Higher Levels Of Social Vulnerability Research Articles

Integrating social vulnerability into high-resolution global flood risk mapping

High-resolution global flood risk maps are increasingly used to inform disaster risk planning and response, particularly in lower income countries with limited data or capacity. However, current approaches do not adequately account for spatial variation in social vulnerability, which is a key determinant of variation in outcomes for exposed populations. Here we integrate annual average exceedance probability estimates from a high-resolution fluvial flood model with gridded population and poverty data to create a global vulnerability-adjusted risk index for flooding (VARI Flood) at 90-meter resolution. The index provides estimates of relative risk within or between countries and changes how we understand the geography of risk by identifying ‘hotspots’ characterised by high population density and high levels of social vulnerability. This approach, which emphasises risks to human well-being, could be used as a complement to traditional population or asset-centred approaches.

Birth Prevalence of Sickle Cell Disease and County-Level Social Vulnerability - Sickle Cell Data Collection Program, 11 States, 2016-2020.

Sickle cell disease (SCD) remains a public health priority in the United States because of its association with complex health needs, reduced life expectancy, lifelong disabilities, and high cost of care. A cross-sectional analysis was conducted to calculate the crude and race-specific birth prevalence for SCD using state newborn screening program records during 2016-2020 from 11 Sickle Cell Data Collection program states. The percentage distribution of birth mother residence within Social Vulnerability Index quartiles was derived. Among 3,305 newborns with confirmed SCD (including 57% with homozygous hemoglobin S or sickle β-null thalassemia across 11 states, 90% of whom were Black or African American [Black], and 4% of whom were Hispanic or Latino), the crude SCD birth prevalence was 4.83 per 10,000 (one in every 2,070) live births and 28.54 per 10,000 (one in every 350) non-Hispanic Black newborns. Approximately two thirds (67%) of mothers of newborns with SCD lived in counties with high or very high levels of social vulnerability; most mothers lived in counties with high or very high levels of vulnerability for racial and ethnic minority status (89%) and housing type and transportation (64%) themes. These findings can guide public health, health care systems, and community program planning and implementation that address social determinants of health for infants with SCD. Implementation of tailored interventions, including increasing access to transportation, improving housing, and advancing equity in high vulnerability areas, could facilitate care and improve health outcomes for children with SCD.

Assessing Social Vulnerability to Coastal Hazards: A Case Study of Bandar Lampung City Coastal Area

Bandar Lampung City’s coastal area is highly susceptible to coastal hazards due to its location within the subduction zone of the Indo-Australian and Eurasian tectonic plates. Additionally, the presence of the Anak Krakatau volcano in the Sunda Strait further increases the vulnerability of the city’s coast to natural disasters. This study analyses the current social vulnerability in the coastal area of Bandar Lampung City. The aim is to provide a starting point for disaster management and policy planning in the city. To determine the level of social vulnerability in the coastal area of Bandar Lampung City, social vulnerability mapping is conducted by overlaying four indices: population, population density, sex ratio, and dependency ratio. The data indicates that there is significant variation in the level of social vulnerability among the coastal areas of Bandar Lampung City. Specifically, 8 out of 25 villages in the coastal area of Bandar Lampung City exhibit high levels of social vulnerability. The villages of Bumi Waras, Pesawahan, and Keteguhan have the highest levels of social vulnerability in the coastal area of Bandar Lampung City. As revealed by this study, the indicators of population size and dependency ratio have the most significant impact on the level of social vulnerability. These findings are expected to provide valuable input to stakeholders in their efforts to reduce social vulnerability in coastal areas.

The Influence of Social Vulnerability and Culture on Physical Inactivity in the United States – Identifying Hot Spots in Need of Attention

BackgroundIn the United States, ongoing efforts to increase individual- and population-level physical activity have made little to no progress over the past decade in reducing the percentage of individuals who report no leisure-time physical activity. The purpose of the current study is to further assess the relationship between social vulnerability and the prevalence of physical inactivity at the county level. MethodsWe merged county-level data on physical inactivity prevalence, the Social Vulnerability Index (SVI), and the American Nations regional cultures schematic. ResultsPhysical inactivity significantly correlated (P < .001) with the overall SVI score and all subtheme scores to varying levels of strength. Clear and statistically significant heterogeneity in the SVI scores was apparent across distinct regions using the American Nations model, consistent with previously demonstrated patterns of physical inactivity prevalence. ConclusionsOn a national level, physical inactivity prevalence is unacceptably high and has not appreciably improved over the past decade. Within the United States, high levels of social vulnerability and physical inactivity are concentrated within specific geographic regions that need tailored solutions to resolve health disparities.

Are Depression and Anxiety Underdiagnosed in Socially Vulnerable Patients With Inflammatory Bowel Disease?

Depression and anxiety are highly prevalent among individuals with inflammatory bowel disease (IBD); however, little is understood about how social determinants of health (SDOH) may impact mental health diagnoses in this population. The social vulnerability index (SVI) is a publicly available tool that can be used to study SDOH in IBD patients. Home addresses from a retrospective cohort of IBD patients at a single center were used to geocode patients to their individual census tract and corresponding SVI. We used multivariable logistic regression to examine the relationship between SVI and comorbid mental health diagnoses in patients with IBD. Secondarily, data from standardized health questionnaires were then used to determine if patients were adequately screened for depression and anxiety. In all, 9644 patients were included; 18% had a diagnosis of depression, 21% anxiety, and 32% had a composite of "any mental health diagnosis." Depression (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.02-1.56) but not anxiety (OR, 0.87; 95% CI, 0.71-1.06) nor "any mental health diagnosis" (OR, 1.09; 95% CI, 0.92-1.30) was associated with higher levels of social vulnerability. However, overall rates of screening for depression and anxiety were low (15% and 8%, respectively), with the lowest screening rates among the most socially vulnerable (depression 8.2%, anxiety 6.3%). Disparities in the diagnoses of depression and anxiety for socially vulnerable patients with IBD exist. Awareness of these inequities is the first step toward developing interventions to improve mental health screening, eliminate barriers and bias, and promote referrals for appropriate mental health management.

Association between social vulnerability factors and unintentional fatal injury rates – United States, 2015–2019

Background: Differences in social and environmental factors can contribute to disparities in fatal injury rates. The purpose of this study was to examine the relationship between social and environmental factors and unintentional fatal injury across counties in the United States and how this relationship varies by geography. Methods: County-level vital statistics on age-adjusted unintentional fatal injury rates for 2015–2019 were linked with county-level data from the 2018 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted linear regression to examine the association between SVI and unintentional fatal injury, overall and by Census region/division. We mapped county-level data for SVI and unintentional fatal injury rates in bivariate choropleth maps using quartiles. Results: SVI was positively associated with unintentional fatal injury (β = 18.29, p < 0.001) across U.S. counties. The geographic distribution of SVI and unintentional fatal injury rates varied spatially and substantially for U.S. counties, with counties in the South and West regions having the greatest levels of SVI and rates of unintentional fatal injury. Conclusions: Our findings demonstrate that the social vulnerability of counties is associated with unintentional fatal injury rates. Modification of the SVI for injury research could include additional social determinants and exclude variables not applicable to injuries. A modified SVI could inform unintentional injury prevention strategies by prioritizing efforts in areas with high levels of social vulnerability. Practical Applications: This study is the first step in combining the SVI and injury mortality data to provide researchers with an index to investigate upstream factors related to injury.

Integrating equity, climate risks, and population growth for targeting conservation planning

Where landowners, non-profit organizations, and government agencies prioritize conservation activities has significant implications for people, ecosystems, and climate resilience. Our study builds on conservation decision-making scholarship by analyzing the relationships between biodiversity priorities, social vulnerability, climate risks, and projected population growth in Texas to identify geographies that simultaneously support multiple goals. Drawing from publicly available datasets, we show the potential for existing conservation priorities to exacerbate the inequitable distribution of environmental goods and services, especially for lower-income residents, communities of color, and socially vulnerable populations. Using bivariate local indicators of spatial autocorrelation, we demonstrate effective ways to avoid negative social impacts by identifying synergistic locations with high levels of social vulnerability and biodiverse landscapes. We overlay these locations with climate risks to further prioritize areas that could meet biodiversity, social vulnerability, and climate adaptation needs. Lastly, we consider how future population growth may inform the urgency of conservation activities given potential development pressures. Our study contributes to academic and policy debates seeking to jointly address biodiversity conservation, climate change, and environmental justice concerns.

Disparities in Hand Surgery Exist in Unexpected Populations.

Background The purpose of our study is to investigate disparities in the patient populations and outcomes of carpal tunnel release (CTR) and trigger finger release (TFR). Methods A retrospective review of 777 CTR and 395 TFR patients from May 2021 to August 2022 was completed. The shortened form of the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (QuickDASH) was recorded to evaluate physical function preoperatively and at one and three months postoperatively. This study was deemed institutional review board-exempt by the institutional clinical research committee. Results Compared to CTR, TFR patients resided in zip codes with higher levels of social vulnerability across dimensions of 'household composition and disability' (p=0.018) and 'minority status and language' (p=0.043). When analyzing QuickDASH scores by demographics and procedure, preoperative scores were statistically significantly higher for non-married (p=0.002), White (p=0.003), and female sex (p=0.001) CTR patients. Further, one-month postoperative scores were statistically higher for White and non-married CTR patients (0.016 and 0.015, respectively). At three months postoperatively, female and non-married patients had statistically significant higher scores (0.010 and 0.037, respectively). In TFR patients, one-month postoperative QuickDASH scores for White and female patients were statistically significantly higher (0.018 and 0.007, respectively). There were no significant differences in QuickDASH scores between rural and non-rural patients, household income (HHI) above or below the median, or the Social Vulnerability Index (SVI) dimensions. Conclusion Our study found marital status, sex, and race were associated with disparities in pre-and postoperative physical function in patients undergoing carpal tunnel or trigger finger release. However, future studies are warranted to confirm and develop solutions to disparities within this population.

Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population

To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries. Retrospective cross-sectional study. 2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage. The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration. Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma. Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR]=0.83; 95% confidence interval [CI]=0.82, 0.84 for Q4 vs. Q1), POAG (aOR=0.85; 95% CI=0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR=0.59; 95% CI=0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR=1.19; 95% CI=1.12, 1.26 for Q4 vs. Q1), MIGS (aOR=1.24; 95% CI=1.15, 1.33 for Q4 vs. Q1), and CPC (aOR=1.49; 95% CI=1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile. In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Is adaptation planning effective and for whom? The case of Louisiana’s 2017 Comprehensive Master Plan for a Sustainable Coast

ABSTRACT Flooding in the United States impacts over 40 million people, disproportionately affecting low-income and non-white communities, while costing at least $8 billion annually. Large scale response-based plans have become popular adaptation tools; however, there are limited analyses of their effectiveness and equity. The State of Louisiana’s 2017 Comprehensive Master Plan for a Sustainable Coast outlines billions of dollars worth of investments into coastal restoration and adaptation projects with the aim to protect the unique communities and cultures of coastal Louisiana. We reviewed the Plan’s storm surge flood-depth modeling to determine the expected beneficiaries of implemented projects and the degree to which the Plan achieves its goals of protecting unique communities and cultures. We constructed two descriptive statistical tests of Master Plan data. We find the Plan is effective at reducing flooding across the region, relative to a future without it. However, racialized populations within areas with high levels of social vulnerability are disproportionately negatively affected or not affected at all. We conclude that the Master Plan is unevenly effective and equitable for the diverse communities of coastal Louisiana. Key planning implications Louisiana’s 2017 coastal Master Plan fails to fully address existing flood hazards. Where the Master Plan does address flood hazards, it does so unevenly, across existing lines of vulnerability and race. The Master Plan reduces risk for some people but not all, creating winners and losers from adaptation projects. Our findings highlight a persistent issue where the lack of analyses pre- and post-implementation of adaptation plans reproduces maladaptive patterns.

Social determinants of neurocognitive and academic performance in sickle cell disease.

Sickle cell disease (SCD) is associated with poor neurocognitive outcomes due to biomedical and psychosocial factors. The aims of this study were to investigate associations between household and neighborhood socioeconomic status (SES) with cognitive and academic outcomes in SCD and to determine if these relationships were modified by sickle genotype, fetal hemoglobin, or age. We prospectively recruited patients to complete a battery of neurocognitive and academic measures. Household SES was measured using the Barratt Simplified Measure of Social Status, a composite index of parent education and occupation. The Social Vulnerability Index was used to classify individuals based on social vulnerabilities at the neighborhood level. Overall, 299 patients between the ages of 4 and 18 (mean=11.4, standard deviation=4.3) years diagnosed with SCD (57% SS/SB0 -thalassemia) completed testing. Stepwise multivariate models demonstrated that patients with low social vulnerability (i.e., high SES) at the neighborhood level displayed intelligence and math scores that were 4.70 and 7.64 points higher than those living in areas with moderate social vulnerability, respectively (p<.05). Reading performance did not differ based on neighborhood SES; however, the effect of neighborhood SES was dependent on age, such that older participants living in neighborhoods with moderate or high levels of social vulnerability displayed poorer reading scores than those with low social vulnerability (p<.05). This study identified patients with SCD at higher risk of poor academic performance based on SES. Interventions addressing academic difficulties should be offered to all children with SCD, but should be emergently offered to this subpopulation.

Examining the Optimal Placement of Cooling Centers to Serve Populations at High Risk of Extreme Heat Exposure in 81 US Cities.

Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.

Disparities in SARS-CoV-2 Infection by Race, Ethnicity, Language, and Social Vulnerability: Evidence from a Citywide Seroprevalence Study in Massachusetts, USA

ObjectivesUncovering and addressing disparities in infectious disease outbreaks require a rapid, methodical understanding of local epidemiology. We conducted a seroprevalence study of SARS-CoV-2 infection in Holyoke, Massachusetts, a majority Hispanic city with high levels of socio-economic disadvantage to estimate seroprevalence and identify disparities in SARS-CoV-2 infection.MethodsWe invited 2000 randomly sampled households between 11/5/2020 and 12/31/2020 to complete questionnaires and provide dried blood spots for SARS-CoV-2 antibody testing. We calculated seroprevalence based on the presence of IgG antibodies using a weighted Bayesian procedure that incorporated uncertainty in antibody test sensitivity and specificity and accounted for household clustering.ResultsTwo hundred eighty households including 472 individuals were enrolled. Three hundred twenty-eight individuals underwent antibody testing. Citywide seroprevalence of SARS-CoV-2 IgG was 13.1% (95% CI 6.9–22.3) compared to 9.8% of the population infected based on publicly reported cases. Seroprevalence was 16.1% (95% CI 6.2–31.8) among Hispanic individuals compared to 9.4% (95% CI 4.6–16.4) among non-Hispanic white individuals. Seroprevalence was higher among Spanish-speaking households (21.9%; 95% CI 8.3–43.9) compared to English-speaking households (10.2%; 95% CI 5.2–18.0) and among individuals in high social vulnerability index (SVI) areas based on the CDC SVI (14.4%; 95% CI 7.1–25.5) compared to low SVI areas (8.2%; 95% CI 3.1–16.9).ConclusionsThe SARS-CoV-2 IgG seroprevalence in a city with high levels of social vulnerability was 13.1% during the pre-vaccination period of the COVID-19 pandemic. Hispanic individuals and individuals in communities characterized by high SVI were at the highest risk of infection. Public health interventions should be designed to ensure that individuals in high social vulnerability communities have access to the tools to combat COVID-19.

Identifying need for spay and neuter services: A GIS-based analysis

Abstract This study provides a method for assessing the need for spay and neuter services in Massachusetts by creating a composite index that accounts for spatial accessibility and social vulnerability. An accessibility index (AI) of existing low-cost spay/neuter (S/N) facilities was created using the two-step floating catchment area (2SFCA) method which was then combined with the social vulnerability index (SVI) from the Centers for Disease Control and Prevention to create a need index (NI). Two methods for selecting the final target areas from the NI results were examined and used to make recommendations for S/N funding allocation. The construction of the NI (i.e. factors included or weights applied to factors) had a significant impact on the results. The NI displayed statistically significant spatial autocorrelation, and hot spot analysis revealed statistically significant clusters of comparatively high- and low-need regions in the state. The target areas identified were strongly influenced by high levels of social vulnerability in urban areas and low spatial accessibility of low-cost S/N facilities in more rural western Massachusetts. The results of this project demonstrate the utility of geographic information systems (GIS)-based analysis in veterinary and shelter medicine, as well as the potential for the use of non-veterinary specific data, such as the CDC SVI, when planning the equitable distribution of limited resources. One Health impact statement Providing spay and neuter (S/N) services to owned and free-roaming cats, dogs and other companion animal species is integral to the health and well-being of the animals themselves. Their human companions also reap the physical and mental health benefits of the human–animal bond, in addition to the environmental and public health impact of limiting free-roaming dog and cat populations. By recognizing the relationships between human and animal populations, existing gaps in need can be addressed through the use of human data to inform decisions on animal health when relevant animal health service data are lacking. A composite index of factors accounting for the social vulnerability was combined with the spatial accessibility of existing S/N resources to create a final index of need for S/N resources. This transdisciplinary approach takes methodologies from public health, acknowledges the impact of the vulnerability of human populations on surrounding companion animal populations, and applies a practical method of identifying the need for specific veterinary medical services.

Developing a social vulnerability to environmental hazards index to inform climate action in Ireland

Ireland faces a wide range of impacts from climate change including increases in fluvial, pluvial and coastal flooding, coastal erosion and heat waves. In Ireland, there has been research undertaken to assess the spatial distribution of some these hazards, for example, the OPW Catchment Flood Risk Assessment and Management programme. However, these assessments do not take into account thatsome individuals or groups are disproportionately affected by climate change as they have less capacity to prepare for, respond to, and recover from climate-related hazards and effects. This concept is termed social vulnerability. Therefore, to support Ireland’stransition to a climate resilient, low carbon society and economy that is inclusive and just, consideration of those groups with high levels of social vulnerability needs to be considered in any risk assessments. In response to this need, the Irish Social Vulnerability to Environmental Hazards Index (ISVEHI) has been developed to map the distribution of social vulnerability to environmental hazards. The ISVEHI has been developed on the basis of CSO data and identified that approximately 772,000 (23%) people and 437,000 (26%) households have levels of social vulnerability above the national average. This information can inform climate action, spatial planning and economic and community planning at a local authority level, to reduce risk from environmental hazards and support Ireland in a just transition to a sustainable and resilient future.

Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States.

Prior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM. Patients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone. Among 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38). An exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations.

The role of families in the response of inclusive schools: A case study from teacher’s perspectives

Some families identified as being at risk, including families of immigrant origin, demonstrate a lower degree of participation in school communities. This constitutes a major challenge for educational institutions. In this research, a case study including three public schools affected by school segregation was carried out. The aim was to analyze and disseminate teachers’ experiences and contributions around the question of family-school relationships, particularly measures they take to promote the participation of families in the daily life of schools. This included a particular focus on schools characterized by high degree of segregation and pupils with higher levels of social vulnerability. The study was carried out as a multi-local ethnographic project in three schools in the Basque Country, Spain, through participant observation, interviews, and focus groups with teachers, pupils, school leadership teams and psycho-pedagogical teams. The results obtained show that schools condition the participation of families, especially those most at risk, and that this has an impact on the socio-emotional development of children. They also highlight the importance of building communication and relationship channels between families and schools. In the current age of globalization, the need to create a network of collaborative and trusting relationships between families and teachers is more evident than ever. Only by these means can children be properly supported to achieve their maximum potential.

Testicular torsion disparities in the pediatric population

BackgroundThere are disparate findings in the literature on the impact of race and insurance status on gonadal loss in testicular torsion. We sought to determine if race or levels of social vulnerability influence the rate of torsion or gonadal loss. MethodsRetrospective cross-sectional review between December 2017 and September 2019. Social vulnerability index was dichotomized using the 75th percentile. Primary outcome was the diagnosis of testicular torsion. Results515 patients were included. There was no difference in median age, torsion diagnosis, and orchiectomy rate between the two institutions. Black/African American patients were >3 times more likely than Caucasian patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age (OR 3.39, 95% CI 1.74 - 6.61, p < 0.01). ConclusionBlack/African American children have an increased risk of testicular torsion. Despite these patients having higher levels of social vulnerability, it was not associated.

Duration of Behavioral Policy Interventions and Incidence of COVID-19 by Social Vulnerability of US Counties, April-December 2020.

State-issued behavioral policy interventions (BPIs) can limit community spread of COVID-19, but their effects on COVID-19 transmission may vary by level of social vulnerability in the community. We examined the association between the duration of BPIs and the incidence of COVID-19 across levels of social vulnerability in US counties. We used COVID-19 case counts from USAFacts and policy data on BPIs (face mask mandates, stay-at-home orders, gathering bans) in place from April through December 2020 and the 2018 Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention. We conducted multilevel linear regression to estimate the associations between duration of each BPI and monthly incidence of COVID-19 (cases per 100 000 population) by SVI quartiles (grouped as low, moderate low, moderate high, and high social vulnerability) for 3141 US counties. Having a BPI in place for longer durations (ie, ≥2 months) was associated with lower incidence of COVID-19 compared with having a BPI in place for <1 month. Compared with having no BPI in place or a BPI in place for <1 month, differences in marginal mean monthly incidence of COVID-19 per 100 000 population for a BPI in place for ≥2 months ranged from -4 cases in counties with low SVI to -401 cases in counties with high SVI for face mask mandates, from -31 cases in counties with low SVI to -208 cases in counties with high SVI for stay-at-home orders, and from -227 cases in counties with low SVI to -628 cases in counties with high SVI for gathering bans. Establishing COVID-19 prevention measures for longer durations may help reduce COVID-19 transmission, especially in communities with high levels of social vulnerability.

Disparities in Care Access to Liver-Directed Therapy Among Medicare Beneficiaries with Colorectal Cancer Liver Metastasis.

BackgroundLiver-directed therapies (LDT) are important components of the multidisciplinary care of patients with colorectal cancer liver metastases (CRCLM) that contribute to improved long-term outcomes. Factors associated with receipt of LDT are poorly understood.Patients and MethodsPatients > 65 years old diagnosed with CRCLM were identified within the Medicare Standard Analytic File (2013–2017). Patients with extrahepatic metastatic disease were excluded. Mixed-effects analyses were used to assess patient factors associated with the primary outcome of LDT, defined as hepatectomy, ablation, and/or hepatic artery infusion chemotherapy (HAIC), as well as the secondary outcome of hepatectomy.ResultsAmong 23,484 patients with isolated CRCLM, only 2004 (8.5%) received LDT, although resectability status could not be determined for the entire cohort. Among patients who received LDT, 61.7% underwent hepatectomy alone, 28.1% received ablation alone, 8.5% underwent hepatectomy and ablation, and 1.8% received HAIC either alone (0.8%) or in combination with hepatectomy and/or ablation (0.9%). Patient factors independently associated with lower odds of LDT included older age, female sex, Black race, greater comorbidity burden, higher social vulnerability index, primary rectal cancer, synchronous liver metastasis, and further distance from a high-volume liver surgery center (p < 0.05). Results were similar for receipt of hepatectomy.ConclusionsDespite the well-accepted role of LDT for CRCLM, only a small proportion of Medicare beneficiaries with CRCLM receive LDT. Increasing access to specialized centers with expertise in LDT, particularly for Black patients, female patients, and those with higher levels of social vulnerability or long travel distances, may improve outcomes for patients with CRCLM.