Large Metropolitan Areas Research Articles

Adolescent E-Cigarette Expectancies: Measure Development and Preliminary Validity of the Electronic Nicotine Vaping Outcomes Measure for Youth.

Electronic nicotine delivery systems ("e-cigarettes") are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure. A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% Hispanic) in a large Southeastern metropolitan area in the United States. Exploratory Factor Analysis revealed a four factor solution: Negative Consequences (Cronbach's α = .92); Positive Reinforcement (α = .83); Negative Affect Reduction (α = .95); and Weight Control (α = .89). Subscales were significantly correlated with vaping susceptibility and lifetime vaping. Subscales successfully differentiated susceptible adolescents from confirmed non-susceptible adolescents, with susceptible adolescents reporting more positive expectancies, eg, Positive Reinforcement, M = 5.0, SD = 2.0 vs M = 3.0, SD = 2.1, P < .001, η2 = 0.19, and less negative expectancies, M = 5.5, SD = 2.3 vs M = 6.5, SD = 2.6, P = .001, η2 = 0.04. Similar results were found comparing adolescents who have never vaped nicotine with those who have vaped nicotine. Hierarchical linear regression demonstrated subscales were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. A preliminary version of an adolescent expectancy measure appears reliable and valid based on expert input and pilot testing with adolescents. Promising results were found in the domains of concurrent validity, discriminant validity, and incremental validity. Future research and evaluation efforts will be able to use this tool to further prevention and treatment goals.

Abstract 139: Regional Disparities in Mechanical Thrombectomy Utilization for Treatment of Acute Ischemic Stroke in the United States

Background: A current national priority is to understand geographic disparities in mechanical thrombectomy (MT) provision for patients with acute ischemic stroke (AIS). We examine variation in rates of MT by geographic region and urban-rural areas to identify utilization disparities across the United States. Methods: The state-specific annual incidence of AIS in 2019 was determined using data from the Global Burden of Disease Collaborative Network. We determined the number of patients who were admitted with AIS due to thrombosis or embolism of anterior circulation arteries and those who received MT in a particular region/state based on the State Inpatient Database of NIS. The National Inpatient Sample data were used to create national weighted estimates of the size of subject populations, age at admission, length of stay, and discharge status. Results: In the United States, approximately 28,165 MT were performed in 2019, representing 4% of the AIS population. In large central metropolitan areas, the proportion of thrombectomies performed to the AIS patient population was significantly higher than the national estimate (4.34%, P &lt; 0.001); small metropolitan areas and rural settings (micropolitan and noncore) had significantly lower proportions of MT-treated patients with 3.2% and 2.9%, respectively (P &lt; 0.001), when compared with the national estimate. West region had significantly higher proportions of MT-treated patients with 4.3%, compared with the national estimate (P &lt; 0.001), whereas South region had significantly lower proportions with 3.8% (P &lt; 0.001). Conclusions: We found prominent regional disparities in the utilization rates of MT in acute ischemic stroke patients in the United States, which may have implications for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities.

Self-Reported Visual Disability and Unemployment: Findings from the National Health Interview Survey

ABSTRACT Purpose To investigate the association between visual impairment and employment status due to disability, utilizing data from the 2022 National Health Interview Survey (NHIS). Methods Adults 18 years of age and older were extracted from the 2022 NHIS dataset. A multivariable logistic regression model was created to evaluate the odds of unemployment (“laid off” and “looking for work”). Persons over the age of 65, as well as persons retired, going to school, self-employed, seasonal, or contract workers were excluded. Independent variables for the model included gender, race, Hispanic ethnicity, urban residency, level of education, citizenship, and self-reported vision. The latter variable was categorized as seeing with “some” difficulty, with “severe” difficulty, “can’t see at all,” and “a lot of difficulty.” Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Associations with unemployment included education less than high school (OR 6.05, 95% CI: 3.98-9.18) and high school (OR 3.80, 95% CI 2.78-5.21); severe vision difficulty (OR 3.68 95% CI 1.73-7.86); Asian race (OR 2.53, 95% CI 1.64-3.89); and Black race (OR 1.78, 95% CI 1.31-2.41). The odds of unemployment were marginally elevated for those living in large metropolitan areas, while being born in the United States had a modest protective effect (OR 0.53, 95% CI 0.42-0.66). Conclusion The degree of visual impairment in this post-COVID-19 pandemic survey substantially affects employment, which is consistent with historical studies. Education among those with impaired vision is an important and modifiable variable that can positively influence the chances of employment.

Opioid Use and Overdose Patterns in Puerto Rico in 2020-2022: A Retrospective Descriptive Study

The opioid epidemic is a recent global phenomenon affecting the United States and its affiliated territories, including Puerto Rico. There is a considerable gap in knowledge on how this epidemic has affected Puerto Rico. This gap can hinder the capabilities of healthcare workers to deliver appropriate treatment and preventative strategies to vulnerable groups. This descriptive study aims to describe opioid use and overdose in Puerto Rico during 2020-2022. This study analyzed data gathered by the Puerto Rico mental health and addiction subdivision of the Public Health Department (Administración de Servicios de Salud y Contra la Adicción; ASSMCA). Some of the noteworthy trends in this study include that most participants who suffered an overdose were overwhelmingly male and in the age group of 35-44 years old. Furthermore, most cases occurred in large metropolitan areas and happened in open spaces during the 12 pm-5:59 pm period. These findings emphasize the need for targeted interventions that consider the sociodemographic characteristics and geographical variations in drug use and overdose incidents in Puerto Rico.

Female Homicide Victims in Cook County, Illinois: A Retrospective Review.

Female homicide is a broad term that includes any homicide in which the victim is a female, representing the most extreme form of violence against women. This study investigated the characteristics of female homicides to determine the types and characteristics of injury, circumstances of the events, and other aspects in this specific population. The Cook County Medical Examiner's Office files were searched for homicides in female subjects between January 2017 and January 2022, with no limits for age, race, or cause of death. A total of 527 cases met the criteria. Most homicides occurred in Chicago during the summer. The most common cause of death was firearm(s) wounds, followed by sharp force traumas, asphyxia, and blunt force injuries. The remaining deaths were due to combined and "other" mechanisms. Different patterns of injuries were observed at the autopsy. Alleged offenders were mostly male subjects and were frequently in a romantic relationship with the victim, and the reasons for homicide were related to jealousy and personal conflicts. This study offers an overview of homicidal deaths in female subjects in a large metropolitan area.

Noisebnb: An Empirical Analysis of Home-Sharing Platforms and Residential Noise Complaints

Practice and Policy-Based Abstract Externalities stemming from digital platforms have had a profound impact on the daily lives of people across the globe. In this work, we examine one such externality that contributes to urban quality of life, the noise stemming from home-sharing platforms, which has been subject to aggressive scrutiny by policymakers and the popular press but has received limited rigorous empirical attention. Against a backdrop of significant investment by municipalities to curb extant levels of urban noise, our findings suggest that these platforms are instead correlated with a decrease in noise complaints in New York City (notably when occupancy rates are lower or the residence is located near tourist attractions). These findings suggest that investments in abating the noise stemming from such short-term rentals are less necessary than indicated by anecdotal evidence and are better directed at other forms of urban noise sources, chiefly because such rental units are frequently unoccupied and therefore remain quieter than residential units. However, these findings also underscore the extent to which home-sharing networks may be further straining the already stressed housing market in large metropolitan areas like New York City.

Seismic Structure‐Soil‐Structure Interaction between inelastic structures

AbstractFrequently, buildings in urban areas are designed by considering their stand‐alone response, that is, as single structures with no neighboring buildings. Nevertheless, the existence of a high density of buildings in large metropolitan areas inevitably results in the likelihood of an important seismic interaction between adjacent buildings through the underlying soil. This paper explores the effects of Structure‐Soil‐Structure Interaction (SSSI) on the seismic response of two yielding structures embedded in a linear elastic soil. A simple two‐dimensional nonlinear reduced‐order parametric model is proposed, where different building parameters are considered. A nonlinear phenomenological Bouc–Wen model is assumed for the buildings. A database of 15 strong ground motion records and an additional spectrally matched seismic ground motion are considered. An extensive parametric study comprising over two million nonlinear cases is conducted. The results show important differences between nonlinear SSSI and nonlinear SSI for particular parameter configurations. Nevertheless, due to energy dissipation and increases in damping in the nonlinear case, the effects of SSSI are less relevant compared with the linear case.

Nurse Reports of Moral Distress During the COVID-19 Pandemic.

COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

Integrative Geospatial Analysis: Unveiling Insights through GIS Modeling and Statistical Evaluation of SPT‐N and Soil Types Data of New Kabul City, Afghanistan

The precise evaluation of subsurface soil information is paramount for effective infrastructure design and planning. Geotechnical soil maps (GSMs) play a pivotal role in estimating subsurface properties. As Kabul City, Afghanistan’s largest metropolitan area, undergoes rapid expansion and the demand for safer infrastructure rises, the necessity for precise geotechnical information becomes increasingly urgent. Nevertheless, there is a lack of comprehensive studies on urban geotechnical zoning maps in Afghanistan. Therefore, to this end, this study utilizes inverse distance weighting (IDW) interpolation approaches for the construction and characterization of GSMs using a traditional geographic information system (GIS). Data about soil types and standard penetration (N‐value) up to 30 m depth were extracted from 130 locations in New Kabul City, Afghanistan. GSMs incorporating N‐value and soil types were constructed utilizing the IDW technique within the ArcGIS platform. The outcomes reveal that the subjected region was dominated by cohesive soil with N‐values varying from 7 to 45 in three different sections. The findings exhibit strong empirical correlations between N‐values and depth, with an R2 value of 0.95 and an RMSD value of 0.71. Moreover, the correlation coefficient to predict soil type classification is 97%, and it stands at 95% for N‐value prediction. These results facilitate the rapid evaluation of subsoil strength and stiffness, offering valuable insights for project planners and feasibility researchers.

Let Us Build for Ourselves a City: A Biblical Look at the Correlation Between Secularism, Liberalism, and Urbanization in America

A map of the 2022 U.S. mid-term election results per House district shows a vastness of ‘Republican red’ engulfing most of the country’s landmass in comparison to small pockets of ‘Democrat blue’ that is concentrated upon the most urbanized metropolitan population centers. Such a unique phenomenon begs the following question: ‘What has happened within the most urbanized metropolitan populations to cause them to overwhelmingly vote for the politically liberal Democratic party, a party whose platform is antithetical in many ways to what is expressly taught in the Bible?’ This question also spawns another: ‘Why have the most populous areas in the country also become bastions of paganism, hedonism, and liberalism?’ This paper demonstrates that past human behavior detailed in biblical narratives is being replicated in today’s modern urbanized culture. As is seen in Scripture, for a large city or metropolitan area to obtain and maintain a consistent and achievable level of peace and prosperity, a compromising layer of tolerance towards immorality and evil must materialize. Subsequently, the sustained tolerance of evil and violence will eventually lead to the approval, propagation, and adoption of evil and violence. Then and now, to the degree an urban population ‘goes along to get along’, the further it drifts from the Lord and plunges downward into paganism, hedonism, and idolatry. Thus, when a society consciously usurps the sovereignty of God and thinks it possesses the highest level of authority, then it has arrived at the point where it believes it has the freedom to redefine societal rules according to what it determines to be “right in its own eyes” (Judg. 21:25). By dismissing God’s existence or discounting His holiness, justice, and power, a population cognitively thinks it has effectively shaken off the yoke of sin, guilt, and shame, and has achieved the human right to “call evil good and good evil” (Isa. 5:20).

Analyzing Transportation Equity in the D.C. Metropolitan Area Using Large-Scale Agent-Based Modeling and Simulation

Policymakers face the challenge of providing equitable infrastructure services to all city dwellers with limited budgets. Further, equity analysis based on the socioeconomic characteristics of travelers is not palatable for some. This paper proposes a novel framework for analyzing equity in terms of access to opportunity rather than equity of outcomes. We showcase the use of a large-scale, high-fidelity agent-based, activity-based transportation model to analyze equity in the Washington DC metropolitan region. Travel time between each traffic analysis zone and its nearest activity area is used as a measure of access-to-opportunities, thereby carrying out equity analysis without using the socioeconomic characteristics of the traveler. The results of this analysis are visualized in a GIS heatmap. Decision-makers can visually identify regions needing attention and focus their funding and efforts on improving infrastructure services in the specified regions. Decision makers may elect to increase the capacity of road segments or develop a new employment activity center in the area of interest. The paper contributes to the literature by analyzing equity of opportunities without considering individuals’ socioeconomic characteristics, applying a higher fidelity activity-based model to a large metropolitan area, and documenting a framework and the results of large-scale equity analysis of the Washington DC metropolitan region.

Differentiation of personal income by the autonomous regions of Spain

Average per capita income of the population is one of the important indicators reflecting the standard of living in the country. It becomes relevant to determine reasons for differentiating income per capita and per household and to identify the causes that affect it. The paper considers the income of the population in the autonomous regions of Spain for 2008–2021 both per capita and per household. A comparative analysis of incomes with and without imputed rents has been carried out, that is, the share of rental expenditure in household income and the trend in its change over the last thirteen years have been determined. The results of the study revealed higher living standards in some industrialized regions of the North of the country, such as Navarra and the Basque Country, as well as in regions where large metropolitan areas are located. These are the Autonomous Region of Madrid with a population of 6.7 million people (directly Madrid – about 5 million people) and Catalonia with a population of 7.7 million people with the administrative center in Barcelona (4.5 million people). Slow growth of citizens’ expenditures on rental housing has also been revealed. Due to growing individualization of the population and reduction of the number of people in a family, the number of people in one household is decreasing on average in the country. The analysis of population change in Spain shows that the demographic situation remains positively stable. In general, there is population growth, but depopulation is occurring in the interior regions of the country, such as Extremadura, Castile-La Mancha, Castile and Leon, Aragon. In addition to living standards, other factors such as climate, proximity to the coast, and tourist attractiveness have an impact on migration processes.

SOCIAL CONNECTIONS AND SUICIDE DESIRE AMONG COMMUNITY-DWELLING OLDER ADULTS

Abstract As the population of older adults in the U.S. continues to increase, so will the prevalence of critical mental health concerns such as suicide (CDC, 2020). The Interpersonal Theory of Suicide posits desire for suicide develops from the simultaneous presence of thwarted belongingness and perceived burdensomeness (Joiner, 2005). Low social connection and perceptions of low social support can result in feelings of thwarted belongingness and perceived burdensomeness among older adults (Van Orden et al., 2012). The purpose of this study was to understand the relationship between social connections (frequency of contact with others, both synchronous or “real-time” and/or asynchronous) and suicide desire among community-dwelling older adults who received home-delivered meals (HDM) during Covid-19. This cross-sectional study was part of a grant-funded project by the Administration for Community Living. Among a sample of 320 older adults in a large southeast metropolitan area, we identified 25 participants who had no social connections of any type within the past week. These individuals had the highest levels of suicide desire and loneliness, and had the lowest levels of perceived social support. Implications for practice and future research include: a) recognition of the social connections HDM volunteers provide to older adults who may be lonely and at risk of suicide, b) an understanding of suicide desire among older adults during the Covid-19 pandemic, and c) opportunities for nutrition service providers to invest in equipping HDM volunteers to respond to suicide.

Assessing Vitamin D Levels and Demographic Profiles of Adult Outdoor Patients: A Descriptive, Cross-sectional Study in a District Medical College Hospital of Bangladesh

Background: Vitamin D deficiency is a highly prevalent nutritional deficiency in Bangladesh. While the majority of the research has been done in the large metropolitan area, few studies have been conducted at the district level. Furthermore, little information has been discovered about the demographics of people with vitamin D deficiency. Thus, this study aimed to identify the district-level demographics of those who suffer from vitamin D insufficiency.&#x0D; Methods: A descriptive cross-sectional study was conducted among 197 participants attending medicine outdoors at Sheikh Hasina Medical College Hospital, Tangail, Bangladesh. Detailed interview on socio-demographic and lifestyle factors and anthropometric measurement was conducted. Serum vitamin D level was estimated by chemiluminescent immunoassay. Data were analyzed by SPSS 22.0.&#x0D; Results: About 46.2% of respondents had insufficient and 36.5% had deficient vitamin D levels. Serum vitamin D level was 22.68 ng/ml ± 7.83. Females (84.92%) had hypovitaminosis D more than males (78.87%) which was statistically significant. BMI, occupation, and monthly income had no significant role in different vitamin D status groups. Among females, wearing Burka had a significant relationship with low vitamin D levels. &#x0D; Conclusion: Females are more prone to suffer from low vitamin D levels especially those who had less sun exposure due to choice of clothing. Prophylactic supplements of vitamin D may be considered in this group.&#x0D; J Shaheed Suhrawardy Med Coll 2022; 14(1): 57-61

Barriers and Facilitators to Breastfeeding Practices Among Immigrant Muslim Arab Women Living in a Metropolitan Area of the Southwestern United States

Objective:Immigrant Muslim Arab women are a fast-growing and underserved minority group in the United States. Immigrant Muslim Arab women face breastfeeding challenges in accessing and seeking healthcare. Little is known about breastfeeding challenges that immigrant Muslim Arab women face to establish successful breastfeeding. This study aimed to identify the barriers and facilitators to adequate breastfeeding among immigrant Muslim Arab women who reside in a metropolitan area of the Southwestern United States and inform recommendations for practice.Methods:A cross-sectional, descriptive study was used to identify facilitators and barriers to adequate breastfeeding using the social–ecological model of health promotion. A survey was carried out with a convenience sample of 116 immigrant Muslim Arab women with at least one child, 5 years or younger, from a large metropolitan area between September and November 2016.Results:Facilitators of breastfeeding within the sample were high intentions to breastfeed, positive breastfeeding attitudes related to the benefits of breastfeeding, religious teachings promoting breastfeeding, and encouragement to breastfeed from the mothers’ social support system. Several barriers to successful breastfeeding were related to lacking the specific knowledge of the benefits of breastfeeding and discomfort with breastfeeding in public and in front of strangers.Conclusions:Nurses and healthcare providers need to apply ecological breastfeeding interventions to promote optimal breastfeeding in this population.

InSAR Monitoring Using Persistent Scatterer Interferometry (PSI) and Small Baseline Subset (SBAS) Techniques for Ground Deformation Measurement in Metropolitan Area of Concepción, Chile

InSAR capabilities allow us to understand ground deformations in large metropolitan areas, this is key to assessing site conditions in areas in an inherently expanding context. The multi-temporal interferometry of SAR data records ground surface displacement velocities over large metropolitan areas, identifying anomalous and potential geological hazards. The metropolitan city of Concepción, Chile, is an alluvial basin in one of the world’s most seismically active subduction zones, where many subduction earthquakes have occurred throughout history. In this study, we monitored the deformations of the ground surface in the metropolitan area of Concepción using two interferometric techniques, the first being Persistent Scatterer Interferometry (PSI) and the second, the Small Baseline Subset (SBAS) technique. To do this, we have used the same Sentinel-1 dataset, obtaining ground movement rates between 2019 and 2021. The velocities were aligned with the GNSS station available in the area. Ground deformation patterns show local deformations depending on factors such as soil type and heterogeneity, and regional deformations due to geographical location in the subduction area. Our results highlight the similarity of the deformation rates obtained with different processing techniques and have also allowed us to identify areas of deformation and compare them to site conditions. These results are essential to evaluate ground conditions and contribute to urban planning and risk management in highly seismic areas.

Legal Issues on Climate Protection at The International Level

Objective: This research focused on the effectiveness of laws related to Natural Resources, Environmental Safety, and Climate Protection at both local and global scales. Methods: A comprehensive survey was conducted among residents of a large metropolitan area to gather data on their usage of urban green spaces and assess their mental well-being. The survey included questions related to the frequency of park visits, types of activities engaged in within green spaces, and self-reported mental health indicators. Statistical analysis, including regression modeling, was employed to examine the relationship between green space utilization and mental well-being. Results: The analysis revealed a significant positive correlation between the frequency of urban green space visits and improved mental well-being among residents. Individuals who visited green spaces more frequently reported lower levels of stress, anxiety, and depression. Moreover, engaging in physical activities and social interactions within these spaces demonstrated an even more pronounced positive impact on mental health. Conclusion: This study underscores the vital role of urban green spaces in promoting the mental well-being of metropolitan residents. Increased access to and utilization of green areas within cities can contribute to lower levels of stress and improved mental health outcomes. Urban planning and policy efforts should prioritize the preservation and creation of green spaces as integral components of urban environments to enhance the overall quality of life for city dwellers.

High Resolution WRF Modelling of Extreme Heat Events and Mapping of the Urban Heat Island Characteristics in Athens, Greece

In recent decades, large-scale urbanisation has developed rapidly, resulting in significant changes in the local and regional environment and climate. Large metropolitan areas worldwide induce significant changes in local atmospheric circulation and boundary layer meteorology by modifying the underlying surface characteristics and through the emission of anthropogenic heat and pollutants into the atmosphere. We investigate the urban heat island (UHI) characteristics in the city of Athens, Greece, which is one of Europe’s largest metropolitan complexes with a population of approximately 3.7 million inhabitants. The UHI effect is intense due to the city’s size, dense construction, high incident solar radiation, and almost complete lack of natural vegetation, with previous studies suggesting a temperature rise of 4 °C on average in the city centre compared to summer background conditions. We used high-resolution WRF simulations (1-km horizontal grid) driven with ERA5 reanalysis data to produce surface temperature maps in the city of Athens and the surrounding areas (Region of Attiki) during the summer period of 1 July–20 August 2021. Different model parameterizations were tested, both with respect to urban characteristics and physical parameters. The daily minimum and maximum temperatures (Tmin and Tmax) derived from the model were validated against observational data from a dense network of weather stations covering metropolitan Athens and surrounding locations. We further investigate the influence of different meteorological conditions on the UHI gradients as produced by the model and the observational dataset, including the extreme heat wave of 28 July–5 August 2021, during which persistent maximum temperatures of &gt;40 °C were recorded for nine consecutive days. The results indicate a strong correlation between WRF output and recorded minimum and maximum temperatures throughout the test period (R ranges from 0.80 to 0.93), with an average mean absolute bias (MAB) of 1.5 °C, and reveal the intensity and spatiotemporal variability of the UHI phenomenon in the city of Athens, with UHI magnitude reaching 8–9 °C at times. Our work aims to maximise the potential of using high-resolution WRF modelling for simulating extreme heat events and mapping the UHI effect in large metropolitan complexes.

Abstract A095: Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic has led to significant changes in the delivery of healthcare across the world, including the widespread adoption of telemedicine. This study examined the prevalence of telemedicine use by rurality and determined whether rurality was associated with its use among cancer survivors in the United States (US). Methods: The 2021 National Health Interview Survey (NHIS) was used to examine the use of telemedicine among cancer survivors during the pandemic. Our primary outcome is telemedicine use and rurality is our main exposure of interest. Other covariates of interest include demographics, health-related factors (number of comorbidities, self-rated health), and types of cancer history. Descriptive statistics and multiple logistic regression models were used to examine the mentioned association. Results: Among 27,500 eligible cancer survivors, 51.6% (14,140 participants) of them reported telemedicine use. The use of telemedicine varied by rurality, with 41.4% of rural cancer survivors using telemedicine compared to 58.4% of cancer survivors in large central metropolitan areas (p&amp;lt;0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared to metropolitan cancer survivors. Cancer survivors residing in rural were 0.58 times less likely (95% CI, 0.43 to 0.78) and cancer survivors residing in medium and small metropolitan areas were 0.72 times less likely (95% CI, 0.56 to 0.93) to report telemedicine use compared to cancer survivors residing in large central metropolitan areas. Conclusion: Significant rural disparities in telemedicine use were evident among cancer survivors. Rural cancer survivors were less likely to use telemedicine during the COVID-19 pandemic. To ensure equitable access to telemedicine, continued reimbursement for telemedicine services, but additional efforts are needed to improve access to and utilization of healthcare for rural cancer survivors. Citation Format: Minjee Lee, Meng-Han Tsai. Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A095.

Epidemiology, Outcomes, and 30-Day Readmissions in Acquired Hemophilia

Background: Acquired Hemophilia is a rare bleeding disorder characterized by the presence of autoantibodies (inhibitors) against coagulation factors, mainly targeting factor VIII. It predominantly affects older individuals with underlying autoimmune disorders or malignancies. Achieving hemostasis and inhibiting autoantibody production through immunosuppression are the mainstays of treatment. However, overcorrection of bleeding poses a risk of thrombosis, while immunosuppression increases the risk of infectious complications in older patients with co-existing comorbidities. This study sheds light on the epidemiology of acquired hemophilia, including readmission rates and causes of readmission. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2019 to identify hospitalizations with acquired hemophilia, using the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code D68.311. Descriptive analysis was performed to report patient demographics, hospital characteristics, various comorbid conditions, and complications. The all-cause 30-day readmission rate was calculated, excluding index admissions from December and deaths during index admissions. Additionally, primary diagnoses at readmission were identified. The analysis produced national estimates after applying weights, utilizing the methodology provided by the Healthcare Cost and Utilization Project. Results: Out of 1,450 admissions for acquired hemophilia between 2016 and 2019 in the United States, 803 (55.4%) were males, and 857 (59.1%) belonged to the age group of 61-80 years, with a median age at admission of 73 years. Furthermore, the majority were admitted to a teaching hospital (83.5%), with the highest quintile of acquired hemophilia-specific hospital volumes (43.8%) in a large metropolitan area with at least 1 million residents (59.8%). Although 20.9% had an underlying solid malignancy, only 28.5% had an otherwise high comorbidity burden with the Charlson comorbidity index of &amp;gt;3. Underlying hematologic malignancy was reported in 3.9% of admissions, and 13.5% had a diagnosis of an autoimmune disease. Regarding complications, acute myocardial infarction occurred in 9.5%, disseminated intravascular coagulation was noted in 1.2%, intracranial hemorrhage in 1.5%, ischemic stroke in 2.5%, and venous thromboembolism in 4.4%, with 30.2% of admissions experiencing some form of bleeding. The median length of stay was 7 days, and 101 deaths occurred during the index admission, resulting in a 7% inpatient mortality rate. Out of 1,349 patients who were discharged alive, 371 were readmitted within 30 days, with a 30-day readmission rate of 27% (table 1). The median time to readmission was 10 days (interquartile range 5-18), and the median length of stay during readmission was 7 days (interquartile range 3-14), with 10.8% mortality during readmission. The median hospitalization charges were $11,3008 for both index admissions and readmissions. After omitting readmissions coded as hemophilia, infection (30.8%), followed by bleeding (28.2%), was the most common cause for readmission (figure 1). Conclusion: The study highlights a high rate of bleeding and thrombotic complications in acquired hemophilia, necessitating a careful approach to factor replacement for achieving hemostasis. Moreover, bleeding and infection are the primary reasons for the elevated 30-day readmission rate of 27%, and there is an additional 11% mortality during readmission, indicating a significant incidence of treatment-related toxicity and disease relapse.