Higher Median Income Research Articles

Refugees’ Transition from Welfare to Work: A Quasi-Experimental Approach of the Impact of the Neighbourhood Context

AbstractThis study analyses the impact of the neighbourhood context on the likelihood that refugees move from social assistance to paid employment. It makes use of Dutch policy that resulted in an exogenous placement of refugees in their first regular housing. This natural quasi-experiment allows us to estimate intent-to-treat effects of initial neighbourhood characteristics on the likelihood of transitioning from welfare to work. We consider the impact of the employment share and the median level of income among natives and co-ethnics, using Dutch longitudinal administrative data and discrete time event-history modelling. Our findings indicate that refugees are more likely to enter the labour market when the neighbourhood’s employment share among natives is higher. A similar effect for employment among co-ethnics is not found. There is also no evidence that the placement of refugees in an area with a higher median income among co-ethnics or natives facilitates the transition from welfare to work.

Intensive Cardiac Rehabilitation Is Markedly Underutilized by Medicare Beneficiaries: RESULTS FROM A 2012-2016 NATIONAL SAMPLE.

Intensive cardiac rehabilitation (ICR) was developed to enhance traditional cardiac rehabilitation (CR) by adding sessions focused on nutrition, lifestyle behaviors, and stress management. Intensive CR has been Medicare-approved since 2010, yet little is known about national utilization rates of ICR in the Medicare population or characteristics associated with its use. A 5% sample of Medicare claims data from 2012 to 2016 was used to identify beneficiaries with a qualifying indication for ICR/CR and to quantify utilization of ICR or CR within 1 yr of the qualifying diagnosis. From 2012 to 2015, there were 107 246 patients with a qualifying indication. Overall, only 0.1% of qualifying patients participated in ICR and 16.2% in CR from 2012 to 2016, though utilization rates of both ICR and CR increased during this period (ICR 0.06 to 0.17%, CR 14.3 to 18.2%). The number of ICR centers increased from 15 to 50 over the same period. There were no differences between ICR and CR enrollees with respect to age, sex, race, discharge location, median income, dual enrollment, or number of comorbidities. Compared with eligible beneficiaries who did not attend ICR or CR, those who attended either program were younger, more likely to be male and White, and had higher median income. Although ICR and CR have a class 1 indication for the treatment of cardiovascular disease and the number of ICR centers has increased, ICR is not widely available and remains markedly underutilized. Continued research is needed to understand the barriers to program development and patient participation.

MP13-14 USE OF NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A POPULATION-BASED STUDY, 2006-2017

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-14 USE OF NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A POPULATION-BASED STUDY, 2006-2017 Natasza Posielski, Nathan Jung, Hannah Koenig, On Ho, John Paul Flores, and Christopher Porter Natasza PosielskiNatasza Posielski More articles by this author , Nathan JungNathan Jung More articles by this author , Hannah KoenigHannah Koenig More articles by this author , On HoOn Ho More articles by this author , John Paul FloresJohn Paul Flores More articles by this author , and Christopher PorterChristopher Porter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). NAC has been shown to confer a survival benefit across all ages. Yet, many elderly patients are not offered NAC due to concern regarding physiologic reserve and postoperative complications. Our objective was to evaluate age-based disparity in treatment and outcomes of MIBC. METHODS: Using the National Cancer Database, we identified patients with MIBC from 2006-2017. First, use of different treatments including RC, RC and adjuvant chemotherapy, RC with NAC (“optimal treatment”), chemo-radiation, and no treatment, was compared between age groups. A second analysis was performed in the cohort of elderly patients, ≥70, undergoing cystectomy. Propensity weighting was used to compare peri-operative and mortality outcomes in those who received NAC vs. no NAC. RESULTS: In 70,911 patients with non-metastatic MIBC, use of RC with NAC was lower in patients ≥70, 7.2 vs. 20.9%, p<0.001 (Table 1, Figure 1). Patients receiving RC with NAC were younger, had private insurance, higher high school completion rate and median income, shorter distance to hospital, lower CCI, diagnosis in recent years, and higher stage disease. NAC use was also associated with pelvic lymph node dissection (OR 4.55, p<0.001). In patients ≥70 undergoing RC, NAC was associated with shorter length of stay (LOS) (8.5 vs 9.6 days, p<0.001), decreased 30-day readmission (8.6 vs 10.6%, p=0.003), lower 30- and 90-day mortality (1.9 vs 3.6%, p=0.01 and 4.9 vs 7.7%, p=0.004, respectively), and better overall survival (OS) (43.8% vs. 37.5%, p<0.001). Multivariate logistic regression found NAC as an independent predictor of shorter LOS, lower 30-and 90-day mortality, and improved OS. CONCLUSIONS: Despite increased omission of NAC in patients ≥70, NAC is not associated with worse peri-operative outcomes or mortality in elderly patients. Advanced age in properly selected patients should not preclude offering NAC prior to radical cystectomy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e249-e249 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Natasza Posielski More articles by this author Nathan Jung More articles by this author Hannah Koenig More articles by this author On Ho More articles by this author John Paul Flores More articles by this author Christopher Porter More articles by this author Expand All Advertisement Loading ...

Geographic disparities and socio-demographic predictors of pertussis risk in Florida.

BackgroundPertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, particularly in infants. Between 2008 and 2011, children less than 3 months old accounted for 83% of the pertussis deaths in the United States. Understanding the geographic disparities in the distribution of pertussis risk and identifying high risk geographic areas is necessary for guiding resource allocation and public health control strategies. Therefore, this study investigated geographic disparities and temporal changes in pertussis risk in Florida from 2010 to 2018. It also investigated socioeconomic and demographic predictors of the identified disparities.MethodsPertussis data covering the time period 2010–2018 were obtained from Florida HealthCHARTS web interface. Spatial patterns and temporal changes in geographic distribution of pertussis risk were assessed using county-level choropleth maps for the time periods 2010–2012, 2013–2015, 2016–2018 and 2010–2018. Tango’s flexible spatial scan statistics were used to identify high-risk spatial clusters which were displayed in maps. Ordinary least squares (OLS) regression was used to identify significant predictors of county-level risk. Residuals of the OLS model were assessed for model assumptions including spatial autocorrelation.ResultsCounty-level pertussis risk varied from 0 to 116.31 cases per 100,000 people during the study period. A total of 11 significant (p < 0.05) spatial clusters were identified with risk ratios ranging from 1.5 to 5.8. Geographic distribution remained relatively consistent over time with areas of high risk persisting in the western panhandle, northeastern coast, and along the western coast. Although county level pertussis risks generally increased from 2010–2012 to 2013–2015, risk tended to be lower during the 2016–2018 time period. Significant predictors of county-level pertussis risk were rurality, percentage of females, and median income. Counties with high pertussis risk tended to be rural (p = 0.021), those with high median incomes (p = 0.039), and those with high percentages of females (p < 0.001).ConclusionThere is evidence that geographic disparities exist and have persisted over time in Florida. This study highlights the application and importance of Geographic Information Systems (GIS) technology and spatial statistical/epidemiological tools in identifying areas of highest disease risk so as to guide resource allocation to reduce health disparities and improve health for all.

Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors.

IntroductionToxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.MethodsThis was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis.ResultsThe study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6–387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI]: 544.5–566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10–19 had a noticeably higher prevalence of TE (1,464.4, 95% CI: 802.9–2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated.ConclusionToxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

Mapping supply of and demand for ecosystem services to assess environmental justice in New York City.

Livability, resilience, and justice in cities are challenged by climate change and the historical legacies that together create disproportionate impacts on human communities. Urban green infrastructure has emerged as an important tool for climate change adaptation and resilience given their capacity to provide ecosystem services such as local temperature regulation, stormwater mitigation, and air purification. However, realizing the benefits of ecosystem services for climate adaptation depend on where they are locally supplied. Few studies have examined the potential spatial mismatches in supply and demand of urban ecosystem services, and even fewer have examined supply–demand mismatches as a potential environmental justice issue, such as when supply–demand mismatches disproportionately overlap with certain socio‐demographic groups. We spatially analyzed demand for ecosystem services relevant for climate change adaptation and combined results with recent analysis of the supply of ecosystem services in New York City (NYC). By quantifying the relative mismatch between supply and demand of ecosystem services across the city we were able to identify spatial hot‐ and coldspots of supply–demand mismatch. Hotspots are spatial clusters of census blocks with a higher mismatch and coldspots are clusters with lower mismatch values than their surrounding blocks. The distribution of mismatch hot‐ and coldspots was then compared to the spatial distribution of socio‐demographic groups. Results reveal distributional environmental injustice of access to the climate‐regulating benefits of ecosystem services provided by urban green infrastructure in NYC. Analyses show that areas with lower supply–demand mismatch tend to be populated by a larger proportion of white residents with higher median incomes, and areas with high mismatch values have lower incomes and a higher proportion of people of color. We suggest that urban policy and planning should ensure that investments in “nature‐based” solutions such as through urban green infrastructure for climate change adaptation do not reinforce or exacerbate potentially existing environmental injustices.

Urban Forest Sustainability in Residential Areas in the City of Santo Domingo

Cities are territories vulnerable to climate change. An alternative to increase resilience and mitigate the effects of the climate context is urban forest planning to increase ecosystem services. This research constructed a forest cover sustainability index, based on 147 semi-structured interviews with residents of four residential areas of the city of Santo Domingo (Gazcue, Zona Colonial, Ciudad Nueva, and San Carlos), in which information was collected based on both benefit perception and tree management in their home and nearby public areas. The socioeconomic characteristics of the population and the information gathered from the measurements of the urban forest in both public and private areas of the city during the 2016–2019 period were considered, including these four residential areas, which established the ecosystem services provided by the urban forest. The results showed that Gazcue had a higher value in the forest cover sustainability index. The factors that influenced this result were: job stability, medium-high income, and property ownership. Likewise, the added value of the territory, whether in terms of tourism or the socioeconomic value of the population that inhabits it, is closely related to a greater attention to urban planning, prioritizing the conservation and landscape harmony that the arboreal component can provide. In conclusion, urban forest planning in cities should consider tree species, the design and structure of spatial arrangements, and a competent legal framework that can meet the challenges of territorial sustainability and contribute to the resilience and mitigation of climate change impacts.

Sex Differences in Outcomes Following Left Atrial Appendage Closure

ObjectiveTo evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). Patients and MethodsCohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. ResultsA total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. ConclusionWomen had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.

A Cross-Sectional Study of SARS-CoV-2 Seroprevalence between Fall 2020 and February 2021 in Allegheny County, Western Pennsylvania, USA

Seroprevalence studies are important for understanding the dynamics of local virus transmission and evaluating community immunity. To assess the seroprevalence for SARS-CoV-2 in Allegheny County, an urban/suburban county in Western PA, 393 human blood samples collected in Fall 2020 and February 2021 were examined for spike protein receptor-binding domain (RBD) and nucleocapsid protein (N) antibodies. All RBD-positive samples were evaluated for virus-specific neutralization activity. Our results showed a seroprevalence of 5.5% by RBD ELISA, 4.5% by N ELISA, and 2.5% for both in Fall 2020, which increased to 24.7% by RBD ELISA, 14.9% by N ELISA, and 12.9% for both in February 2021. Neutralization titer was significantly correlated with RBD titer but not with N titer. Using these two assays, we were able to distinguish infected from vaccinated individuals. In the February cohort, higher median income and white race were associated with serological findings consistent with vaccination. This study demonstrates a 4.5-fold increase in SARS-CoV-2 seroprevalence from Fall 2020 to February 2021 in Allegheny County, PA, due to increased incidence of both natural disease and vaccination. Future seroprevalence studies will need to include the effect of vaccination on assay results and incorporate non-vaccine antigens in serological assessments.

Trends in utilization of reflectance confocal microscopy in the United States, 2017-2019

Trends in utilization of reflectance confocal microscopy in the United States, 2017-2019

Use of neoadjuvant chemotherapy in elderly patients with muscle invasive bladder cancer: A population-based study, 2006 to 2017.

4536 Background: Current guidelines recommend neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). NAC has been shown to confer a survival benefit across all ages. Yet, many elderly patients are not offered NAC due to concern regarding physiologic reserve and postoperative complications. Our objective was to evaluate age-based disparity in treatment and outcomes of MIBC. Methods: Using the National Cancer Database, we identified patients with MIBC from 2006-2017. First, use of different treatments, RC, RC and adjuvant chemotherapy, RC with NAC (“optimal treatment”), chemo-radiation, and no treatment, was compared between age groups. A second analysis was performed in the cohort of elderly patients, ≥70, undergoing cystectomy. Propensity weighting was used to compare peri-operative and mortality outcomes in those who received NAC vs. no NAC. Results: In 70,911 patients with non-metastatic MIBC, use of RC with NAC was lower in patients ≥70, 7.2 vs. 20.9%, p&lt;0.001 (Table). Patients receiving RC with NAC were younger, had private insurance, higher high school completion rate and median income, shorter distance to hospital, lower CCI, diagnosis in recent years, and higher stage disease. NAC use was also associated with pelvic lymph node dissection (OR 4.55, p&lt;0.001). In patients ≥70 undergoing RC, NAC was associated with shorter length of stay (LOS) (8.5 vs 9.6 days, p&lt;0.001), decreased 30-day readmission (8.6 vs 10.6%, p=0.003), lower 30- and 90-day mortality (1.9 vs 3.6%, p=0.01 and 4.9 vs 7.7%, p=0.004, respectively), and better overall survival (OS) (43.8% vs. 37.5%, p&lt;0.001). Multivariate logistic regression found NAC as an independent predictor of shorter LOS, lower 30-and 90-day mortality, and improved OS. Conclusions: Despite increased omission of NAC in patients ≥70, NAC is not associated with worse peri-operative outcomes or mortality in elderly patients. Advanced age in properly selected patients should not preclude offering NAC prior to radical cystectomy.[Table: see text]

Community-level factors and incidence of gun violence in the United States, 2014–2017

Rationale and objectiveIn the United States, gun violence claims thousands of lives each year and is a pressing public health issue. To gain a better understanding of this phenomenon, this study spatially analyzed county- and state-level predictors of yearly gun violence rates and gun-related casualty rates. MethodsThis study modeled hypothesized predictors of gun violence incidence and casualties across four years. Data sources included the Gun Violence Archive (gun violence data in the United States for 2014–2017), the U.S. Census Bureau (socioeconomic, demographic, geologic features), ICPSR (crime reports), the U.S. Geologic Survey (elevation data), and U.S. gun laws and ownership. Random forest analyses identified relevant additional interaction terms to include. ResultsThe extent to which counties are urban was the most robust predictor of both gun violence incident and casualty rates. Similarly, places characterized by greater income disparity were also more likely to experience higher gun violence rates, especially when high income was paired with high poverty. ConclusionsCommunity- and state-level features are markedly associated with gun violence. Gun violence is higher in counties with both high median incomes and higher levels of poverty; poverty did not seem related to gun violence rates in counties with relatively low median incomes. Some of these findings may well be due to racial segregation and concentrated disadvantage, due to institutional racism, police-community relations, and related factors.

Travel Cost Budget and Ability of Urban Bus Users to Pay Considering the Income Classes in Indonesia

The Bus Reform policy known as Trans Koetardja was adopted and implemented in Banda Aceh of Indonesia in early 2018 to promote bus ridership and to specifically mitigate the dependency on private means of transportation. This system is presently being run as a trial and free of service charge through the subsidy provided by the government of Aceh with the amount being spent projected to escalate by the year 2020 due to expansion in the number of bus lines. There is, however, the plan to introduce bus fare to ease the burden of subsidies on the government but most of those engaged in the ridership are generally students and people from low-income households. Therefore, there is the need to determine an appropriate charge or tariff based on the household's ability to pay (ATP), especially with the focus on the need for low-income people to sustain the subsidy for their daily travel. This study was conducted to determine the ability to pay (ATP) for bus users through the use of travel cost budget (TCB) which is defined as the maximum money allocated by a household for transportation within a month as a constraint. The TCB was classified based on income classes into low-income and medium-high income to ensure simplicity. The research was conducted in 2019 by collecting 450 samples from three Trans Koetardja lines using reveal preference (RP) survey after which Ordinary Least Square (OLS) method was adopted to identify the factors significantly contributing to TCB based on the income classes. Moreover, the ATP for each income class was also determined using the household budget method. The empirical results from the OLS showed the TCB usually allocated by medium-high income households is slightly different from those with low-income as observed with 0.306 million IDR/month (20.85 USD/month) and 0.208 million IDR/month (14.17 USD/Month) while the predicted ATP was 7,397 IDR/trip (0.5 USD/trips) and 2,259 IDR/trip (0.15 USD/trips), respectively. It is, however, important to note that 1 USD = 14,677.73 IDR. Furthermore, the factors observed to be influencing the variation in TCB include age, monthly income, gender, and the number of private cars or motorcycles owned within the household.

Barriers to Care among Patients with Sarcoidosis: A Qualitative Study.

Rationale: Lower-income patients with sarcoidosis experience worse outcomes than those with higher incomes. The reasons for these disparities are not well understood. Objectives: To identify patient-reported barriers to and facilitators of self-empowered care among patients with sarcoidosis residing in high- and low-median-income zip-code areas. Methods: Patients with biopsy-proven sarcoidosis who had received pharmacologic treatment within the past year and who were cared for in a sarcoidosis clinic of a large, urban medical system were included. Focus groups were stratified by high- and low-median-income zip-code areas. Transcriptions were analyzed using grounded theory. Results: Five focus groups were created; two included patients living in zip-code areas with high median incomes ($84,263; interquartile range [IQR], $79,334-$89,795), and three included patients living in zip-code areas with low median incomes ($27,470; IQR, $22,412-27,597). Patients with sarcoidosis from low-income and high-income zip-code areas reported remarkably similar experiences. Patients reported that sarcoidosis was a burden owing to its disease manifestations and the adverse effects of treatment, which led to a compromised ability to perform their activities of daily living at home or at work. Reported barriers to care included perceived inadequate knowledge about sarcoidosis among providers, communication barriers with providers, and the high cost of treatment. Patients from low-income zip-code areas experienced discrimination related to race and income, which served to compound their mistrust. Patients sought to overcome these barriers through self-empowerment, including independent learning, self-advocacy, medication nonadherence, and use of alternative therapies. Conclusions: Patients with sarcoidosis who lived in high- and low-income zip-code areas expressed similar overall concerns regarding sarcoidosis care. However, patients from low-income zip-code areas more frequently expressed concerns about racial and income-based discrimination. Patients from both groups addressed these barriers through self-empowerment, which included not adhering to prescribed therapies. Future work should focus on the effects of culturally and socioeconomically congruent, community-engaged interventions for quality of life of patients with sarcoidosis.

Exploring the Characteristics and Influencing Factors of Leisure Walking Based on the Demand of Behavior

Leisure walking has been an important topic in space-time behavior and public health research. However, prior studies pay little attention to the integration and the characterization of diverse and multilevel demands of leisure walking. This study constructs a theoretical framework of leisure walking behavior demands from three different dimensions and levels of activity participation, space-time opportunity, and health benefit. On this basis, through a face-to-face survey in Nanjing, China (N = 1168, 2017–2018 data), this study quantitatively analyzes the characteristics of leisure walking demands, as well as the impact of the built environment and individual factors on it. The results show that residents have a high demand for participation and health benefits of leisure walking. The residential neighborhood provides more space opportunities for leisure walking, but there is a certain constraint on the choice of walking time. Residential neighborhood with medium or large parks is more likely to satisfy residents’ demands for engaging in leisure walking and obtaining high health benefits, while neighborhood with a high density of walking paths tends to limit the satisfaction of demands for space opportunity and health benefit. For residents aged 36 and above, married, or retired, their diverse demands for leisure walking are more likely to be fulfilled, while those with high education, medium-high individual income, general and above health status, or children (&lt;18 years) are less likely to be fulfilled. These finding that can have important implications for the healthy neighborhood by fully considering diverse and multilevel demands of leisure walking behavior.

00001 Demographic disparities in proximity to stroke care in the United States

ABSTRACT IMPACT: Given the association between lower time to treatment and better clinical outcomes in stroke patients, identifying factors correlated with reduced proximity and thus greater time to stroke care can aid efforts to reduce disparities in stroke outcomes. OBJECTIVES/GOALS: The objective of this study is to quantify the relationship between distance to the nearest certified stroke hospital and census-derived demographics of age, race/ethnicity, income, and insurance status. METHODS/STUDY POPULATION: This is a cross-sectional study. Population data for all census tracts in the contiguous United States were obtained from the US Census Bureau’s 2014-2018 American Community Survey. Stroke hospitals were identified from national or state level certification databases and were required to offer at least IV tPA. The main outcome is driving distance in kilometers from each census tract to the nearest certified stroke center, which was calculated using OSMnx, a Python package to retrieve, model and analyze real-world street networks. Quantile regression analysis was used to compare relationships between distances and tract-level demographics of age, race/ethnicity, income, and insurance status. RESULTS/ANTICIPATED RESULTS: 2,423 stroke centers and 71,929 census tracts containing 316,995,649 individuals were included. 49,918 (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in non-urban areas than in urban areas. Higher representation of individuals with age ≤65 years were associated with increased median distance to a certified stroke center in non-urban areas, but not urban areas. Median distance was greater with greater representation of American Indian or uninsured populations in urban and non-urban census tracts. Higher median income was associated with decreased median distance in non-urban census tracts and greater median distance in urban census tracts. DISCUSSION/SIGNIFICANCE OF FINDINGS: Reduced proximity to stroke care exists in areas with greater representation of elderly, American Indian, or uninsured persons; and low median income. These disparities are magnified in non-urban settings. Such knowledge can aid efforts to address and reduce disparities in stroke outcomes.

The Importance of Neighborhood in 9-1-1 Ambulance Contacts: A Geospatial Analysis of Medical and Trauma Emergencies in Denver

Background: Prehospital emergency care is a vital component of healthcare access, and emergency medical services (EMS) plays an essential role in healthcare delivery. Understanding the distribution of medical and trauma EMS calls at the neighborhood level would be beneficial to identify at-risk communities and facilitate targeted interventions. Objectives: The primary objective was to evaluate and characterize 9-1-1 ambulance contacts for medical and trauma-related events in Denver. The secondary objective was to evaluate the co-existence of medical and trauma-related EMS calls to determine if these emergencies occur in the same neighborhoods. Methods: We conducted a secondary analysis of prospectively collected EMS calls in Denver between January 1, 2011, through August 8, 2017. The primary outcome was the incidence of trauma and medical EMS calls in each census tract. EMS events were aggregated to tracts and incidence rates were calculated based on the adult daytime and nighttime population. Three different spatial analysis methods (SaTScan’s spatial scan statistic, Gini coefficient, and Local Moran’s I) were utilized to identify clusters of medical and trauma EMS events at the tract level. Results: A total of 425,527 EMS calls in 142 census tracts occurred during the study period. The median age of study participants was 48 (IQR 33, 62), 56% were male, and the majority (74%) of EMS calls were for medical events. An emergent EMS return to the hospital occurred in 5% of all calls. We identified several high-risk census tracts with a coexistence of medical and trauma EMS events. When compared to the Denver County population, the tracts with high EMS call rates were diverse, with many tracts exhibiting a higher proportion of black, unemployment, below poverty, and lower median income while other tracts demonstrated a smaller proportion of black, unemployment, below poverty, and a higher median income. Conclusions: Disparities exist in the distribution of medical and trauma EMS calls in varied census tracts in Denver. Identifying neighborhoods in which there is an incidence of higher medical and trauma emergencies is important to guide EMS care delivery and may help facilitate targeted public health interventions for at-risk populations to improve health outcomes.

Colleges and Communities: A Preliminary Analysis of the Impact of Four-Year Colleges and Universities on Communities

This study examines all counties in the United States that have four-year colleges and universities and compared the civic, socio-economic, and health factors of college communities compared to those without four-year institutions. The data analyzed, using single factor analysis of variance, provide evidence that counties with colleges and universities have higher levels of civic engagement and social capital, higher median incomes, and lower mid-life mortalities than counties without four-year institutions. The results have implications for municipalities and counties with baccalaureate institutions. The results are particularly important from a policy perspective as institutions face financial challenges from the coronavirus pandemic.

Craft beer: An overview.

The purpose of the work was to provide an overview on craft beer. Details and issues concerning history and legal definition market, fiscal policy, innovation, safety, healthiness, consumer profile, and sustainability are supplied. The term "craft brewery" generally refers to a brewery able to produce low volumes of beer, often made with traditional ingredients-for emulating historic styles-but also with the addition of nontraditional ingredients as a distinctiveness sign of the master brewer. In many countries, the importance of the company size is related to the opportunity to take advantage of reduced excise rates for low production volumes. In several countries, another important requisite of a craft brewery is represented by its independence from other alcohol industry members. Even in the presence of a great heterogeneity of the size of craft breweries in the various countries, their number in the world is around 17,000. Craft beer is mainly consumed in restaurants and bars. Innovation of craft beer concerns aspects, such as ingredients, alcohol content, aging, and packaging, and the profile of the typical craft beer drinker is that of a young man, with a higher education and a medium-high income. Craft beers are often not filtered/not pasteurized and, for these reasons, they are beverages rich in health compounds but with a reduced shelf life. As in the case of larger breweries, the environmental impact of craft breweries is mainly represented by water consumption and production of liquid and solid wastes.

How does socio-economic and demographic dissimilarity determine physical and virtual segregation?

It is established that socio-economic and demographic dissimilarities between populations are determinants of spatial segregation. However, the understanding of how such dissimilarities translate into actual segregation is limited. We propose a novel network-analysis approach to comprehensively study the determinants of communicative and mobility-related spatial segregation, using geo-tagged Twitter data. We constructed weighted spatial networks representing tie strength between geographical areas, then modeled tie formation as a function of socio-economic and demographic dissimilarity between areas. Physical and virtual tie formation were affected by income, age, and race differences, although these effects were smaller by an order of magnitude than the geographical distance effect. Tie formation was more frequent when "destination" area had higher median income and lower median age. We hypothesize that physical tie formation is more "costly" than a virtual one, resulting in stronger segregation in the physical world. Economic and cultural motives may result in stronger segregation of relatively rich and young populations from their surroundings. Our methodology can help identify types of states that lead to spatial segregation, and thus guide planning decisions for reducing its adverse effects.