D. The mean value of R is 0.93 and the sample range is 0.49. D has the lowest mean value, with a range of 0.37. (4) There is a regional difference in the average values of spirituality index (S) as follows: “plain area &gt; mountain area &gt; hilly area”, from the perspective of geomorphic units, and “high-income area &gt; middle-income area &gt; low-income area”, from the perspective of the regional economy.

Cross Culture Adaptation of CASP 19 To Assess Quality of Life of Older Adults in Karachi, Pakistan

CASP-19 (Control, Autonomy, Self-realization, and Pleasure) is a well-established and theoretically derived instrument to assess the quality of life, which has been translated into multiple languages for global application. This study provides a cross-cultural validation of CASP-19 in older adults in Karachi, Pakistan. Objective: To assess quality of life of 50+ older adults in Karachi, Pakistan. Methods: Focus groups were used to pilot-test a translated CASP-19 survey from English to Urdu, with back translation to explore the language, cultural and conceptual similarities of the tool to the original version. A population survey was administered using cluster sampling. The translated version was administered to 100 participants from each low, middle, and high-income areas via door-to-door recruitment. Confirmatory factor analysis was used to test the psychometric validation of the Urdu version. A regression analysis assessed social determinants of quality of life. Results: Pilot-testing confirmed that CASP-19 has conceptual relevance to Pakistani culture in a revised CASP-13 with 6 items remove. Conclusion: CASP13 is a valid and reliable tool to assess the quality of life of 50+ older adults in Karachi.

FUNCTIONAL DISABILITY INVENTORY AND ASSOCIATIONS WITH RACE, ETHNICITY, INCOME AND FOOD INSECURITY

Abstract PURPOSE Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn’s Disease (CD) and ulcerative colitis (UC). Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity or about 13 million children. Louisiana has one of the higher rates of food insecurity in the country with over 249,000 children affected. Food insecurity has been associated with worse health outcomes in children including developmental risks, poor mental health, and poor educational outcomes. Functional Disability Inventory (FDI) is a measure of limitations in both physical and psychosocial functioning secondary to physical health. Our hypothesis is that patients in food insecure homes will have higher FDI scores compared to those in food secure homes. METHODS This study is a prospective study of newly diagnosed IBD patients seen by the Division of Pediatric Gastroenterology at Children’s Hospital of New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture’s food insecurity screening questionnaire and the American Academy of Pediatrics’ Food Insecurity 2-Question Screen. Disability scores were obtained at diagnosis using the FDI self-reporting questionnaire if older than 12 years of age or a parent form was completed for patients less than 12. RESULTS Our study consisted of 20 newly diagnosed pediatric IBD patients with an average age of 14.5 years. Nineteen (95%) patients had CD. Most patients were female (70%), non-Hispanic white (50%) with Medicaid (55%) as their primary insurance. Eight (40%) patients were African American and two (10%) were listed as other. Eight patients or their caregivers identified as living in a food insecure home (40%) and these patients averaged a FDI score of 10.2 The food secure group had an average FDI of 9.3. Non-Hispanic, white patients had an average FDI score of 10.5 while the minority patients had an average FDI of 8.5. Only two patients lived in an area with a median household income below poverty with an average FDI of 15.5. Ten patients lived below the state median income and had an average FDI was 8.2. Those patients living in areas above the state median income level, 8 total, had the highest FDI scores, 10.8. CONCLUSION Food insecurity had higher rates of disability scores compared to families from food secure homes. Families in higher income areas and who were non-Hispanic white had higher FDI scores compared to minority patients and those in lower income areas. Further data will be collected with changes in FDI through the first 6 months of diagnosis. Additional larger studies are needed to determine a relationship between FDI scores and food insecurity in pediatric IBD.

Interventions in the first 1000 days to prevent childhood obesity: a systematic review and quantitative content analysis

BackgroundChildhood obesity poses a global health challenge. In recent years, there has been an increase in interventions that begin in pregnancy, putting the concept of early programming and early risk factors into practice. The present study aims to update the findings regarding interventions in the first 1000 days of life.MethodsA systematic review based on the PRISMA guidelines was carried out in PubMed, WoS, Scopus and CINAHL to obtain the articles to be analysed. We included those studies published between 2016 and 2021. Human interventions that started within the first 1000 days of life and acted on at least one programming factor were included. Once selected, coding and quantitative content analysis was carried out to obtain a profile of the interventions during the first 1000 days.ResultsFrom all screened articles, 51 unique interventions, which met the selection criteria, were included. The majority of interventions (81%) took place in high-income areas. Almost all (86%) were targeted at the general population. The majority (54%) started in the second trimester of pregnancy. A clear majority (61%) ended at the time of birth. 44% of the interventions included all pregnant women. Only 48% of these interventions were focused on improving the nutritional status of the offspring in the short term. Most interventions collected the baby's weight at birth (68%).ConclusionsIt can be concluded that current interventions are not covering as many aspects as they should. Future research should be conducted more frequently in developing countries and target disadvantaged groups. These interventions should include all pregnant women, regardless of their nutritional status, aiming to cover as many programming factors as possible and extending through the first 1000 days of life, with body mass index or skinfolds as measures of effectiveness during this period.

How do the socio-economic indicators influence the travel behaviour pattern?: Case study Amman-Jordan

Limited research has been conducted in developing countries on travel behavior and its prediction. This study aimed to investigate if socio-economic conditions affect travel behavior patterns in Amman, Jordan, and propose regression models for trips defining the contributory factors. A total of 681 interviews were conducted with households (210) and workplace employees (335), assessing behavioral travel styles in two neighborhoods with different characteristics. Compared to residents of high-income areas (HIA), residents of low-income areas (LIAs) travel more by all modes of transportation; in LIA and HIA, the trip rate per person was (2.2) and (2.0), respectively, while in low-income and high-income areas, the number of trips per household was 5.14 (153.6 minutes) and 3.7 (155 minutes). Most household trips in low-income neighborhoods, mainly for education and work, were made on foot, while private cars were more common in high-income areas. For trips related to the office and shops, the private car was the most common mode of transportation. In low-income neighborhoods, shared taxis were commonly used for household and shop trips, and buses were often used for commutes. School and university students, as well as household size, provided valid trip predictions. Employees can predict work trips to the office, customer visits, and shop-related trips.

Characterizing equitable access to grocery stores during disasters using location-based data

Natural hazards cause disruptions in access to critical facilities, such as grocery stores, impeding residents’ ability to prepare for and cope with hardships during the disaster and recovery; however, disrupted access to critical facilities is not equal for all residents of a community. In this study, we examine disparate access to grocery stores in the context of the 2017 Hurricane Harvey in Harris County, Texas. We utilized high-resolution location-based datasets in implementing spatial network analysis and dynamic clustering techniques to uncover the overall disparate access to grocery stores for socially vulnerable populations during different phases of the disaster. Three access indicators are examined using network-centric measures: number of unique stores visited, average trip time to stores, and average distance to stores. These access indicators help us capture three dimensions of access: redundancy, rapidity, and proximity. The findings show the insufficiency of focusing merely on the distributional factors, such as location in a food desert and number of facilities, to capture the disparities in access, especially during the preparation and impact/short-term recovery periods. Furthermore, the characterization of access by considering combinations of access indicators reveals that flooding disproportionally affects socially vulnerable populations. High-income areas have better access during the preparation period as they are able to visit a greater number of stores and commute farther distances to obtain supplies. The conclusions of this study have important implications for urban development (facility distribution), emergency management, and resource allocation by identifying areas most vulnerable to disproportionate access impacts using more equity-focused and data-driven approaches.

African American Race Is a Potential Favorable Biologic Factor That Impacts Clinical Outcome for Patients with Multiple Myeloma

Multiple myeloma (MM) remains an incurable malignancy characterized by plasma cells that are nurtured and proliferate within the permissive bone marrow milieu. It has a greater incidence in African Americans (AA) compared to whites (13.8 vs. 6.5/100,000). The five-year age adjusted mortality rate, according to SEER database, is greater in AA compared to white Pts (5.8 vs. 2.9/100,000), which is likely explained by a greater incidence in the AA population. However, recent reports have also shown that AAs with equal access to care have an even better survival than their white counterparts [Fiala et al. Cancer. 2017]. Conversely, results from the CoMMpass registry database showed that OS was shorter for AA compared with Whites (age-adjusted hazard ratio (HR) 1.7, 95% confidence interval 1.2-2.4, P = 0.003) [Derman et al. Blood Cancer J. 2020]. Here, we report the interplay of race and other dimensions of MM care using the National Cancer Database (NCDB). Methods: NCDB is the largest cancer database in the US including >70% of all newly diagnosed cancer patients. The International Classification of Diseases for Oncology (ICD-O) code of 9732 was used. OS was calculated from the date of MM diagnosis. Given that Smoldering MM (SMM) does not have specific ICD code, we defined patients who did not receive any treatment within 3 months after the diagnosis as SMM, similar to other authors (Ravindran et al. Blood Cancer J. 2016). Initiation of systemic treatment was considered as a surrogate of progression to symptomatic MM. Overall survival (OS) of SMM patients was calculated from initiation of systemic treatment after they progressed to MM, estimated by the Kaplan-Meier method, and compared with the log-rank test. Cumulative incidence of progression from SM to MM was calculated with death as a competing risk and compared with the Gray's test. Multivariable Cox and logistic regression analysis were performed to identify independent predictors of OS and progression to MM, respectively. Results: We identified 56,021 patients with MM and 11,485 with SMM between 2010 to 2014 in this database. Among MM patients, 42,836 (76%) were white and 11,255 (20%) self-identified as AA. For AA patients, there was a lower proportion of Medicare (46 vs. 56%), and private insurance (35 vs. 36%) and a higher percentage of Medicaid (11 vs. 5%) and uninsured Pts (6 vs. 3%) compared to Pts that self-identified as white. A larger proportion of AAs had a Charlson score ≥1 (30 vs. 24%, p<0.001). The percentage of Pts who underwent radiation was higher among whites compared to AA (23 vs 8%). However, unadjusted OS was greater for AA compared to white Pts, 55 vs. 48 months, respectively (P < 0.0001). Among SMM patients, 8,324 (72%) were white and 2,756 (24%) were AA. SMM was diagnosed in AA patients at a median of 3.7 years younger than in white patients. Similar socioeconomic disparities were observed in SMM as in MM cohort. The time from diagnosis of SMM to first therapy which is indicative of progression from SMM to MM is the same among AA and white (median time in days 136 vs 135 days, p=0.672) with comparable OS. Multivariable Cox and logistic regression analysis showed that lower age, AA race, Female gender, ASCT, living in a higher income area and having Medicare or Private insurance compared to no insurance were independent predictors for better OS in MM. Although other predictive factors persisted for patients with SMM, race did not reach statistical significance. Conclusion: Taken together, our results utilizing one of the largest available datasets in the US, reflect a similar outcome for AA and white patients with MM despite a clear disparity in healthcare access and SES. This finding might suggest a more favorable biology of the disease among AA Pts. The lower rate of radiation among AA is also an indirect measure of bone complications. AA enjoy less bone loss and fractures under physiologic and pathologic conditions. Further studies to elucidate the role of bony compartment of the MM microenvironment at the cellular and molecular levels might be able to explain this disparity and help advance a more personalized treatment options to improve outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009-2018.

Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed.

Abstract 14920: Differences in Socioeconomic Factors in Patients Obtaining Coronary Calcium Score Computed Tomography in a Large Midwestern Healthcare Network

Introduction: Coronary artery calcium score (CACS) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. The 2018 ACC/AHA Cholesterol Guideline includes CACS as a decision aid in asymptomatic, intermediate-risk patients. In most US states, including Wisconsin, CACS is not covered by insurance with out-of-pocket costs ranging from $50-400. This study aimed to examine the socioeconomic factors of Wisconsin patients who obtained a CACS CT at Advocate Aurora Health (AAH). Methods: Using the 2018 American Community Survey data from the Census Bureau, we evaluated the socioeconomic characteristics of the areas in Wisconsin where patients who underwent CACS CT at AAH lived. These included race, ethnicity, median income, median age, average household size, household without vehicles, and completion of high school. We categorized the income as low (≤$35,000), medium (&gt;$35,000 - &lt;$100,000), and high (≥$100,000). Additionally, we compared self-referred versus physician-referred patient characteristics. Results: A total of 19,726 patients presented for CACS CT at AAH from 2019 through 2021. The median income for patient residential areas was $73,981. The median percentage of white race in these areas was 94.6%, while that of black race was only 0.3%. Additionally, median percentage of Hispanics was 2.9%. The median average household size was 2.5 people, median percentage of households who did not own a vehicle was 2.2%, and the median high school completion rate was 95.2%. When we stratified by income, most patients were from areas with medium income (75.2%), followed by high (17.3%), and only 7.5% were from low-income areas. When comparing self-referred versus physician-referred patients, self-referred were found to live in higher-income areas compared to physicians-referred (19.4% vs. 16.4%; p&lt;0.0001). Conclusion: Social and economic factors are well known to affect access to health care. Our study demonstrated that patients in Wisconsin who obtain out-of-pocket CACS CT live predominantly in medium and high-income areas. Patient access to preventive health care may be affected by the lack of insurance coverage.

The impacts of non-farming income on rural household energy choices: Empirical evidence from China.

This study uses data from the China Family Panel Studies to analyze the possible impact of non-farming income on household energy choices. We use ordinary least squares and instrumental variable estimation methods to investigate the causal effect of non-farming income on household energy choices. We find that an increase in non-farming income assisted farmers in reducing their use of solid fuels in favor of clean energy. Our heterogeneity analysis, based on the average rural household income and geographical location of the village, shows that the energy upgrade effect of non-farming income is more obvious in high-income areas and suburbs closer to the county seat center. Further, we find that non-farming income has an impact on rural household energy choice mainly through the optimization of household energy-saving appliances and the enhancement of environmental awareness.

Perceptions of the use of mobile phones to access reproductive health care services in Tamale, Ghana.

Africa has one of the world's highest populations of young people. In addition, Africa has one of the highest proportions of young people facing the worst health challenges. Although previous scholars have reported that young people were using mobile phones to fill in the gaps in accessing reproductive health services, among other health services, there was little comprehensive research on the perception of young people in Tamale, Ghana, on the use of mobile phones to access reproductive health services. This study analyzed the perceptions on mobile phone use to access reproductive health services among young people in Tamale, Ghana. The research used a quantitative method design from a target population of 72,706 young people from selected peri-urban, low-income, middle income and high-income residential areas in Tamale Metropolis, Ghana. The sample size used was 397 young people. Participants were selected using a stratified multistage sampling strategy. Descriptive statistics were used to analyse the data. A total of 86% of the respondents agree that the use of mobile phones helps to overcome cultural challenges that young people in Tamale encounter in accessing reproductive health care. Also, 84.6% of the respondents agree that the use of mobile phones helps them to overcome inadequate access to reproductive health information and services. The use of mobile phones helps to overcome the negative attitude of health providers toward young people in need of reproductive health services was agreed by most of the respondents [strongly agree (35.4%) and agree (49.4%)]. This study informed highly positive perceptions and attitudes toward the use of mobile phones to access Reproductive Health Services in Tamale, Ghana. There is, therefore the need for the health sector to reform its mode of prescriptions of medication, consultation, and service delivery to leverage on the advantages that mHealth presents.

Regulatory requirements and voluntary interventions create contrasting distributions of green stormwater infrastructure in Baltimore, Maryland

Green stormwater infrastructure (GSI) has been increasingly promoted as a strategy to augment gray infrastructure because it can reduce flooding, improve water quality, and provide additional social and ecological benefits. Government regulations in many places now require or encourage the use of GSI to mitigate impacts of development, while numerous funding opportunities incentivize installation of additional GSI features to enhance community and environmental benefits. The equity of GSI benefits may be affected by these different underlying motivations for GSI installation—mandatory compliance with regulations vs voluntary community improvement—which could create distinct patterns of GSI across the landscape. We examined this hypothesis in Baltimore, Maryland, USA, by comparing the city’s database of GSI facilities that meet regulatory requirements (“regulatory GSI”) to a dataset we compiled of GSI installed voluntarily by nonprofit organizations and community groups (“voluntary GSI”). We found that regulatory GSI included more facility types than voluntary GSI, which was dominated by microscale practices like rain gardens. The presence of regulatory GSI was negatively related to greater Black populations, while voluntary GSI was more likely to be found both in low-income areas with predominantly Black populations and in high-income areas with predominantly white populations. Voluntary GSI was much more commonly located on public land, and GSI on public land tended to be in more disadvantaged areas. These patterns of GSI distribution, which reflect different motivations and constraints in a fragmented implementation process, provide an opportunity for improving equitable access to GSI benefits through more systematic planning and management efforts.