Home Zip Code Research Articles

Community and Patient Features and Health Care Point of Entry for Pediatric Concussion

Many recent advances in pediatric concussion care are implemented by specialists; however, children with concussion receive care across varied locations. Thus, it is critical to identify which children have access to the most up-to-date treatment strategies. To evaluate differences in the sociodemographic and community characteristics of pediatric patients who sought care for concussion across various points of entry into a regional health care network. This cross-sectional study included children seen for concussions across a regional US health care network from January 1, 2017, to August 4, 2023. Pediatric patients aged 0 to 18 years who received an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification code for concussion were included. The study took place at emergency department (ED) and outpatient (primary care [PC] and specialty care [SC]) settings. Age at visit, biological sex, parent-identified race and ethnicity, payer type, median income and percentage of adults with a bachelor's degree for home zip code, and overall and subdomain Child Opportunity Index (COI) score based on patient address. The association of exposures with point of entry of ED, PC, and SC were examined in both bivariate analysis and a multinomial logistic regression. Overall, 15 631 patients were included in the study (median [IQR] age, 13 [11-15] years; 7879 [50.4%] male; 1055 [6.7%] Hispanic, 2865 [18.3%] non-Hispanic Black, and 9887 [63.7%] non-Hispanic White individuals). Race and ethnicity were significantly different across settings (1485 patients [50.0%] seen in the ED were non-Hispanic Black vs 1012 [12.0%] in PC and 368 [8.7%] in SC; P < .001) as was insurance status (1562 patients [52.6%] seen in the ED possessed public insurance vs 1624 [19.3%] in PC and 683 [16.1%] in SC; P < .001). Overall and individual COI subdomain scores were also significantly different between settings (overall COI median [IQR]: ED, 30 [9-71]; PC, 87 [68-95]; SC, 87 [69-95]; P < .001). Race, insurance status, and overall COI had the strongest associations with point of entry in the multivariable model (eg, non-Hispanic Black patients seen in the ED compared with non-Hispanic White patients: odds ratio, 2.03; 95% CI, 1.69-2.45). In this cross-sectional study, children with concussion seen in the ED setting were more likely to be non-Hispanic Black, have public insurance, and have a lower Child Opportunity Index compared with children cared for in the PC or SC setting. This highlights the importance of providing education and training for ED clinicians as well as establishing up-to-date community-level resources to optimize care delivery for pediatric patients with concussion at high risk of care inequities.

Access to National Cancer Institute-Designated Cancer Centers Among Native American Cancer Patients

Introduction/Purpose Native Americans (NAs) are subject to high cancer mortality rates in the USA. Despite that, they face significant geographic barriers to access to cancer care. This study aims to estimate the travel distance to a National Cancer Institute (NCI)-designated cancer center for NA patients in Utah and the continental USA. Methods This IRB-approved study utilized retrospective data on genitourinary cancer patients from both NAs and white populations from February 2013 to January 2023. The distance of their geographical location to the Huntsman Cancer Institute (HCI) at the University of Utah was calculated using their home zip code and a GeoData ZIP Code Distance Calculations Matrix Template. A shapefile containing NCI-designated cancer centers was used alongside the Area Deprivation Index (ADI), matched to block groups from the 2020 census, to serve as a national control group. All geographic data was visualized in ArcGIS 10.7 by using the coordinates and a 5-digit zip code tabulation area to map locations. Results A total of 468 NA patients were eligible and included. The median travel distance for NA patients vs. white patients to HCI was 190.6 miles (range: 1.1-596.4 miles) vs. 21.6 miles (range: 1.1-269 miles, p&lt;0.0001). In the continental US, the median travel distance from NA reservations vs. ADI-matched block groups to the nearest NCI-designated cancer centers was 186.5 miles (range 77.8-629 miles) vs. 159 miles (range 1.9-671.3 miles, p&lt;0.01). Conclusion The travel distance to NCI-designated cancer center for NA cancer patients in Utah was around nine times longer than that of white cancer patients. This study highlights the significant disparity in cancer care accessibility faced by NA communities.

Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level.

Burn injury can have profound detrimental effects on the quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016 to 2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for preschool-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index (COI) score, which is composed of subdomains for Education, Health and Environment, and Social and Economic. We calculated the odds ratio for odds of pediatric burn admission for each COI subdomain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (P < .001). There was a dose-response relationship between COI and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings.

Examining associations between social vulnerability and maternal morbidity among a multicentre cohort of pregnancies complicated by placenta accreta spectrum disorder in New York City

BackgroundPlacenta accreta spectrum (PAS) disorder is a source of severe obstetric morbidity and mortality worldwide. The objective of this paper was to evaluate the potential relationship between social vulnerability and...

Influence of Social Deprivation on Patient-Reported Outcomes in Foot and Ankle Patients.

The impact of social health on patient-reported outcomes (PROs) is gaining increasing attention within the orthopaedic community. Few studies have explored any relationship between social deprivation levels and PROs in orthopaedic foot and ankle patients. We retrospectively identified patients who presented to an orthopaedic foot and ankle clinic for new evaluation. Patients completed PROs including PROMIS physical function (PF), PROMIS pain interference (PI), and the Foot and Ankle Ability Measure (FAAM). Social deprivation was measured using the Area Deprivation Index (ADI), a metric that incorporates various domains of poverty, education, housing, and employment. The ADI score quantifies the degree of social deprivation based on the 9-digit home zip code but is not a specific measure to an individual patient. Briefly, a lower ADI indicates less deprivation whereas a higher score denotes greater deprivation. Patient characteristics and outcomes were summarized and stratified by the nationally defined median ADI. Multivariable linear regression models assessed the relationships between PROs and continuous ADI controlling for demographics (age, sex, race/ethnicity, marital status, and employment status). Our cohort consisted of 1565 patients with PRO and appropriate zip code data. Patients in the most-deprived median ADI split had more pain (median PROMIS-PI 62.7 vs 61.2, P = .001) and less function (median PROMIS-PF 37.1 vs 38.6, P = .021) compared with the least-deprived median ADI split. The clinical significance of these findings is unclear, though, given the minimal differences between groups for PROMIS measures. There was no relationship between ADI and FAAM scores. More socially deprived patients presented to the clinic with marginally less function and greater pain. Although statistically significant, the clinical significance of these relationships is unclear and merits further exploration. We plan to continue to study the connection between social deprivation and patient outcomes in specific clinical conditions as well as before/after surgical interventions. Level IV, retrospective cases series.

Child mental health treatment access and retention in integrated primary care and traditional outpatient services.

There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity. This study compared treatment attendance in an outpatient psychiatry clinic (OPC) versus an IPC clinic to assess whether the IPC was associated with reduced disparities in access to care and treatment retention. This study assessed whether there were differences in who is connected to care from the intake appointment to first follow-up appointment. Results showed that the IPC clinic served a more diverse patient population than the OPC clinic in terms of SES, race, and ethnicity. Differences in treatment attendance in the IPC and OPC were also found. After controlling for race, ethnicity, insurance, and distance from patient's home zip code to clinic, the IPC treatment setting was associated with poorer intake and follow-up appointment attendance. The IPC model may be more accessible to historically underserved youth, but the treatment setting does not inherently eliminate disparities in child mental health treatment retention. Replication of this study has the potential to contribute to the external validity of study findings, improve quality assurance policies, and develop equitable workflow policies. Future research is needed to identify factors that can improve treatment attendance for populations who face greater retention barriers and to shine light on ways that healthcare systems may inadvertently maintain disparity in treatment retention.

Mental Health Aftercare Availability for Juvenile Justice-Involved Youth in New York City.

The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.

The Impact of Social Deprivation on Anterior Urethral Stricture Recurrence After Urethroplasty: A Trauma and Urologic Reconstructive Network of Surgeons Analysis.

Several factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty. We performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDIs, 0-100), which quantify the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox proportional hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and BMI. Median age was 46.0 years with a median follow-up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution-only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027). Patient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery.

Pre-injury methamphetamine use is associated with increased length of hospital stay in rural orthopaedic trauma patients

ObjectivesThe primary focus of this study is to determine if rural methamphetamine positive patients experience longer hospital length of stays compared to urban methamphetamine positive patients following an orthopaedic trauma. MethodsPatients presenting with traumatic orthopaedic injuries and urine drug screen were categorized into urban, suburban, and rural cohorts found in the Rural Urban Commuting Area codes based on home residence zip codes. Demographic, injury, hospital stay, and follow-up data were collected from the medical records. Comparisons between cohorts were determined by Chi square, Fisher exact, unpaired t-Tests, or ranked sum tests. DesignA retrospective cohort analysis. SettingAcademic Level I Trauma Center. Patient selection criteriaPatient records were examined between January 2013 to January 2023 for a traumatic orthopaedic injury and a urine drug screen result at the time of presentation to an academic Level I trauma center. Outcome measures and comparisonsMethamphetamine use status, patient age at time of admission, sex, marital status, insurance status, home zip code, orthopaedic injury location, complications, if the patient underwent surgery for orthopaedic injuries, admission date, discharge date, and discharge location were measured. Results249 patients met inclusion criteria for this analysis. Methamphetamine positive patients are significantly more likely to be younger, more likely to have surgery for orthopaedic injuries, experience a medical complication, or be discharged to home or a rehabilitation facility compared to methamphetamine negative patients. Urban patients experienced a shorter length of stay compared to suburban and rural patients, regardless of methamphetamine use status. Patients with Medicare, military, workers compensation, or commercial insurance are significantly more likely to attend follow-up appointments than patients with Medicaid or self-pay. ConclusionsMethamphetamine positive patients overall do not experience a longer length of hospital stay compared to methamphetamine negative patients. Rural methamphetamine positive patients experience a longer length of hospital stay compared to urban methamphetamine positive patients.

Should I See You Again Soon? Multispecialty Assessment of Impact and Burden of Preoperative History and Physical Update Visits.

Federal regulations require a history and physical (H&P) update performed 30 days or less before a planned procedure. We evaluated the use and burdens of H&P update visits by determining impact on operative management, suitability for telehealth, and visit time and travel burden. We identified H&P update visits performed in our health system during 2019 for 8 surgical specialties. As available, up to 50 visits per specialty were randomly selected. Primary outcomes were interval changes in history, examination, or operative plan between the initial and updated H&P notes, and visit suitability for telehealth, as determined by 2 independent physician reviewers. Clinic time was captured, and round-trip driving time and distance between patients' home and clinic ZIP codes were estimated. We identified 8,683 visits and 362 were randomly selected for review. Documented changes were most commonly identified in histories (60.8%), but rarely in physical examinations (11.9%) and operative plans (11.6%). Of 362 visits, 359 (99.2%) visits were considered suitable for telehealth. Median clinic time was 52 minutes (interquartile range 33.8 to 78), driving time was 55.6 minutes (interquartile range 35.5 to 85.5), and driving distance was 20.2 miles (interquartile range 8.5 to 38.4). At the health system level, patients spent an estimated aggregate 7,000 hours (including 4,046 hours of waiting room and travel time) and drove 142,273 miles to attend in-person H&P update visits in 2019. Given their minimal impact on operative management, regulatory requirements for in-person H&P updates should be reconsidered. Flexibility in update timing and modality might help defray the substantial burdens these visits impose on patients.

Association between summertime emergency department visits and maximum daily heat index in rural and non-rural areas of Virginia (2015–2022)

There is growing evidence that high ambient temperatures are associated with a range of adverse health outcomes. Further evidence suggests differences in rural versus non-rural populations' vulnerability to heat-related adverse health outcomes. The current project aims to 1) refine estimated associations between maximum daily heat index (HI) and emergency department (ED) visits in regions of Virginia, and 2) compare associations between maximum daily HI and ED visits in rural versus non-rural areas of Virginia and within those areas, for persons 65 years of age and older versus those younger than 65 years. Our study utilized 16,873,213 healthcare visits from Virginia facilities reporting to the Virginia Department of Health syndromic surveillance system between May and September 2015–2022. Federal Office of Rural Health Policy defined rural areas were assigned to patient home ZIP code. The estimated daily maximum HI at which ED visits begin to rise varies between 25 °C and 33 °C across climate zones and regions of Virginia. Across all regions, estimated ED visits attributable to days with maximum HI above 25.7 °C were higher in rural areas (3.7%, 95% CI: 3.5%, 3.9%) versus in non-rural areas (3.1%, 95% CIs: 3.0%, 3.2%). Patients aged 0–64 years had a higher estimated heat attributable fraction of ED visits (4.2%, 95% CI: 4.0%, 4.3%) than patients 65 years and older (3.1%, 95% CI: 2.9%, 3.4%). Rural patients older than 65 have a higher estimated fraction of heat attributable ED visits (2.7%, 95% CI: 2.2%, 3.1%) compared to non-rural patients 65 years and older (1.5%, 95% CI: 1.3%, 1.8%). State-level syndromic surveillance data can be used to optimize heat warning messaging based on expected changes in healthcare visits given a set of meteorological variables, and can be further refined based on climate, rurality and age.

The differential impacts of COVID-19 mortality on mental health by residential geographic regions: The Los Angeles Pandemic Surveillance Cohort Study.

This study examines the association between changes in mental health before and during the COVID-19 pandemic and COVID-19 mortality across geographic areas and by race/ethnicity. A cross-sectional survey was conducted in Los Angeles County between April and May 2021. The study used the Patient Health Questionnaire-2 to assess major depression risk. Participants' home ZIP codes were classified into low, middle, and high COVID-19 mortality impacted areas (CMIA). While there were existing mental health disparities due to differences in demographics and social determinants of health across CMIA in 2018, the pandemic exacerbated the disparities, especially for residents living in high CMIA. Non-White residents in high CMIA reported the largest deterioration in mental health. Differences in mental health by CMIA persisted after controlling for resident characteristics. Living in an area with higher COVID-19 mortality rates may have been associated with worse mental health, with Non-White residents reporting worse mental health outcomes in the high mortality area. It is crucial to advocate for greater mental health resources in high COVID-19 mortality areas especially for racial/ethnic minorities.

The Performance of Critical Congenital Heart Disease Screening in Rural Versus Urban Locations in the Northwest United States

Pulse oximetry screening of newborns detects critical congenital heart disease (CCHD). Rural birth location is known to affect timing and management of when infants with CHD undergo surgery, but its association with CCHD screening is unknown. We assess the relationship between rural location and postnatal CCHD diagnosis and describe lesion-specific modes of diagnosis. Data were abstracted from medical records at 2 cardiac surgery centers in Washington state. Infants with CCHD, defined as CHD requiring either cardiac intervention or resulting in death at <1month of age, born between July 2015 and June 2020, were included and classified by method of identification. Patient home ZIP codes were used to determine rural location. We included 561 newborns with CCHD; 35% were diagnosed postnatally. Predominant postnatal mechanisms of identification (n=194) included symptomatic before CCHD screening period (56%), CCHD screening (22%), and symptomatic after false-negative screen (15%). Postnatal diagnosis rate increased with degree of ruralness (48% in small rural/isolated regions vs 32% in urban regions; P=.01) and incidence of undiagnosed CCHD at birth increased with lower nursery levels (5.5/10000 live births in nursery level 1 vs 2.1/10000 live births in level 4). CCHD screening identifies 22% of postnatally diagnosed CCHD and 7% of cases overall in our region. Postnatal diagnosis is more common in rural regions. The incidence of undiagnosed CCHD at birth increases with decreasing nursery levels. This study supports the value of CCHD screening in routine newborn care, especially in rural areas and hospitals with lower nursery levels.

Estimated Incidence of Pediatric Distal Radius Buckle Fractures in the United States

BackgroundDistal radius buckle fracture care has been extensively studied, yet the incidence in the United States is unknown. This study aims to determine the incidence of pediatric buckle fractures using geospatial analysis. MethodsPediatric distal radius buckle fractures (patients aged <18) from 2018 to 2022 were identified via a retrospective chart review from a single health care organization. The catchment area was defined as all of the home ZIP codes of verified buckle fracture patients. Corrections were made for buckle fractures treated at institutions with overlaying catchment areas. Adjusted incidence was then used to calculate annual buckle fractures nationally. Pediatric Orthopaedic Society of North America member rolls were used to identify and locate pediatric orthopaedic surgeons. It was assumed that each pediatric orthopaedic surgeon would treat up to 20 buckle fractures annually from a 25-mile radius of the primary office. Based on this, the percentage of buckle fractures nationally that are able to be treated by pediatric Orthopaedic surgeons was estimated. ResultsA total of 594 distal radius buckle fractures over 5 years were confirmed in an estimated catchment area of 866,238 population. With adjustments for overlapping institutions, the estimated annual incidence was 17.3 per 100,000 people (95% CI [14.5, 20.1]). In the United States, there are an estimated 66,513 buckle fractures annually, with 1,182 pediatric orthopaedic surgeons potentially able to treat 26.5% of these cases. ConclusionsThis investigation estimates the incidence of pediatric buckle fractures in the United States, allowing for estimates of expected volumes and implications for care. Based on the geographic distribution of pediatric orthopaedic surgeons and estimated incidence, it is impractical for buckle fracture care to be delivered exclusively by pediatric orthopaedic surgeons. Key Concepts(1)The estimated annual incidence of distal radius buckle fracture is 17.3 per 100,000 people.(2)Pediatric orthopaedic surgeons are able to treat up to 26.5% of these cases.(3)Buckle fractures cannot be the exclusive domain of pediatric orthopaedic surgeons, as the number of pediatric Orthopaedic surgeons is too small for them to be the sole providers of care. Level of EvidenceIII

Early environments and exploration in the preschool years.

A great deal of research has demonstrated how children's exploration is driven by opportunities for learning. However, less work has investigated how individual differences across children and their environmental contexts relate to patterns in playful exploration. We performed a "mega-analysis" in which we pooled preschool-aged children's play data from four past experiments in our lab (N = 278; M(age) = 56 months) and correlated play behaviors with age and socioeconomic status (median income, modal education in children's home zip codes). We found that, with age, children performed more unique actions during play. Additionally, children from lower SES areas explored more variably; the link between this play and tendencies to focus on pedagogically demonstrated features traded off differently than it did for higher SES children. This work lays critical groundwork for understanding exploration across developmental contexts.

Gun violence revictimization in New York State: What increases the risk of being shot again?

While gun injuries are more likely to occur in urban settings and affect people of color, factors associated with gun violence revictimization-suffering multiple incidents of gun violence-are unknown. We examined victim demographics and environmental factors associated with gun violence revictimization in New York State (NYS). The 2005 to 2020 NYS hospital discharge database was queried for patients aged 12 years to 65 years with firearm-related hospital encounters. Patient and environmental variables were extracted. Patient home zip code was used to determine the Social Deprivation Index (SDI) for each patient's area of residence. We conducted bivariate and multivariate analyses among patients who suffered a single incident of gun violence or gun violence revictimization. We identified 38,974 gun violence victims among whom 2,243 (5.8%) suffered revictimization. The proportion of revictimization rose from 4% in 2008 to 8% in 2020 ( p < 0.01). The median [interquartile range] time from first to second incident among those who suffered revictimization was 359 days [81-1,167 days]. Revictimization was more common among Blacks (75.0% vs. 65.1%, p < 0.01), patients with Medicaid (54.9% vs. 43.2%, p < 0.01), and in areas of higher deprivation (84.8 percentile vs. 82.1 percentile, p < 0.01). Gun violence revictimization is on the rise. People of color and those residing in areas with high social deprivation are more likely to be re-injured. Our findings emphasize the importance of community-level over individual-level interventions for prevention of gun violence revictimization. Prognostic and Epidemiological; Level IV.

Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in idiopathic pulmonary fibrosis

BackgroundIdiopathic pulmonary fibrosis (IPF) is a progressive condition associated with a variable prognosis. The relationship between socioeconomic status or distance travelled to respiratory clinics and prognosis is unclear. Research questionTo determine whether socioeconomic status, distance to hospital and time to referral affects survival in patients with IPF. Study design and methodsIn this retrospective cohort study, we used data collected from the British Thoracic Society Interstitial Lung Diseases Registry, between 2013 and 2021 (n = 2359) and calculated the quintile of Index of Multiple Deprivation 2019 score, time from initial symptoms to hospital attendance and distance as the linear distance between hospital and home post codes. Survival was assessed using Cox proportional hazards models. ResultsThere was a significant association between increasing quintile of deprivation and duration of symptoms prior to hospital presentation, Gender Age Physiology (GAP) index and receipt of supplemental oxygen and antifibrotic therapies at presentation. The most deprived patients had worse overall survival compared to least deprived after adjusting for smoking status, GAP index, distance to hospital and time to referral (HR = 1.39 [1.11, 1.73]; p = 0.003). Patients living furthest from a respiratory clinic also had worse survival compared to those living closest (HR = 1.29 [1.01, 1.64]; p = 0.041). InterpretationThe most deprived patients with IPF have more severe disease at presentation and worse outcomes. Living far from hospital was also associated with poor outcomes. This suggests inequalities in access to healthcare and requires consideration in delivering effective and equitable care to patients with IPF.

Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions

ObjectivesSafety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study...

Pediatric telemedicine visits reduce greenhouse gas emissions

IntroductionThe planet is facing a substantial crisis of global warming from the burning of fossil fuels. The global healthcare system contributes to 4.4 % of global emissions part of which can be attributed to patient travel. Telemedicine has the opportunity to provide care while obviating the need for travel. We hypothesized that the use of pediatric telemedicine will decrease carbon emissions. MethodsWe performed a review of a prospective electronic medical record system of all children that presented to an outpatient children's hospital center from August 2019 through February 2022. The primary outcome was the number of telemedicine visits that occurred per month during the time period. The home zip code for each patient was included and used to calculated the median round trip distance to travel to the outpatient clinic. The EPA greenhouse gas equivalents calculator was utilized to convert car emissions data to carbon dioxide (CO2) emissions data. ResultsOver the investigation period, there were 20,845 pediatric telemedicine visits. The travel distance that was eliminated was 1,562,716 miles (roundtrip). Using an estimate of 22.5 miles per gallon, this represents a savings of 69,454 gallons of fuel, which translates to 618 metric tonnes of CO2 saved. ConclusionIn children, telemedicine can decrease time away from school, work for parents, need for childcare, as well as the cost and time for travel. Pediatric telemedicine use can benefit the environment through the substantial reduction of carbon dioxide emissions.

Survival disparities in rural versus urban patients with pancreatic neuroendocrine tumor: A multi-institutional study from the US neuroendocrine tumor study group

BackgroundPancreatic Neuroendocrine Tumors (PNETs) are indolent malignancies that often have a prolonged clinical course. This study assesses disparities in outcomes between PNET patients who live in urban (UA) and rural areas (RA). MethodsA retrospective cohort study was performed using the US Neuroendocrine Tumor Study Group database. PNET patients with a home zip code recorded were included and categorized as RA or UA according to the Federal Office of Rural Health Policy. Overall survival (OS) was analyzed by Kaplan-Meier method, log-rank test, and logistical regression. ResultsOf the 1176 PNET patients in the database, 1126 (96%) had zip code recorded. While 837 (74%) lived in UA, 289 (26%) lived in RA. RA patients had significantly shorter median OS following primary PNET resection (122 vs 149 months, p ​= ​0.01). After controlling for income, local healthcare access, distance from treatment center, ASA class, BMI, and T/N/M stage, living in a RA remained significantly associated with worse OS (HR 1.60, 95%CI 1.08–2.39, p ​= ​0.02). ConclusionRural patients have significantly shorter OS following PNET resection compared to their urban counterparts.