Higher Median Household Income Research Articles

Predictors of Patient-Related Cancellations and No-Shows for Pediatric Orthopaedics and Sports Medicine Appointments Are Condition Specific

Background: Visit cancellations have detrimental effects on patient health and reduce clinic productivity. We sought to understand the factors that influence cancellation rates across the major subspecialties in pediatric orthopaedics and sports medicine (OSM).Methods: In-person OSM visits from a high-volume multi-site academic pediatric hospital (01/01/2019-02/28/2020) were used to study the effect of patient demographics, distance to clinic, insurance type, visit type (new vs. follow-up) on visit cancellation (canceled by patient and no-shows). When available, chief complaint was used to categorize visits into major subspecialties: cerebral palsy, foot and ankle, hip, knee, other lower extremity, spine, and upper extremity. Logistic regression was used to identify contributors to the visit cancellations in a multivariate model.Results: 424,397 visits (15.9% canceled) were included in the analysis. Based on the multivariate analysis, being non-white (OR=1.139), Hispanic (OR=1.133), older age (OR=1.007), female (OR=1.046), living farther from clinic (OR=1.002), and having public insurance (OR=1.163) were associated with higher cancellations, whereas median household income (OR=0.994, per $10,000) and new visit (OR=0.969) were associated with lower cancellations (P<0.04). 241,305 visits were categorized into subspecialties. The effects of studied patient-related factors and visit types on cancellations were highly variable across subspecialties. When significant, having public insurance and living farther from the clinic were consistently associated with higher rates of cancellations, while being a non-English speaker and having a new visit were associated with lower rates of cancellation. The remaining factors showed variable effects.Conclusion: Disparities exist in patient-related visit cancellations in pediatric and young-adult OSM with different patterns across major OSM subspecialties. These findings highlight the importance of looking at these specific orthopedic conditions separately to develop more effective strategies to improve patient compliance and efficiently utilize healthcare resources.Level of Evidence: Level IIIKey Concepts•Across all pediatric and young-adult OSM visits, being non-white, Hispanic, female, living farther from clinic, and having public insurance were associated with higher odds of cancellation.•While disparities exist in patient-related visit OSM care, the factors that influence cancellation in specific subspecialties are varied and complex.•Further research that looks at specific orthopedic conditions separately will improve efficiency and effectiveness of care and increasing patient compliance.

Hemophagocytic lymphohistiocytosis in inflammatory bowel disease: a nationwide analysis.

Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening immune dysregulation disease. Patients with inflammatory bowel disease (IBD) can become profoundly immunocompromised due to immunosuppressive therapy, hence increasing the risk of viral infections that can trigger HLH. However, data on the association between IBD and HLH remains limited. We used data from the National Inpatient Sample (2012-2019) utilizing International Classification of Diseases (ICD)-9 or ICD-10 codes to identify individuals with IBD, either Crohn's disease (CD) or ulcerative colitis (UC), and HLH. The primary outcome was to compare the prevalence of HLH among patients with IBD with those without IBD. Secondary outcomes included in-hospital mortality, mean hospital length of stay, and description of HLH-associated triggers in IBD patients. A total of 513,322 hospitalizations included a diagnosis of IBD, 188,297 had UC and 325,025 had CD. Compared to the general population, patients with IBD were older (median age of 52 vs. 49years, p < 0.05), more likely to be male, and of Asian/Pacific Islander descent, and had a higher median household income. There was also a higher prevalence of liver disease, autoimmune diseases, tobacco abuse, and hypothyroidism (all had p-value of < 0.001) in IBD patients. There were 94 hospitalizations identified with a diagnosis of HLH in IBD patients. Compared to patients without IBD, patients with IBD had increased odds of developing HLH (0.02% vs 0.01%, p-value < 0.001). After adjusting for various demographic characteristics, co-morbidities, and HLH-related conditions, IBD was an independent predictor for developing HLH (adjusted OR, 2.3; 95% CI, 1.847-2.866, p-value of < 0.001). There was no statistical difference between CD and UC in the odds of developing HLH. Compared to IBD patients without HLH, patients with IBD and HLH had a lower mean age at diagnosis (38 vs 52, p-value of < 0.001), higher in-hospital mortality (14.9% vs 1.5%, p-value of < 0.001), and longer mean hospital length of stay (days) (17 vs 5.4, p-value of < 0.001). Prevalence of different HLH-associated illnesses was identified in HLH patient's discharge data. Lymphoma was the most common associated malignancy (18.1%) and cytomegalovirus infection was the most common associated infection (16.0%). Our population-based study suggests that IBD is independently associated with developing HLH. Early recognition of IBD patients presenting with features suggestive of HLH is warranted to aide early diagnosis and aggressive treatment.

Socioeconomic disparity in the association between fine particulate matter exposure and papillary thyroid cancer

BackgroundLimited data exists suggesting that cumulative exposure to air pollution in the form of fine particulate matter (aerodynamic diameter ≤ 2.5 μm [PM2.5]) may be associated with papillary thyroid carcinoma (PTC), although this relationship has not been widely established. This study aims to evaluate the association between PM2.5 and PTC and determine the subgroups of patients who are at the highest risk of PTC diagnosis.MethodsUnder IRB approval, we conducted a case-control study of adult patients (age ≥ 18) newly diagnosed with PTC between 1/2013–12/2016 across a single health care system were identified using electronic medical records. These patients were compared to a control group of patients without any evidence of thyroid disease. Cumulative PM2.5 exposure was calculated for each patient using a deep learning neural networks model, which incorporated meteorological and satellite-based measurements at the patients’ residential zip code. Adjusted multivariate logistic regression was used to quantify the association between cumulative PM2.5 exposure and PTC diagnosis. We tested whether this association differed by gender, race, BMI, smoking history, current alcohol use, and median household income.ResultsA cohort of 1990 patients with PTC and a control group of 6919 patients without thyroid disease were identified. Compared to the control group, patients with PTC were more likely to be older (51.2 vs. 48.8 years), female (75.5% vs 46.8%), White (75.2% vs. 61.6%), and never smokers (71.1% vs. 58.4%) (p < 0.001). After adjusting for age, sex, race, BMI, current alcohol use, median household income, current smoking status, hypertension, diabetes, COPD, and asthma, 3-year cumulative PM2.5 exposure was associated with a 1.41-fold increased odds of PTC diagnosis (95%CI: 1.23–1.62). This association varied by median household income (p-interaction =0.03). Compared to those with a median annual household income <$50,000, patients with a median annual household income between $50,000 and < $100,000 had a 43% increased risk of PTC diagnosis (aOR = 1.43, 95%CI: 1.19–1.72), and patients with median household income ≥$100,000 had a 77% increased risk of PTC diagnosis (aOR = 1.77, 95%CI: 1.37–2.29).ConclusionsCumulative exposure to PM2.5 over 3 years was significantly associated with the diagnosis of PTC. This association was most pronounced in those with a high median household income, suggesting a difference in access to care among socioeconomic groups.

Racial, Ethnic, and Socioeconomic Inequities in Access to Left Atrial Appendage Occlusion.

Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code-level racial, ethnic, and socioeconomic composition and age-adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non-LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197-$1629], P=0.01). Zip code-level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%-0.35%) lower for each $1000 zip code-level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients. Conclusions Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age-adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.

The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status

Although socioeconomic disparities in outcomes of peripheral arterial disease (PAD) have been well studied, little is known about relationship between severity of PAD and socioeconomic status. The objective of this study was to examine this relationship. Patients who had operations for severe PAD (rest pain or tissue loss) were identified in the National Inpatient Sample, 2005 - 2014. They were stratified by the median household income (MHI) quartiles of their residential ZIP codes. Other characteristics such as race/ethnicity and insurance type were extracted. Factors associated with more severe disease (tissue loss) were evaluated using multivariable regression analyses. There were 765,175 patients identified; 34% in the 1st MHI quartile and 18% in the 4th MHI quartile. Compared to patients in the 1st quartile, those in the 4th quartile were more likely White (69% vs. 42%, P <0.001), more likely ≥65 years old (75% vs. 62%, P <0.001), and were less likely to undergo amputations (25% vs. 34%, P <0.001). After adjusting for patient characteristics, the 4th quartile was associated with more severe disease [Odds ratio: 1.19, 95% CI: 1.11 - 1.27] compared to the 1st quartile.. While higher MHI was associated with higher PAD severity, patients with high MHI were less likely to undergo amputations indicating a disparity in the choice of treatment for PAD. Increased efforts are necessary to reduce socioeconomic disparities in the treatment of severe PAD.

Factors Associated with Follow-Up Adherence After Teleophthalmology for Diabetic Eye Screening Before and During the COVID-19 Pandemic.

Abstract Background: Follow-up adherence with in-person care is critical for achieving improved clinical outcomes in telemedicine screening programs. We sought to quantify the impact of the COVID-19 pandemic upon follow-up adherence and factors associated with follow-up adherence after teleophthalmology for diabetic eye screening. Methods: We retrospectively reviewed medical records of adults screened in a clinical teleophthalmology program at urban and rural primary care clinics between May 2015 and December 2020. We defined follow-up adherence as medical record documentation of an in-person eye exam within 1 year among patients referred for further care. Regression models were used to identify factors associated with follow-up adherence. Results: Among 948 patients, 925 (97.6%) had health insurance and 170 (17.9%) were referred for follow-up. Follow-up adherence declined from 62.7% (n = 52) prepandemic to 46.0% (n = 40) during the pandemic (p = 0.04). There was a significant decline in follow-up adherence among patients from rural (p < 0.001), but not urban (p = 0.72) primary care clinics. Higher median household income (odds ratio [OR] 1.68, 95% confidence interval [CI]: 1.19-2.36) and obtaining care from an urban clinic (OR 5.29, 95% CI: 2.09-13.43) were associated with greater likelihood of follow-up during the pandemic. Discussion: Follow-up adherence remains limited after teleophthalmology screening even in a highly insured patient population, with a further decline observed during the COVID-19 pandemic. Our results suggest that rural patients and those with lower socioeconomic status experienced greater barriers to follow-up eye care during the COVID-19 pandemic. Conclusions: Addressing barriers to in-person follow-up care is needed to effectively improve clinical outcomes after teleophthalmology screening.

Influence of High School Socioeconomic Status on Athlete Injuries during the COVID-19 Pandemic: An Ecological Study.

It is presently unclear how the cessation of high school sport has affected injury incidence at different socioeconomic levels. The COVID-19 pandemic may have disproportionately affected athletes of lower socioeconomic status, potentially increasing injury risk in this population. To 1) Describe athlete injury incidence prior to and during the 2019-2020 and 2020-2021 school years in high school athletes by socioeconomic status; 2) Investigate the association between socioeconomic status and injury incidence in high school athletes. Ecological Study. High schools were matched between the 2019-2020 and 2020-2021 school years. All athletes from all sports were included. High school socioeconomic status was determined by the school district median household income. Socioeconomic strata were defined as <$30,000, $30,000-50,000, $50,001-100,000, and >$100,000. Injury incidence proportion with 95% confidence interval (95% CI) was calculated for each academic year. Mixed effects negative binomial models with robust errors were performed to assess the association between the incidence proportion ratio and high school median household income. Six states and 176 high schools were included (2019-2020: 98,487 athletes; 2020-2021: 72,521 athletes). Injury incidence increased in three of four socioeconomic strata during the 2020-2021 year (<$30,000: 2019-2020: 15.6 (13.1-18.1), 2020-2021: 26.3 (23.1-29.6); $30,000-50,000: 2019-2020: 7.8 (7.1-8.6), 2020-2021: 14.9 (13.8-15.9); $50,001-100,000: 2019-2020: 15.1 (14.7-15.4), 2020-2021: 21.3 (20.9-21.8); >$100,000: 2019-2020: 18.4 (18.1-18.8), 2020-2021: 17.3 (16.8-17.7)). An association was observed between injury incidence ratio and log median high school household income in 2019-2020 [1.6 (1.1-2.5)] but not 2020-2021 [1.1 (0.8-1.6)] school years. Athletes from lower socioeconomic high schools reported increased injury incidence compared to higher socioeconomic high schools during the 2020-2021 academic school year. These results highlight the increased COVID-19 pandemic vulnerability in athletes from lower socioeconomic high schools. High school sport stakeholders should consider how abrupt sport stoppage can affect lower socioeconomic athletes. 2.

Evaluating the Effect of Socioeconomic Status on Complex Abdominal Wall Reconstruction Outcomes.

In complex abdominal wall reconstruction, maintenance and follow-up are vital to effective long-term patient care. This can present a challenge for individuals from a low-income household who may have less ability to afford time away from work or caring for dependents as well as challenges with transportation to and from follow-up appointments. Given the expenses and high complication rate in abdominal wall reconstruction, we elected to determine whether socioeconomic status had an impact on patient outcomes. After obtaining institutional review board approval, all patients who underwent complex abdominal wall reconstruction between 2002 and 2021 by the senior author were reviewed in a retrospective cohort analysis of a prospectively maintained database. Complications were classified into overall, major, infection, and delayed wound healing. Outcomes were classified into recurrence and reoperation. The cohort was divided by median household income (MHI) level and race. A total of 478 patients received complex abdominal wall repair over a 19-year interval. A total of 324 patients identified MHI as <$75,000 (low MHI), and 154 patients identified MHI as > $75,000 (high MHI). Mean patient age was 53.9 (SD, 12.3) years. Mean patient body mass index (BMI) was 32.1 (SD, 7.8) kg/m 2 . There was no significant difference in age between the 2 MHI cohorts. There was a significant difference in BMI between MHI cohorts, with higher BMI among patients with low MHI ( P = 0.0001). The majority of risk factors and surgical techniques were comparable. There was a statistically significant difference in hernia etiology, with higher rates of recurrent hernia repair among patients with low MHI ( P = 0.007). The risk of overall complications ( P = 0.0307) and delayed wound healing ( P = 0.0263) was higher among patients with low MHI. Median household income was found to be an independent risk factor for complications after controlling for BMI, diabetes mellitus, and hernia etiology. There was no significant difference in follow-up time between cohorts. Patients with low MHI who undergo complex abdominal wall reconstruction are at an increased risk for complications and poor outcomes, including delayed wound healing and hernia recurrence. This indicates the need to provide resources to address barriers to follow-up and maintenance following complex abdominal wall reconstruction in this patient cohort.

High Prevalence of Iron Deficiency and Socioeconomic Disparities in Laboratory Screening of Non-Pregnant Females of Reproductive Age

BACKGROUND Iron deficiency anemia (IDA) is one of the most prevalent medical conditions in the world. Iron deficiency (ID) and IDA are common among females of reproductive age, with health consequences both during and outside of pregnancy. However, screening for ID and IDA is variable, and often screening is performed with a complete blood count (CBC) alone, which is neither sensitive nor specific for IDA, in contrast to ferritin. OBJECTIVES The primary objective was to determine the prevalence of screening for ID and IDA over a 3-year period in non-pregnant females of reproductive age who had tests performed at outpatient laboratories in Ontario, Canada. Secondary objectives were to determine the prevalence and severity of ID and IDA, and to identify demographic and provider characteristics that influence the likelihood of screening. METHODS This was a retrospective cohort study of non-pregnant females ages 15-54 in Ontario, Canada. Laboratory data was provided by Dynacare, the second-largest laboratory company in the province, performing around 30% of annual non-hospital outpatient laboratory testing. Tests between January 2017 and December 2019 were retrieved. Tests ordered by providers other than physicians, midwives, or nurse practitioners were excluded. As this was a study of non-pregnant patients, records from patients who had a beta-hCG test of 5 IU or greater, explicitly defined antenatal laboratory testing, or who fulfilled criteria of a previously published laboratory definition of pregnancy were excluded. ID was defined as ferritin < 30 µg/L and severe ID ferritin < 15 µg/L. Anemia was defined as hemoglobin < 120 g/L, and IDA defined as a ferritin < 30 µg/L and hemoglobin < 120 g/L measured within 90 days of each other. Annual household income was estimated using the patient's postal code and Statistics Canada census data. Research ethics board approval was obtained. Dynacare was not involved in study design or analysis. RESULTS 6,652,487 records were retrieved from the Dynacare database. 4,623,284 records representing 784,132 non-pregnant females were eligible for inclusion (Figure 1). Of this cohort, 644,066 patients (82.1%) had a ferritin checked at least once during the study period, with a mean ferritin of 60.7 µg/L (SD 86.9 µg/L). 245,953 (38.3%) were iron deficient with a < 30 µg/L at least once, with 14.4% of patients having severe ID with ferritin < 15 µg/L. Family physicians or general practitioners ordered most ferritin tests (74.1%). 709,434 patients (90.5%) had a CBC checked at least once, with a mean hemoglobin of 130.1 g/L (SD 12.9 g/L). Of those who had a CBC checked, 134,265 (19%) had anemia (hemoglobin < 120 g/L) at least once. 633,396 patients (80.8%) were screened for and 82,655 (13.1%) had IDA. The proportion of ferritin testing increased with increasing anemia severity (Table 1), ranging from 40.2% of patients with normal hemoglobin levels having a ferritin test, to 66.4% of patients with hemoglobin < 70 g/L having a ferritin checked. Median annual household income was CAD$89,387.80 (IQR 69178.8, 107037.5) at the first service date. Compared to patients in the lowest household income quintile (Q1, <CAD$60,000 per year), the odds of ever having a normal hemoglobin generally increased with increasing income quintiles, with odds ratio (OR) 1.08 (95% CI 1.05-1.11), 1.07 (95% CI 1.04-1.10), 1.36 (95% CI 1.30-1.43), and 1.47 (95% CI 1.25-1.72) for Q2-5 respectively. Compared to patients in Q1, the odds of having a ferritin checked was also greater with higher income quintiles with OR for Q2-5 1.20 (95% CI 1.18-1.23), 1.56 (95% CI 1.53-1.60), 1.67 (95% CI 1.61-1.73), and 1.21 (95% CI 1.09-1.34) respectively (Figure 2). CONCLUSION: This was a large study of non-pregnant females of reproductive age in Ontario, Canada, a high-income province within a publicly funded health services system. Our cohort had a high median household income ($89,387.80, compared to a province-wide median of $65,285 in 2016). A large proportion of patients were screened for ID - yet even in this relatively privileged population, ID affected nearly 40% and IDA 13% of those screened. Screening for ID was more likely with increasing anemia severity. Despite low household income being associated with the greatest odds of anemia, low income was associated with lower odds of having a ferritin check. These findings highlight socioeconomic disparities in screening and inequitable diagnosis of ID and IDA in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Bucket-Handle Meniscus Tear Management With Meniscectomy Versus Repair Correlates With Patient, Socioeconomic, and Hospital Factors.

Bucket-handle meniscus tears are common knee injuries that are often treated surgically with meniscectomy or meniscal repair. Although clinical factors may influence the choice of one treatment approach over the other, the influence of patient, socioeconomic, and hospital factors remains poorly characterized. This study aimed to estimate the relative nationwide utilization of these two procedures and delineate a variety of factors that are associated with the selection of one treatment approach over the other. Meniscal repair and meniscectomy procedures conducted for isolated bucket-handle meniscus tears in 2016 and 2017 were identified in the Nationwide Ambulatory Surgery Sample database. Cases were weighted using nationally representative discharge weights. Univariate analyses and a multivariable logistic regression model were used to compare patient, socioeconomic, and hospital factors associated with meniscal repair versus meniscectomy. In total, 12,239 cases were identified, which represented 17,236 cases after weighting. Of these, meniscal repair was conducted for 4,138 (24.0%). Based on the logistic regression model, meniscal repair was less likely for older and sicker patients. By contrast, several factors were associated with markedly higher odds of undergoing meniscal repair compared with meniscectomy. These included urban teaching hospitals; geographic location in the midwest, south, and west; and higher median household income. Using a large nationally representative cohort, the current data revealed that only 24.0% of surgically treated bucket-handle meniscus tears were treated using repair. Identification of patient, socioeconomic, and hospital factors differentially associated with meniscal repair suggest that other factors may systematically influence surgical decision-making for this patient population. Surgeons should be conscious of these potential healthcare disparities when determining the optimal treatment for their patients. Level III.

Exclusionary Effects of Campsite Allocation through Reservations in U.S. National Parks: Evidence from Mobile Device Location Data.

Campsites represent highly sought after recreational amenities in the national parks of the United States. Equitable allocation of scarce recreational resources has long been a key management issue in U.S. national parks, but has become increasingly difficult in an era of increasing demand. At present, a growing number of national park campsites are allocated through an online reservation system well in advance of a camper's arrival at a park. Compounding the challenge of allocating these campsites is a long history of exclusivity within national park camping-institutionalized through campground design and predicated on a legacy of the leisure class's affinity for camping in national parks. Given national park camping's history of exclusivity, this exploratory study seeks to explore how online reservation systems may impact the demographics of national park campers. Using mobile device location data, estimated demographics were calculated for campers in five national park campgrounds in the U.S. that each contained some sites requiring reservations and some sites available on a first-come, first-served basis. We detail results from analyses of variance between campsites requiring reservations and those that are available on a first-come, first-served basis. Results suggest that for each of the five campgrounds, those campers camping in sites that require reservations came from areas with higher median household incomes, on average. In three of the five campgrounds, this difference was significant. Additionally, in an urban-proximate setting, those camping in sites requiring reservations came from areas with a higher portion of White residency than those campers in campsites not requiring reservations, on average. We conclude with discussion that includes management implications concerning the growing prominence of online reservation systems for outdoor recreation amenities, and a brief research agenda for diversity, equity, and inclusion (DEI) as they relate to campgrounds. Principally, the former group of implications includes the realization that online reservation systems present the unintended consequence of excluding low-income, and perhaps non-White, would-be campers-a conclusion drawn from the results of this exploratory study. This discussion includes an analysis of the distributive justice of online reservation systems.

Breast Cancer Screening Disparity in a Safety Net Health System: The Intersection of Race, Ethnicity, Language, and Mental Health

INTRODUCTION: Breast cancer screening (BCS) disparity leaves historically underserved groups vulnerable to worse adverse outcomes. This study seeks to explore association between BCS and granular patient sociodemographic factors in a uniquely resourced safety-net health system. METHODS: A retrospective review of female patients ages 50–74 years within an urban safety-net health system was conducted in 2019. Patients who had a primary care provider (PCP) visit within 2 years were included, and those with a history of breast cancer or breast operation were excluded. Multiple patient health and sociodemographic characteristics were obtained, as well as PCP gender. Univariate analyses and multivariable logistic regression were performed. RESULTS: Of 12,363 included patients, 8,540 (69.1%) received BCS. Most of the cohort (72.4%) had public insurance, 37% of the population was White, and 44.2% had a non-English primary language. Latino patients had the highest screening rate (77%), whereas White patients had the lowest (63.2%). In multivariable analysis, the odds of BCS significantly increased with Spanish language, African ethnicity, commercial insurance, increased PCP visits, higher median household income, or having a female PCP. BCS odds significantly decreased with substance use disorder or severe mental health diagnoses. CONCLUSION: Challenging traditional US cancer screening disparity in our large safety-net health system, patients who were non-White, non–North American/European ethnicity, and non–English-speaking had significantly higher odds of BCS compared with their counterparts. Our data emphasize how specific communities and sociodemographic characteristics can have unique BCS disparity, which may help guide future BCS outreach and implementation strategies.

S789 The Differences of Hospitalization Outcomes Between Teaching and Non-Teaching Hospitals in Taking Care of Patients With Inflammatory Bowel Disease in the United Sates

Introduction: IBD costs continue to rise in the US.1 Teaching hospitals tend to have more resources for care, but the effect of these resources on cost and utilization is unknown.2 We therefore investigated the differences in characteristics and outcomes of patients admitted to teaching hospitals vs non-teaching hospitals. Methods: We utilized the national inpatient sample data (NIS) 2016-20183 and hospitalized patients with a 1ry discharge diagnosis of IBD were identified. We excluded all patients who were younger than 18 years and classified our population to those who were admitted to teaching and non-teaching hospitals. Our outcomes included hospital length of stay (LOS), hospital charges, mortality, and discharge disposition. Survey analysis was applied to account for discharge weight and multistage sampling of the NIS data.4 We calculated the propensity score for patients based on their demographics, hospital bed size and region, Charlson comorbidity index,5 obesity, and tobacco, alcohol, or drug use. We estimated the average treatment effect weight based on the propensity score and used it to adjust differences between the two groups. Results: 281,440 patients (weighted number) were eligible for our study and 203,815 patients were admitted to teaching hospitals. These patients were more likely to be from larger counties, had private insurance, higher median household income, and their hospitals were more likely to be located at the Northeast or the Midwest (Table). In the adjusted analyses, patients who were admitted to teaching facilities had a higher mean difference of LOS (0.82 days, 95% CI 0.7 – 0.94, P < 0.001), hospital charges ($9,482.75, 95%CI 7,336.2 – 11,629.3, P=0.14), higher odds ratio (OR) of discharge with visiting nurse (2.02, 95%CI 1.81 – 2.26, P=< 0.001), and lower OR to be transferred to other hospitals (0.4, 95%CI 0.34 – 0.48, P< 0.001). (Figure) Conclusion: In this national analysis of hospitalized patients with IBD, patients who were admitted to teaching hospitals were associated with higher utilization of healthcare resources even after adjusting for demographic, hospitals differences, and comorbidities. Further studies are needed to understand the differences in care at teaching and non-teaching hospitals to explain the cause for the increased utilization of resources in teaching hospitals compared to non-teaching hospitals.Figure 1.: The hospitalization outcomes for patients with Inflammatory Bowel Disease based on their hospital type, teaching vs non-teaching facilities. Table 1. - Baseline characteristics for hospitalized patients with IBD comparing patients who were admitted to teaching vs non-teaching hospitals Characteristics Teaching Hospitals Non- teaching Hospitals P value Total number (Weighted) 203,815 77,625 Age (mean (SD)) 44.56 (17.81) 47.74 (18.33) < 0.001 Female (%) 108,075 (53) 42,730 (55.1) < 0.001 Race (%) < 0.001 •F020White 139,595 (71.0) 59,149.9 (78.7) •F020Black 30,525 (15.5) 7,785 (10.4) •F020Hispanic 17,065 (8.7) 5,185 (6.9) •F020Others 9,505 (4.8) 3,075 (4.1) Patient Location: NCHS Urban-Rural Code (%) < 0.001 •F020"Central" counties of ≥1 million population 68,235 (33.6) 12,725 (16.4) •F020"Fringe" counties of ≥1 million population 57,420 (28.3) 20,360 (26.3) •F020Counties of 250,000-999,999 population 42,580 (21.0) 13,740 (17.7) •F020Counties of 50,000-249,999 population 16,120 (7.9) 8,890 (11.5) •F020Not metropolitan or micropolitan counties 18,685 (9.2) 21,739.9 (28.1) Expected primary payer (%) < 0.001 •F020Medicare 48,645 (23.9) 23,385 (30.2) •F020Medicaid 39,290 (19.3) 14,000 (18.1) •F020Private insurance 98,510 (48.4) 32,045 (41.4) •F020Self-pay/ Others/No charge 17,100 (8.4) 8,025 (10.4) Median household income for patients ZIP Code (%) < 0.001 •F0200-25th percentile 48,885 (24.3) 22,435 (29.4) •F02026th to 50th percentile 47,765 (23.8) 22,730 (29.8) •F02051st to 75th percentile 53,400 (26.6) 17,320 (22.7) •F02076th to 100th percentile 50,780 (25.3) 13,845 (18.1) Weighted Charlson Comorbidity (mean (SD)) 0.64 (1.30) 0.68 (1.30) 0.003 Alcohol use disorder (%) 3,655 (1.8) 1,670 (2.2) 0.007 Drug use disorder (%) 12,795 (6.3) 4,600 (5.9) 0.16 Tobacco use (history and current) (%) 34,295 (16.8) 15,345 (19.8) < 0.001 Patients with Obesity (%) 18,370 (9) 6545 (8.4) < 0.001 Weekend admissions (%) 40,890 (20.1) 17,940 (23.1) < 0.001 Bed size of the hospital (%) < 0.001 •F020Small 40,970 (20.1) 12,300 (15.8) •F020Medium 55,340 (27.2) 23,860 (30.7) •F020Large 107,505 (52.7) 41,465 (53.4) Region of the hospital (%) < 0.001 •F020Northeast 49,705 (24.4) 10,870 (14.0) •F020Midwest 51,420 (25.2) 17,025 (21.9) •F020South 71,525 (35.1) 35,110 (45.2) •F020West 31,165 (15.3) 14,620 (18.8)

Understanding public perspectives on fracking in the United States using social media big data

ABSTRACT People’s attitudes towards hydraulic fracturing (fracking) can be shaped by socio-demographics, economic development, social equity and politics, environmental impacts, and fracking-related information. Existing research typically conducts surveys and interviews to study public attitudes towards fracking among a small group of individuals in a specific geographic area, where limited samples may introduce bias. Here, we compiled geo-referenced social media big data from Twitter during 2018–2019 for the entire United States to present a more holistic picture of people’s attitudes towards fracking. We used a multiscale geographically weighted regression (MGWR) to investigate county-level relationships between the aforementioned factors and percentages of negative tweets concerning fracking. Results indicate spatial heterogeneity and varying scales of those associations. Counties with higher median household income, larger African American populations, and/or lower educational level are less likely to oppose fracking, and these associations show global stationarity in all contiguous US counties. Eastern and Central US counties with higher unemployment rates, counties east of the Great Plains with less fracking sites nearby, and Western and Gulf Coast region counties with higher health insurance enrolments are more likely to oppose fracking activities. These three variables show clear East-West geographical divides in influencing public perspective on fracking. In counties across the southern Great Plains, negative attitudes towards fracking are less often vocalized on Twitter as the share of Republican voters increases. These findings have implications for both predicting public perspectives and needed policy adjustments. The methodology can also be conveniently applied to investigate public perspectives on other controversial topics.

Mapping of Pediatric COVID-19 Cases in Miami-Dade and Broward Counties: an Analysis of Sociodemographic Disparities.

BackgroundNumerous studies have shown a disproportionate impact of COVID-19 infection on Black and Hispanic Americans in the adult patient population. However, few studies have been done with pediatric populations. The aim of this study is to identify the prevalence and distribution of COVID-19 cases among pediatric patients in Miami-Dade and Broward counties and identify any sociodemographic disparities.MethodsA total of 10,087 children/adolescents ages zero years-old to 20 years-old were tested from July 1, 2020, to December 31, 2020. ArcGIS was used to map cases and obtain sociodemographic data. SPSS software was used to determine significance of data trends and create a predictive model.ResultsThere were 1,161 pediatric COVID-19 cases detected. White Hispanics and Black Hispanics had statically significantly higher cases when compared to White non-Hispanics and Black non-Hispanics. Percentage of households on food stamps, percentage of households below the poverty line, percentage of minority populations, and percentage of Hispanic population showed a positive correlation with detected pediatric COVID-19 cases. Alternatively, areas with higher median household incomes and higher educational status were negatively correlated with COVID-19. Percentage of Hispanic population and percentage of households below the poverty line were predictive of pediatric COVID-19 cases.ConclusionThere was a disproportionate impact of pediatric COVID-19 infection on zip codes of lower socioeconomic status and increased racial/ethnic minority populations. This study demonstrates the need for public health policies that prioritize testing children/adolescents in these communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-022-01362-y.

Taking the Long Way to Care: Who is Traveling Farthest to Undergo Elective Total Hip Arthroplasty?

BackgroundDisparities in access to total hip arthroplasty (THA) exist. The purpose of this study is to examine how distance traveled to undergo elective THA correlates with sociodemographic variables and postoperative outcomes.Material and methodsThe Healthcare Cost and Utilization Project New York and Florida state inpatient databases were used to identify patients who underwent elective THA between 2006 and 2014. Data from the American Hospital Association and United States Postal Service were used to calculate the distance patients traveled to receive THA, and only those who traveled more than 25 miles were included. We stratified patients into 4 groups based on their distance traveled (25-50 miles, 50.01-100 miles, 100.01-500 miles, and >500.01 miles) and compared demographic characteristics and postoperative outcomes between groups.ResultsAge, race, insurance provider, zip code income quartile, and Charlson Comorbidity Index scores were each significantly associated with travel distance (P < .001) among our cohort of 25,734 patients. Patients who were older, were white, had Medicare insurance coverage, lived in zip codes with a higher median household income, and had increased comorbidities were more likely to travel the farthest to receive care. There were minimal associations between travel distance and postoperative outcomes.ConclusionThere may be specific demographic groups who either are forced to travel long distances to receive care or have the resources to seek out and travel to distant hospitals in an effort to receive optimal care. Understanding the interconnected relationships between demographic variables is necessary to address disparities in access to specialized orthopedic surgical care.

Factors associated with caregiver adherence to mobile health interstage home monitoring in infants with single ventricle or biventricular shunt-dependent heart disease.

Mobile health technology is an emerging tool in interstage home monitoring for infants with single ventricle heart disease or biventricular shunt-dependent defects. This study sought to describe adherence to mobile health monitoring and identify factors and outcomes associated with adherence to mobile health monitoring. This was a retrospective, single-institution study of infants who were followed in a mobile health-based interstage home monitoring programme between February 2016 and October 2020. The analysis included 105 infants and subjects were grouped by frequency of adherence to mobile health monitoring. Within the study cohort, 16 (15.2%) had 0% adherence, 25 (23.8%) had <50% adherence, and 64 (61.0%) had >50% adherence. The adherent groups had a higher percentage of infants who were male (p = 0.02), white race (p < 0.01), non-Hispanic or non-Latinx ethnicity (p < 0.01) and had mothers with primary English fluency (p < 0.01), married marital status (p < 0.01), and a prenatal diagnosis of faetal cardiac disease (p = 0.03). Adherent groups also had a higher percentage of infants with non-Medicaid primary insurance (p < 0.01) and residence in a neighbourhood with a higher median household income (p < 0.04). Frequency of adherence was not associated with interstage mortality, unplanned cardiac reinterventions, or hospital readmissions. Impact of mobile health interstage home monitoring on caregiver stress as well as use of multi-language, low literacy, affordable mobile health options for interstage home monitoring warrant further investigation.

Ancillary treatment referrals and visits after breast cancer surgery in a sociodemographically diverse population.

1533 Background: Ancillary therapies by rehabilitative, palliative, and survivorship specialists mitigate breast cancer surgery's physical and emotional effects. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive such care. We investigated provider referrals and patient visits at a high-volume urban cancer center to identify associated sociodemographic factors and characterize which populations may not be maximally benefiting from ancillary services. Methods: Data was culled from electronic health records of surgically-treated breast cancer patients at Yale-New Haven Health System between 2010-2017. Post-operative provider referrals to Physical/Occupational Therapy, Palliative Medicine, and Survivorship Program were evaluated for associations with demographic and disease variables in univariable and multivariable logistic regression analyses. Patient utilization of referrals, defined as attending at least one consultation, were analysed similarly. Results: Among 5,496 patients identified, 2,288 (41.6%) were referred for ancillary treatments and 1,572 (28.6%) attended at least one consultation. Provider referrals were highest among patients of Hispanic and Black ancestry (57.5% and 54.9%, respectively), no health insurance (57.6%), lowest percentage high school degree for zip code (50.5%), and lowest median income for zip code (50.7%). These associations remained significant in multivariable analysis [all p&lt;0.050]. In contrast, referral utilization was greatest among patients with private insurance (70.7%), highest percentage high school degree (72.8%), and highest median household income (72.2%), in addition to Hispanic ethnicity (73.5%). In multivariable analysis, highest median household income (OR 1.45, p = 0.019) and Hispanic ethnicity (OR 1.50, p = 0.048) remained associated. Conclusions: In a large urban health system serving a diverse population, traditional markers of poor healthcare access were positively associated with provider referral for ancillary services after breast cancer surgery. However, referral did not translate to utilization, suggesting that access remains a critical barrier to therapies that target post-operative morbidity and elevate quality of life.[Table: see text]

MP22-14 A MIXED METHODS APPROACH TO EXPLORING PATIENT MOTIVATIONS FOR DELAYING DEFINITIVE TREATMENT OF URETHRAL STRICTURE DISEASE

You have accessJournal of UrologyCME1 May 2022MP22-14 A MIXED METHODS APPROACH TO EXPLORING PATIENT MOTIVATIONS FOR DELAYING DEFINITIVE TREATMENT OF URETHRAL STRICTURE DISEASE Abimbola Ayangbesan, George Koch, Helen Gambrah, Rohan Bhalla, Jackson Cabo, Stephen Hill, and Niels Johnsen Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Stephen HillStephen Hill More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethroplasty (UPL) for urethral stricture disease (USD) has high success and satisfaction rates, yet many patients trial endoscopic management with either dilation or urethrotomy. Access to care, surgeon expertise and counseling, and patient health literacy all play a role in the decision to defer UPL. Mixed methods research using both qualitative and quantitative data may allow for a more comprehensive understanding of patient's motivations to defer UPL. We hypothesize that decreased access to care and the logistical ease of endoscopic procedures will be associated with delayed UPL. METHODS: Retrospective review of our institutional UPL database was performed. Patients were categorized based on whether or not they had undergone at least two endoscopic procedures prior to UPL. Demographic data were collected, including median household income (MHI). Multivariable logistic regression using an a priori model was used to determine the odds of undergoing ≥2 prior endoscopic procedures. Telephone interviews were conducted with patients who had undergone ≥2 procedures in order to better understand their experiences and to identify motivations for delaying UPL. RESULTS: One hundred and five patients who underwent UPL from September 2019 to July 2021 were included in the study. Of these, 50 (47.6%) had previously undergone ≥2 endoscopic procedures (IQR 3-5), with 6 patients undergoing ≥10 procedures. On multivariable analysis, age at UPL (OR 1.03 [95% CI 1.01-1.06] p=0.02) and referral from non-teaching facility (OR 2.90 [95% CI 1.07-7.83] p=0.04) were predictors of delayed definitive treatment. Conversely, MHI >$100,000 was protective (OR 0.07 [95% CI 0.01-0.72] p=0.03). When interviewed, 83% of patients expressed a desire to have undergone UPL sooner and 61% were unaware of the lower success rates for repeated endoscopic treatments. Reasons for delaying UPL included not wanting to be admitted overnight due to being sole provider for family members, scheduling conflicts/times constraints, and fear of a more involved recovery. CONCLUSIONS: Predictors of delayed definitive treatment included age and referral from non-teaching facility, while higher MHI was protective. Most patients who underwent multiple endoscopic procedures prior to UPL expressed a desire to have pursued definitive management sooner. Patients in the delayed group cited logistical issues with a more involved procedure, as well as fear of longer recovery. These results illustrate the need for improved patient counseling and access to care for urethral stricture patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e376 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abimbola Ayangbesan More articles by this author George Koch More articles by this author Helen Gambrah More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Stephen Hill More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF DownloadLoading ...

Overflowing Disparities: Examining the Availability of Litter Bins in New York City.

In the 1980s, activists’ concerns about the disproportionate placements of landfills in low-income communities ignited the environmental justice movement. Today, similar issues of environmental injustice—the limited availability of litter bins across New York City (NYC) neighborhoods—remain unresolved. This study examines the association between NYC neighborhood income and litter bin availability. The NYC Department of Sanitation 2020 Litter Bin Inventory and archival measures of neighborhood composition and socioeconomic status were aggregated within NYC census tract neighborhoods. Multilevel Bayesian conditional autoregressive Poisson models estimated the prevalence rate ratio for counts of litter bins according to median household income in each census tract, accounting for spatial autocorrelation. Bivariate associations identified that census tracts with higher median household income had a greater prevalence of litter bins than census tracts with lower median household income; however, spatial autocorrelation attenuated the relationship between median household income and availability of litter bins. Further research is necessary to identify the spatially structured condition that accounted for the observed effect. The results warrant further investigation of both perceived and actual disparities in litter bin availability.