High-income Neighborhoods Research Articles

Reconfiguring rickshaw mobilities: formalization and exception in Dhaka’s diplomatic zone

This paper examines the relationship between formalization and (im)mobilities by focusing on the reconfiguration of cycle-rickshaw journeys in the ‘diplomatic zone’ of Dhaka, Bangladesh. Following two terrorist attacks in 2015 and 2016, this high-income neighborhood witnessed a strong trend toward the securitization, regularization, and sanitization of urban space. Consequently, the local transport system underwent significant changes, including a number of interventions aimed explicitly at regularizing cycle-rickshaw mobilities. These changes involved the introduction of a formal license system, a fixed fare chart, and the designation of a limited number of registered rickshaws to clearly demarcated areas. This paper critiques the insular and exclusionary logic that underpins this area-based rickshaw system and argues that formalization – in this particular instance – has led to the deepening of existing inequalities. In analyzing these inequalities, I present formalization as an inherently unfinished process that gains shape through simultaneous and often contradictory processes of fixing, enclosure, and exception. I offer that this conceptual triad provides a useful starting point for making sense of the relationship between formalization and (im)mobilities in a way that does not reify or assume intuitive and simplistic conflations between the formal/static and informal/mobile.

Social epidemiology of urban COVID-19 inequalities in Latin America and Canada

BackgroundThe COVID-19 pandemic has spread through pre-existing fault lines in societies, deepening structural barriers faced by precarious workers, low-income populations, and racialized communities in lower income sub-city units. Many studies have quantified the magnitude of inequalities in COVID-19 distribution within cities, but few have taken an international comparative approach to draw inferences on the ways urban epidemics are shaped by social determinants of health.MethodsGuided by critical epidemiology, this study quantifies sub-city unit-level COVID-19 inequalities across eight of the largest metropolitan areas of Latin America and Canada. Leveraging new open-data sources, we use concentration indices to quantify income- and vulnerability-related inequalities in incidence, test positivity, and deaths over the first 125 weeks of the pandemic between January 2020 and May 2022.ResultsOur findings demonstrate that incidence, deaths, and test positivity are all less concentrated in low-income sub-city units than would be expected, with incidence ranging concentration in lower income neighbourhoods in Toronto (CI = -0.07) to concentration in higher income neighbourhoods in Mexico City (CI = 0.33). Drawing on relevant studies and evaluations of data reliability, we conclude that the best available public surveillance data for the largest cities in Latin America are likely not reliable measures of the true COVID-19 disease burden. We also identify recurring trends in the evolution of inequalities across most cities, concluding that higher income sub-city units were frequent early epicentres of COVID-19 transmission across the Latin America and Canada.ConclusionsJust as critical epidemiology points to individuals biologically embodying the material and social conditions in which we live, it may be just as useful to think of cities reifying their material and social inequities in the form of sub-city unit-level infectious disease inequities. By shifting away from a typical vulnerability-based social determinants of health frame, policymakers could act to redress and reduce externalities stemming from sub-city unit-level income inequality through redistributive and equity-promoting policies to shift the centre of gravity of urban health inequalities before the next infectious disease epidemic occurs.

Investigating the Spatial Patterns of Heavy Metals in Topsoil and Asthma in the Western Salt Lake Valley, Utah

Mining activities, particularly in large excavations like the Bingham Canyon Copper Mine in Utah, have been increasingly linked to respiratory conditions due to heavy-metal-enriched waste and dust. Operating continuously since 1906, the Bingham Canyon Copper Mine contributes 4.4% of the Salt Lake Valley PM2.5 pollution. However, the extent of its contributions to larger-sized particulate matter (PM10) dust, soil and water contamination, and human health impacts is largely unknown. Aerosol optical depth data from Sentinel-2 imagery revealed discernible dust clouds downwind of the mine and smelter on non-prevailing-wind days, suggesting potential heavy metal dispersion from this fugitive dust and subsequent deposition to nearby surface soils. Our analysis of topsoils from across the western Salt Lake Valley found mean arsenic, copper, lead, and zinc concentrations to be well above global background concentrations. Also, the minimum values for arsenic and maximum values for lead were well above the US EPA regional screening levels for residential soils. Thus, arsenic is the metal of greatest concern for impacts on human health. Elevated concentrations of all metals were most notable near the mine, smelter, and tailings pond. Our study linked these elevated heavy metal levels to regional asthma outcomes through cluster analysis and distance-related comparison tests. Significant clusters of high asthma rates were observed in regions with elevated topsoil heavy metal concentrations, impacting both low- and high-income neighborhoods. The findings of this preliminary study suggest that the mine, smelter, and recent construction activities, especially on lands reclaimed from former tailings ponds, could be contributing to atmospheric dust containing high levels of heavy metals and exacerbating asthma outcomes for residents. However, the methods used in the study with aggregated health outcome data cannot determine causal links between the heavy metal contents of soil and health outcomes; they can only point to potential links and a need for further investigation. Such further investigation should involve individual-level data and control for potential confounding factors, such as socioeconomic status, access to healthcare, and lifestyle factors, to isolate the effect of metal exposures on asthma outcomes. This study focused on atmospheric deposition as a source of heavy metal enrichment of topsoil. However, future research is also essential to assess levels of heavy metals in subsoil parent materials and local surface and groundwaters to be able to assess the links between the sources or methods of soil contamination and health outcomes.

Street tree communities reflect socioeconomic inequalities and legacy effects of colonial planning in Nairobi, Kenya

Street trees provide ecological and social benefits that sustain urban life, yet their distribution frequently mirrors socioeconomic inequalities, meaning underprivileged social groups also have fewer trees. The distribution patterns of urban trees are least documented in the cities of rapidly evolving middle-income countries. We assessed whether street tree abundance, size, condition, diversity, and composition vary across census-derived socioeconomic strata in Nairobi, Kenya. We sampled 2047 trees across 12 neighborhoods, covering 24 km of street, then used linear regression to understand how socioeconomic strata relate to street tree characteristics. We found substantial disparities in tree abundance, with affluent areas harboring 91.5 % of the trees sampled. Low-income areas and informal settlements had comparably few trees. Mean diameter and condition did not vary across socioeconomic strata, but high-income, formerly European neighborhoods had a higher proportion of small trees, indicating a bias in recent urban greening investments further benefiting these areas. Species diversity followed a similar pattern of inequality. High-income neighborhoods had over 30 % higher species richness and diversity than low-income areas. Even so, lower income neighborhoods exhibited greater differences in street tree community composition, and a higher proportion of trees that bear edible fruit or are used in traditional medicine. Overall, our results reveal pronounced spatial inequality in the distribution of street trees in Nairobi, reflecting not only socioeconomic differences but the enduring legacies of colonial planning.

Festive culture, social hierarchization, and urban inequality: Analysis of the fallas of València (1981–2019)

ABSTRACT Festive rituals have been analyzed as rituals of interaction with great capacity to generate group membership and economic impact. However, the conflictual dimension of these rituals should be taken into account, as festive rituals are also spaces of conflict and exclusion. In this sense, ritual festivities can lead to urban cohesion and the generation of local identities, but they can also reinforce internal social divisions, reproducing social inequalities and expressing the social hegemony of the dominant elites. In this sense, the fallas of Valencia constitute a carnivalesque festive ritual that shows exactly these effects, since the organization of the fallas commissions represents one of the city’s principal forms of social participation and cohesion, but at the same time reproduces the social hierarchization of urban districts. Thus, one of the main formats is found in the stratification by neighborhoods. The fallas reflect the economic strength of the traditionally socially dominant neighborhoods, but also show the emergence of new high-income neighborhoods, with new commissions defined by high resources. In this way, studying the fallas is a way of studying the urban hierarchy of Valencia, as they have gone hand in hand throughout the period studied.

On the uncertainty of real estate price predictions

ABSTRACT Uncertainty quantification associated with real estate appraisal has largely been overlooked in the literature. In this paper, we address this gap by analysing the uncertainty in automated property valuations using conformal prediction, a distribution-free procedure for constructing prediction intervals with valid coverage in finite samples. Through an empirical study of property prices in the San Francisco Bay Area, we find that prediction intervals obtained using conformal quantile regression have exact coverage. In contrast, prediction intervals obtained from non-conformal quantile regressions severely undercover the data. Furthermore, we show that the intervals adapt to various characteristics of the dwellings, which is crucial given the heterogeneous nature of real estate data. Indeed, we observe that larger and older properties, those in both low and high-income neighbourhoods, as well as those on the market for less than one year are more challenging to evaluate.

Income differences in time to colon cancer diagnosis.

People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.

Making the Case: Exploring the Role of Case Management in Relocation and Return Decisions in Choice Neighborhoods Initiative

Leveraging novel case management data, we present the first comprehensive investigation into the role of case management services in housing relocation and return decisions within the framework of the Choice Neighborhoods Initiative (CNI), the current place-based public housing revitalization program. Our study employs multinomial logistic (MNL) regression models to demonstrate that a higher level of involvement in case management services is correlated with an increased probability of moving to a higher-income neighborhood during the redevelopment process, as well as a greater likelihood of returning to the revitalized neighborhood afterward. By achieving these outcomes, case management services play a crucial role in enhancing the chances for original CNI residents to reap the benefits of neighborhood redevelopment—a matter of enduring concern among social scientists. These findings are contextualized with both sociodemographic and neighborhood characteristics associated with relocation and return decisions.

Neighborhood Gentrification and Food Insecurity Among Urban Older Adults: Evidence From New York City.

Gentrification is a prevalent neighborhood development process in urban areas across the United States. Prior studies have identified the influence of gentrification on late-life health and quality of life, yet little is known about its relationship with food insecurity, an important public health issue for older adult populations. Using New York City as a case study, this study investigated associations between living in a gentrifying neighborhood and food insecurity, as well as the mediating roles of neighborhood environment factors-social cohesion, public transportation, and food environment. This study adopted 2 waves of annual data from the Poverty Tracker Study (2015-2016; N = 703) merged with American Community Survey and spatial data sets to measure gentrification and neighborhood factors. Adjusted logistic regressions were used to examine the associations between gentrification and food insecurity. Further mediation analyses were conducted to test the mechanisms of such associations. Older adults in gentrifying neighborhoods were more likely to have food insecurity than those in moderate- to high-income neighborhoods. Compared to low-income neighborhoods, older adults in gentrifying neighborhoods had a lower likelihood of reporting food insecurity. Two significant mediators were found when comparing gentrification with moderate- to high-income neighborhoods: social cohesion and healthy food outlets. This study highlights the importance of gentrification in determining late-life food insecurity and identifies possible mechanisms with policy and social service implications to reduce the risk of food insecurity in urban areas.

Low Socioeconomic Status is Associated With Higher In-Hospital Mortality in Stanford Type A Aortic Dissection Repair: A Population Study of National Inpatient Sample From 2015 to 2020

IntroductionStanford Type A Aortic Dissection (TAAD) is characterized by a high in-hospital mortality rate and necessitates urgent surgical intervention. While socioeconomic status is known to influence health-care outcomes, its specific association with TAAD remains underexplored. This study aimed to investigate the population-based association between socioeconomic status with TAAD repair outcomes using a national registry. MethodsPatients who had TAAD repair were identified in National Inpatient Sample from Q4 2015-2020. National Inpatient Sample stratified estimated median household income of residents within a patient's ZIP code. Patients residing in neighborhoods of incomes in the lowest and highest quartiles were selected as the study cohorts. Multivariable logistic regressions were used to compare in-hospital outcomes, adjusted for demographics, comorbid conditions, hospital characteristics, primary payer status, and transfer status. ResultsCompared to patients from high-income neighborhoods, patients in low-income communities had higher risks of mortality (adjusted odds ratio [aOR] 1.45, P = 0.01), acute kidney injury (aOR 1.225, P = 0.03), and infection (aOR 1.474, P = 0.02), as well as longer wait from admission to operation (24.96 ± 2.64 versus 18.00 ± 1.92 h, P = 0.03) and longer length of stay (15.06 ± 0.38 versus 13.80 ± 0.36 d, P = 0.01). In contrast, patients from low-income communities had less risk of hemorrhage/hematoma (aOR 0.691, P < 0.01) and lower total hospital charge (428,746 ± 10,658 versus 487,017 ± 16,770 US dollars, P < 0.01). ConclusionsEvidence suggests patients from lower-income communities may have limited access to health care and treatment delays, leading to higher mortality and complications. The underlying reasons for these disparities in economically disadvantaged communities warrant further investigation, which could focus on health-care accessibility, timely detection of TAAD, and prompt transfers to specialized centers.

Bottled Water Consumption and Perceptions of Household Water Quality: An Intra-Urban Analysis of Greensboro, North Carolina

abstract: Perceived household water quality can affect decision-making about bottled water consumption, an issue of environmental justice. Residents who do not trust the quality of their tap water may drink bottled water as an alternative, but people also choose to drink bottled water for other reasons, such as taste or convenience. This study examines patterns of bottled water consumption and perceptions of tap water quality across neighborhoods of Greensboro, North Carolina, with differing income levels. Household surveys were used to investigate residents' consumption of bottled water and tap water and their stated reasons for consuming bottled water. Results indicate that respondents in low-income neighborhoods report drinking significantly (p=0.001) more bottled water than respondents in higher-income neighborhoods. Concerns about the safety of tap water were a significantly (p=0.00005) more important reason for respondents in low-income neighborhoods to choose bottled water compared to respondents in higher-income neighborhoods. The results of this study indicate that intra-urban differences in perceptions of household water quality are a major environmental justice issue in that concerns about safety drive low-income residents to spend their limited income on bottled water.

Patient factors associated with chemotherapy modifications: Results from the Optimal Breast Cancer Chemotherapy Dosing (OBCD) study.

520 Background: Understanding patient factors associated with an increased likelihood of receiving chemotherapy modifications is important for treatment planning and anticipating which patient groups might require extra support through the course of treatment. Methods: We have evaluated patient and tumor factors associated with chemotherapy modifications in a cohort of 9700 women receiving adjuvant chemotherapy for breast cancer at Kaiser Permanente Northern California (KPNC) and Kaiser Permanente Washington (KPWA) in the Optimal Breast Cancer Chemotherapy Dosing (OBCD) Study diagnosed between 2005-2019. The outcome variable, receipt of a ‘chemotherapy modification’ is defined as a composite representing any of the following deviations from the intended regimen: dose reduction &gt;10% (first cycle or overall), extensive delay (any single delay &gt;14 days), regimen change, or receipt of fewer cycles of any given drug than intended in the original chemotherapy plan. Multivariable-adjusted prevalence ratios (PR) and corresponding 95% confidence intervals (95% CI) were calculated using generalized linear models of the Poisson family with a log link-function and robust standard errors. Results: Several factors were associated with chemotherapy modifications. Notably, older age was associated with an increased likelihood of modifications (p-trend&lt;0.001), with adults aged 80+ years at diagnosis 1.93-fold more likely to experience modification than adults 18-39 years (95% CI: 1.50-2.50). Increased comorbidity and BMI were also associated with increased likelihood of modification (p-trend for both:&lt;0.001), with patients with a Charlson Comorbidity Index of 3+ (vs 0) having an PR of 1.33 (95% CI: 1.19-1.48) and those with a BMI of 35+ kg/m2 (vs &lt;25 kg/m2) having an PR of 1.53 (95% CI: 1.41-1.65). HER2+ status (PR HER2+ vs HER2-: 1.99 95% CI: 1.89-2.10) and higher stage of disease (PR IIIA vs I:1.24; 95% CI: 1.13-1.35; p-trend&lt;0.001) were associated with increased likelihood of chemotherapy modification, while hormone receptor positivity was associated with lower likelihood of modification (PR ER+ and/or PR+ vs ER-/PR-: 0.93; 95% CI: 0.88-0.99). Diagnosis in more recent years was also associated with decreased likelihood of modification (PR 2015-2019 vs 2004-2009: 0.70; 95% CI: 0.66-0.75), as was higher neighborhood income (PR Q4 vs Q1: 0.78; 95% CI: 0.72-0.84). Conclusions: Several patient-level and clinical factors were associated with chemotherapy modifications, including age, comorbidity, BMI, and ER/PR/HER2 status. Future research might focus on the groups noted to have increased risk of treatment modification to better understand the factors underlying these changes, as well as the impact on patient outcomes.

Exposome-Wide Association Study of Body Mass Index Using a Novel Meta-Analytical Approach for Random Forest Models.

Overweight and obesity impose a considerable individual and social burden, and the urban environments might encompass factors that contribute to obesity. Nevertheless, there is a scarcity of research that takes into account the simultaneous interaction of multiple environmental factors. Our objective was to perform an exposome-wide association study of body mass index (BMI) in a multicohort setting of 15 studies. Studies were affiliated with the Dutch Geoscience and Health Cohort Consortium (GECCO), had different population sizes (688-141,825), and covered the entire Netherlands. Ten studies contained general population samples, others focused on specific populations including people with diabetes or impaired hearing. BMI was calculated from self-reported or measured height and weight. Associations with 69 residential neighborhood environmental factors (air pollution, noise, temperature, neighborhood socioeconomic and demographic factors, food environment, drivability, and walkability) were explored. Random forest (RF) regression addressed potential nonlinear and nonadditive associations. In the absence of formal methods for multimodel inference for RF, a rank aggregation-based meta-analytic strategy was used to summarize the results across the studies. Six exposures were associated with BMI: five indicating neighborhood economic or social environments (average home values, percentage of high-income residents, average income, livability score, share of single residents) and one indicating the physical activity environment (walkability in buffer area). Living in high-income neighborhoods and neighborhoods with higher livability scores was associated with lower BMI. Nonlinear associations were observed with neighborhood home values in all studies. Lower neighborhood home values were associated with higher BMI scores but only for values up to . The directions of associations were less consistent for walkability and share of single residents. Rank aggregation made it possible to flexibly combine the results from various studies, although between-study heterogeneity could not be estimated quantitatively based on RF models. Neighborhood social, economic, and physical environments had the strongest associations with BMI. https://doi.org/10.1289/EHP13393.

The integration of big data analytics in examining the effects of mental illness screening on mortality and burden of illness among patients with cancer.

e23083 Background: Cancer patients receiving cancer care in US hospitals undergo notable psychological suffering, characterized by manifestations of multiple psychiatric disorders and a further doubling of healthcare spending each year. The psychological burden of illness (BOI) frequently accompanies the physical obstacles of the disease, hence increasing the intricacy of cancer care. Analysis was conducted on cancer patients admitted to hospitals in the US in 2017 for the treatment of prostate (PC), cancers of the lip, oral cavity, and pharynx (CLOP), lung (LC), and leukemia. The aim was to understand better and compare the differences in mental illness screening (MIS) and its impact on these patients. Methods: We employed generalized linear models to examine the association between MIS and outcomes––BOI, such as cost, total charge, length of stay (LOS), and in-hospital mortality after controlling for clinical and patient variables. Results: Among 224,540 LC, 178,470 patients underwent MIS. This was 151,285 vs. 58,125 among PC; among CLOP, 35,770 vs. 18,495; for leukemia, this was 53,019 vs.18,759. In the adjusted analysis, MIS among the LC cohort was associated with lower length of stay—(coefficient, 0.96, 95% CI, 0.92-0.98), lower total charges, (0.94, 0.92-0.96), and lower mortality (aOR, 0.77, 95% CI, 0.73-0.82). In the LC cohort, when compared to Whites, Blacks (1.11, 1.05-1.17) and Others (Native Americans, Asians, and Others (1.1, 1.02-1.20) had longer LOS. Compared to high-income neighborhoods, low-income neighborhoods showed higher LOS (1.09, 1.03-1.153), and compared to "Central" counties of metro areas of ≥ 1 million population, Not metropolitan or micropolitan counties had a lower LOS (0.86, 0.80-0.92). Private insurance holders had lower total charges than Medicare beneficiaries (0.84, 0.81-0.88). Females, when compared to males, had a lower total charge (0.96, 0.94-0.98), and when compared to Whites, Hispanics (1.35, 1.25-1.45), and Others (1.28, 1.19-1.37) had a higher total-charges. And compared to Whites, Others had a higher in-hospital mortality (aOR, 1.16, 95% CI, 1.03-1.31). Further, the analysis was stratified into surgical and non-surgical cohorts in the LC cohort. Compared to LC, none of the other solid or liquid cancer cohorts, MIS showed no beneficial association with BOI or mortality. Conclusions: The LC cohort showed a positive association between MIS and BOI and in-hospital mortality. To provide holistic treatment for all cancer patients, including MIS as a standard practice is advantageous. This study can offer helpful information for future research on the impacts and implementation of routine mental illness screening among patients with cancer.

Mobilidade, cidadania e desigualdade: analisando a infraestrutura cicloviária do Rio de Janeiro

Abstract In this paper, the concept of citizenship is related to that of urban mobility, which unfolds in bicycle mobility. To this end, the distribution of the cycling infrastructure in the city of Rio de Janeiro, Brazil, is analyzed. The aim is to relate the socio-spatial distribution of the population in the territory to the available cycling infrastructure. The extension and quality of such infrastructure is investigated in two neighborhoods that are different both in territorial and social terms (Bangu and Copacabana). The results show a concentration of cycling infrastructure of greater extension and quality in Rio de Janeiro’s highest-income neighborhoods (Copacabana) and of lesser extension and quality in the periphery (Bangu), and the difference in existence, extension, and quality of Rio de Janeiro’s cycling infrastructures is related to greater or lesser citizenship.

Multifetal Pregnancy After Implementation of a Publicly Funded Fertility Program

A publicly funded fertility program was introduced in Ontario, Canada, in 2015 to increase access to fertility treatment. For in vitro fertilization (IVF), the program mandated an elective single-embryo transfer (eSET) policy. However, ovulation induction and intrauterine insemination (OI/IUI)-2 other common forms of fertility treatment-were more difficult to regulate in this manner. Furthermore, prior epidemiologic studies only assessed fetuses at birth and did not account for potential fetal reductions that may have been performed earlier in pregnancy. To examine the association between fertility treatment and the risk of multifetal pregnancy in a publicly funded fertility program, accounting for both fetal reductions and all live births and stillbirths. This population-based, retrospective cohort study used linked administrative health databases at ICES to examine all births and fetal reductions in Ontario, Canada, from April 1, 2006, to March 31, 2021. Mode of conception: (1) unassisted conception, (2) OI/IUI, or (3) IVF. The main outcome was multifetal pregnancy (ie, a twin or higher-order pregnancy). Modified Poisson regression generated adjusted relative risks (ARRs) and derived population attributable fractions (PAFs) for multifetal pregnancies attributable to fertility treatment. Absolute rate differences (ARDs) were used to compare the era before eSET was promoted (2006-2011) with the era after the introduction of the eSET mandate (2016-2021). Of all 1 724 899 pregnancies, 1 670 825 (96.9%) were by unassisted conception (mean [SD] maternal age, 30.6 [5.2] years), 24 395 (1.4%) by OI/IUI (mean [SD] maternal age, 33.1 [4.4] years), and 29 679 (1.7%) by IVF (mean [SD] maternal age, 35.8 [4.7] years). In contrast to unassisted conception, individuals who received OI/IUI or IVF tended to be older, reside in a high-income quintile neighborhood, or have preexisting health conditions. Multifetal pregnancy rates were 1.4% (95% CI, 1.4%-1.4%) for unassisted conception, 10.5% (95% CI, 10.2%-10.9%) after OI/IUI, and 15.5% (95% CI, 15.1%-15.9%) after IVF. Compared with unassisted conception, the ARR of any multifetal pregnancy was 7.0 (95% CI, 6.7-7.3) after OI/IUI and 9.9 (95% CI, 9.6-10.3) after IVF, with corresponding PAFs of 7.1% (95% CI, 7.1%-7.2%) and 13.4% (95% CI, 13.3%-13.4%). Between the eras of 2006 to 2011 and 2016 to 2021, multifetal pregnancy rates decreased from 12.9% to 9.1% with OI/IUI (ARD, -3.8%; 95% CI, -4.2% to -3.4%) and from 29.4% to 7.1% with IVF (ARD, -22.3%; 95% CI, -23.2% to -21.6%). In this cohort study of more than 1.7 million pregnancies in Ontario, Canada, a publicly funded IVF program mandating an eSET policy was associated with a reduction in multifetal pregnancy rates. Nevertheless, ongoing strategies are needed to decrease multifetal pregnancy, especially in those undergoing OI/IUI.

Improving Population Health and Health Equity: The Potential of Transitioning Public Open Spaces to Optimise the Production of Urban Ecological Services in Adelaide, South Australia

ABSTRACT This research examines the potential of transitioning public “green spaces” to optimise health benefiting urban ecological services in metropolitan Adelaide, South Australia. The research found strengths but also significant weaknesses. The major weaknesses observed were poor quality amenities and facilities within open spaces, low landscape complexity, poor maintenance and inadequate integration with the built form and pedestrian networks of the surrounding neighbourhoods. Previous research has shown that the weaknesses we observed are adversely affecting the health and wellbeing of many residents. In addition, our research shows there are far more strengths and fewer weaknesses in pre-1945 and high-income neighbourhoods.

161 Importance of Hospital Centrality Analysis in Brain Metastasis

INTRODUCTION: Management of patients with brain metastasis (BrM) is complex and interdisciplinary, with patients transitioning between distinct hospitals within an interconnected network at different points of their disease. Prior neurosurgical health delivery quality studies often analyze hospitals in isolation, negating the complexities of patient journey. A facility’s position in an integrated clinical network may therefore play a critical consideration in patient management and outcomes. METHODS: We selected BrM patients using ICD codes from the Healthcare Cost and Utilization Project (HCUP) inpatient and emergency department databases from Massachusetts (2018-2019). Hospitals were separated into quartiles based on connectivity, defined as sum of all weighted ties to other hospitals in MA. We compared patient and hospital characteristics across connectivity quartiles and determined impact of hospital connectivity on all-cause mortality, readmission rates, and length of stay using multivariate regression. RESULTS: A total of 4679 BrM patients were mapped across MA. While highly connected hospitals were on average larger than peripheral hospitals (p &lt; 0.001), many highly connected hospitals had a low number of patient beds. Patients who visit highly connected hospitals were more likely to live in large metropolitan areas and higher income neighborhoods, and be covered by private insurance (all p &lt; 0.001). Comorbidity scores and age were not meaningfully different between hospitals of varying connectivity scores. Hospital centrality, but not hospital volume, was inversely associated with mortality and readmissions rate, with highly connected hospitals having a lower risk of death (Q1: 2.4 (1.46-3.83); Q2: 1.6 (1.07-2.29); Q3: 1.4 (1.11-1.86); Q4 (ref)). CONCLUSIONS: We demonstrate a vital role for hospital connectedness in impacting BrM patient outcome, independent of hospital volume and patient characteristics. Structural barriers, such as insurance or patient residence, may impede patients from receiving care at highly connected hospitals.

"I Would Have My Children Participate IF …": Perceptions of Canadian Caregivers Towards School Food Programs.

Purpose: The Canadian federal government has expressed an intention to work with provinces and territories to develop a national school food program (SFP). This study aimed to explore caregivers' perception of attributes important to include in a future SFP.Methods: An online cross-sectional survey was conducted. Fifteen elementary schools from high, medium, or low median income neighbourhoods in Saskatoon were invited to participate. School principals sent a survey link to students' caregivers. The 37-item survey included an item with 15 statements asking caregivers to rate the importance of various components of a SFP. Descriptive statistics and exploratory factor analysis were conducted.Results: A total of 510 caregivers completed the survey (response rate of 52%). The factor analysis indicated four key components of a future SFP: (1) learning opportunities on growing and preparing food, (2) offering healthy food following Canada's Food Guide, (3) affordability of the meals offered, and (4) cultural adaptability of the meal program. Over 90% of caregivers thought providing healthy meals and ample time to eat meals to be very important.Conclusion: Our results indicate caregivers support multicomponent meal programs that, along with providing nutritious food, help children build healthy habits and sustainable food systems. These findings will help dietitians understand caregivers' perspectives to inform the design of a national SFP.

Community testing practices for autism within the autism and developmental disabilities monitoring network.

No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. Data are from the Autism and Developmental Disabilities Monitoring Network, a multi-site surveillance system reporting prevalence estimates and characteristics of 8-year-old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. Of 5058 8-year-old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI-R test. Overall, 115 children (2.3%) had both the ADOS and ADI-R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4-66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6-43.2%). Children in low-income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co-occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices.