Metropolitan Statistical Areas Research Articles

Hepatitis C virus infection and co-infection with HIV among persons who inject drugs in 10 U.S. cities—National HIV Behavioral Surveillance, 2018

BackgroundCharacterizing acute and chronic hepatitis C virus (HCV) infection and HIV/HCV co-infection among persons who inject drugs (PWID) can inform elimination efforts. MethodsDuring 2018 National HIV Behavioral Surveillance in 10 U.S. metropolitan statistical areas (MSAs), PWID were recruited using respondent-driven sampling and offered a survey, HIV testing, and HCV antibody and RNA testing. We examined prevalence and associated characteristics of HCV infection and HIV/HCV co-infection. Associations were assessed using log-linked Poisson regression models with robust standard errors accounting for clustering by recruitment chain and adjusting for MSA and network size. ResultsOverall, 44.2% had current HCV infection (RNA detected), with 3.9% classified as acute infection (HCV antibody non-reactive/RNA detected) and 40.3% as chronic (HCV antibody reactive/RNA detected). Four percent had HIV/HCV co-infection. Current HCV infection was significantly higher among PWID who were male, White, injected >1 time/day, shared syringes in past year, and shared injection equipment in past year. PWID who were transgender, injecting >5 years, and most often injected speedball (heroin and cocaine together) or stimulants alone were more likely to have HIV/HCV co-infection. Among PWID who never previously had HCV infection, 9.9% had acute HCV infection. Among PWID who started injecting ≤5 years ago, 41.5% had already acquired HCV infection. ConclusionsAcute and chronic HCV infections were substantial among a sample of PWID in 10 U.S. MSAs. Accessibility to HCV RNA testing, promoting safer practices, and intervening early with harm reduction programs for recent injection initiates will be critical to disease elimination efforts for PWID.

Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019-2021.

During the COVID-19 public health emergency, states waived in-state licensure and pre-existing patient-physician relationship requirements to increase access to care. We exploit this state telehealth policy variation to estimate the association of in-state licensure requirement waivers and pre-existing patient-physician relationship requirement waivers with out-of-state tele-mental health care utilization of patients diagnosed with COVID-19. Using claims from January 2019 until December 2021 of 2 037 977 commercially insured individuals in 3 metropolitan statistical areas (MSAs) straddling Midwestern state borders, we found increased out-of-state telehealth utilization as a share of out-of-state mental health care by 0.1411 and 0.0575 visits per month or 1679.76% and 467.48% after licensure and relationship waivers, respectively. Within-MSA analyses illustrate an urban-rural digital divide in out-of-state utilization as a share of total or telehealth mental health care. Our findings indicate waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state health care online. Interstate medical licensure compact participation may provide broader access to out-of-state tele-mental health care than emergency waivers.

Structural Discrimination against and Structural Support for Lesbian, Gay, and Bisexual People as a Predictor of Late HIV Diagnoses among Black Men who Have Sex with Men.

Black men who have sex with men (MSM) have been consistently reported to have the highest estimated HIV incidence and prevalence among MSM. Despite broad theoretical understanding that discrimination is a major social and structural determinant that contributes to disparate HIV outcomes among Black MSM, relatively little extant research has empirically examined structural discrimination against sexual minorities as a predictor of HIV outcomes among this population. The present study therefore examines whether variation in policies that explicitly discriminate against lesbian, gay, and bisexual (LGB) people and variation in policies that explicitly protect LGB people differentially predict metropolitan statistical-area-level variation in late HIV diagnoses among Black MSM over time, from 2008 to 2014. HIV surveillance data on late HIV diagnoses among Black MSM in each of the 95 largest metropolitan statistical areas in the United States, from 2008 to 2014, were used along with data on time-varying state-level policies pertaining to the rights of LGB people. Results from multilevel models found a negative relationship between protective/supportive laws and late HIV diagnoses among Black MSM, and a positive relationship between discriminative laws and late HIV diagnoses among Black MSM. These findings illuminate the potential epidemiological importance of policies pertaining to LGB populations as structural determinants of HIV outcomes among Black MSM. They suggest a need for scrutiny and elimination of discriminatory policies, where such policies are currently in place, and for advocacy for policies that explicitly protect the rights of LGB people where they do not currently exist.

Distributional impacts of fleet-wide change in light duty transportation: mortality risks of PM2.5 emissions from electric vehicles and Tier 3 conventional vehicles

Abstract Light-duty transportation continues to be a significant source of air pollutants that cause premature mortality and greenhouse gases (GHGs) that lead to climate change. We assess PM2.5 emissions and its health consequences under a large-scale shift to electric vehicles (EVs) or Tier-3 internal combustion vehicles (ICVs) across the United States, focusing on implications by states and for the fifty most populous metropolitan statistical areas (MSA). We find that both Tier-3 ICVs and EVs reduce premature mortality by 80%–93% compared to the current light-duty vehicle fleet. The health and climate mitigation benefits of electrification are larger in the West and Northeast. As the grid decarbonizes further, EVs will yield even higher benefits from reduced air pollution and GHG emissions than gasoline vehicles. EVs lead to lower health damages in almost all the 50 most populous MSA than Tier-3 ICVs. Distributional analysis suggests that relying on the current gasoline fleet or moving to Tier-3 ICVs would impact people of color more than White Americans across all states, levels of urbanization, and household income, suggesting that vehicle electrification is more suited to reduce health disparities. We also simulate EVs under a future cleaner electric grid by assuming that the 50 power plants across the nation that have the highest amount of annual SO2 emissions are retired or retrofitted with carbon capture and storage, finding that in that case, vehicle electrification becomes the best strategy for reducing health damages from air pollution across all states.

Built environment’s nonlinear effects on mode shares around BRT and rail stations

This study investigates nonlinear associations between built environment (BE) attributes and commuting mode share within rail and bus rapid transit (BRT) catchment areas. Data from approximately 2,790 fixed guideway transit station areas across 34 metropolitan statistical areas in the United States were analyzed using a random forest approach. Results show nonlinear associations of the BE with mode share in transit catchment areas with substantial differences between rail and BRT catchment areas. Rail catchment areas exhibit greater sensitivity to the BE to reduce car dependency as compared to BRT stations. Moreover, polycentricity and population density at regional level are effective at reducing car dependency. We suggest that policymakers consider BE threshold effects and station types when adjusting land-use policies, e.g., in transit-oriented development. Additionally, BRT systems could be a useful alternative to rail in sprawling areas that do not have the compactness needed to support rail.

Psychotropic Medication Prescriptions and Large California Wildfires

Wildfires, intensified by climate change, have known effects on physical health but their effects on mental health are less well characterized. It has been hypothesized that the residential proximity to a large wildfire can exacerbate underlying mental health conditions as evidenced by increased prescriptions of psychotropic medications. To evaluate the association between the occurrence of large wildfires and the prescription rates of psychotropic medications immediately following the start of the fire. This cohortstudy used an interrupted time-series analysis to compare psychotropic medication prescriptions in the 6 weeks before and after each of 25 wildfires. The setting was California counties within metropolitan statistical areas (MSAs) experiencing large wildfires from 2011 through 2018. Participants included individuals residing in California MSAs with prescriptions of psychotropic medications recorded in the Merative MarketScan Research Database (MarketScan) during the study period. Statistical analysis was performed for these 25 large wildfires occurring between September 2011 and November 2018. Residential proximity to large wildfires that burned more than 25 000 acres occurring in a California county within an MSA. Prescriptions of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, hypnotics, and mood-stabilizers, with statins as a negative control outcome. For the study period, prescription data and patient-level attributes were extracted for 7 115 690 unique individuals (annual mean [range]: 889 461 [455 705-1 426 928] individuals) enrolled in MarketScan and residing in fire-affected MSAs. This study found a statistically significant increase in prescriptions of antidepressants (rate ratio [RR], 1.04 [95% CI, 1.01-1.07]), anxiolytics (RR, 1.05 [95% CI, 1.02-1.09]), and mood-stabilizing medications (RR, 1.06 [95% CI, 1.01-1.13]) in the fire period compared with the prefire baseline. However, the prescriptions of antipsychotics, hypnotics, and the negative control outcome, statins, showed no significant association. In this cohort study of large California wildfires, the occurrence of wildfire was associated with increased mental health burden as reflected in increased prescription rates of certain psychotropic medications. The findings underscore the need for further scientific examination into the mental health effects of wildfires and the allocation of mental health resources in disaster responses. California experienced a substantial burden of wildfires from 2011 to 2018, and as wildfires become more intense and frequent in the context of anthropogenic climate change, it is increasingly important to understand and address their mental health effects.

Individual and interlinked SDGs: higher education institutions and metro area sustainability performance

PurposeRecent scholarship has explored higher education institutions’ (HEIs) role in transitioning to a sustainable society, but empirically, questions remain regarding their impact on the sustainability of surrounding areas. This study aims to examine the correlation between HEIs’ sustainability actions and local sustainability performance.Design/methodology/approachThis study uses a linear regression model and principal component analysis to examine the sustainability performance of 105 US metropolitan statistical areas (MSAs) using the US cities sustainable development goal (SDG) index, which hosts 427 HEIs known for sustainability efforts. The weighted HEI sustainability performance score is calculated based on the QS sustainability universities ranking.FindingsThe correlation between MSA and HEI sustainability performance exhibits a mix of positive and negative associations, with individual and interlinked SDGs serving as proxies. These correlations encompass a wide range of goals, from economic aspects of SDG 1, 2, 3, 7, 9, social aspects of SDG10 and 16, to socio-environmental aspects of SDG12.Research limitations/implicationsFurther exploration is needed to identify the causal mechanisms behind associations between SDG measures and HEI sustainability performance, whether influenced by the institution, the individual or both.Practical implicationsThis study suggests that HEIs are already associated with some aspects of community sustainability, but greater contributions to a broader array of sustainability measures are possible.Social implicationsThe correlation found between HEI sustainability actions and SDG10, 12 and 16 index performance in an MSA highlights a connection between HEIs and the attainment of societal goals.Originality/valueTo the best of the authors’ knowledge, this study is the first to examine the correlation between HEI and MSA sustainability performance in the US through individual and interlinked SDG proxies. It provides novel empirical evidence that demonstrates an association between HEI and some aspects of community sustainability performance.

Do Political Leaders Impact Economic Freedom at the Local Level? Evidence from Close Elections

This paper examines whether state and local political leaders’ partisan affiliations affect economic freedom at the metropolitan statistical area (MSA) level. Because political leaders’ partisan affiliations likely correlate with unobserved state- and local-level characteristics that also affect the economic freedom levels of MSAs, we use a regression discontinuity design that leverages close elections as natural experiments to identify a causal effect. Using Stansel (2019)’s index, which aggregates a bundle of policies into a single measure of economic freedom, we find that close Republican majorities in the lower State House increase overall MSA-level economic freedom. This effect is realized through consistent governments (i.e., Republican governor and Republican State House majority) and primarily through changes in labor market policy. At the city level, Republican mayors also increase overall MSA-level economic freedom levels.

Racial disparities in law enforcement/court-ordered psychiatric inpatient admissions after the 2008 recession: a test of the frustration-aggression-displacement hypothesis.

Societies under duress may selectively increase the reporting of disordered persons from vulnerable communities to law enforcement. Mentally ill African American males reportedly are perceived as more threatening relative to females and other race/ethnicities. We examine whether law enforcement/court order-requested involuntary psychiatric hospitalizations increased among African American males shortly after ambient economic decline-a widely characterized population stressor. We identified psychiatric inpatient admissions requested by law enforcement/court orders from 2006 to 2011 across four US states (Arizona, California, New York, North Carolina). Our analytic sample comprises 13.1 million psychiatric inpatient admissions across 95 counties over 72months. We operationalized exposure to economic downturns as percent change in monthly employment in a metropolitan statistical area (MSA). We used zero inflated negative binomial and linear fixed effects regression analyses to examine psychiatric inpatient admissions requested by law enforcement/court orders following regional employment decline over a time period that includes the Great Recession of 2008. Declines in monthly employment precede by one month a 6% increase in psychiatric hospitalizations requested by law enforcement/court order among African American males (p < 0.05), but not among other race/sex groups. Estimates amount to an excess of 2554 involuntary admissions among African American males statistically attributable to aggregate-level employment decline. Economic downturns may increase involuntary psychiatric commitments among African American males. Our findings underscore the unique vulnerability of racial/ethnic minorities during economic contractions.

Impacts of Vaccination and Severe Acute Respiratory Syndrome Coronavirus 2 Variants Alpha and Delta on Coronavirus Disease 2019 Transmission Dynamics in Four Metropolitan Areas of the United States.

To characterize Coronavirus Disease 2019 (COVID-19) transmission dynamics in each of the metropolitan statistical areas (MSAs) surrounding Dallas, Houston, New York City, and Phoenix in 2020 and 2021, we extended a previously reported compartmental model accounting for effects of multiple distinct periods of non-pharmaceutical interventions by adding consideration of vaccination and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants Alpha (lineage B.1.1.7) and Delta (lineage B.1.617.2). For each MSA, we found region-specific parameterizations of the model using daily reports of new COVID-19 cases available from January 21, 2020 to October 31, 2021. In the process, we obtained estimates of the relative infectiousness of Alpha and Delta as well as their takeoff times in each MSA (the times at which sustained transmission began). The estimated infectiousness of Alpha ranged from 1.1x to 1.4x that of viral strains circulating in 2020 and early 2021. The estimated relative infectiousness of Delta was higher in all cases, ranging from 1.6x to 2.1x. The estimated Alpha takeoff times ranged from February 1 to February 28, 2021. The estimated Delta takeoff times ranged from June 2 to June 26, 2021. Estimated takeoff times are consistent with genomic surveillance data.

Emotion Regulation Moderates Associations between Discrimination and Cannabis Use Patterns among Sexual Minority Young Adult Women.

Sexual minority young adults (SMYAs) experience discrimination and have high cannabis use prevalence. Discrimination may be associated with cannabis use, including hazardous use and co-use with tobacco, depending on emotion regulation and gender. Fall 2020 survey data assessed discrimination, use frequency of emotion regulation strategies (i.e., cognitive reappraisal, expressive suppression), current cannabis use, hazardous use, and cannabis-tobacco dual use among SMYAs (age 18-34) in 6 United States metropolitan areas (women: n=450, M age =24.1, SD=4.7, 69.6% bisexual, 18.2% lesbian/gay, 12.2% other; men: n=254, M age=24.7, SD=4.5, 33.5% bisexual, 54.3% gay, 12.2% other). Multivariable logistic regression examined the moderating roles of cognitive reappraisal and expressive suppression on associations of discrimination with cannabis use outcomes, stratified by gender and adjusted for age, race and ethnicity, and employment. Among SMYA women, 89.5% experienced any discrimination; 53.1% reported current cannabis use, of whom 49.4% and 47.7% reported hazardous use and cannabis-tobacco dual use, respectively. Adjusting for sociodemographics, experiencing greater discrimination was associated with greater odds of hazardous cannabis use (aOR=1.08, 95% CI [1.02, 1.15]) and cannabis-tobacco dual use (aOR=1.04, 95% CI [1.01, 1.08]) among SMYA women with greater use of expressive suppression. Among SMYA men, 83.9% experienced any discrimination; 49.2% reported current cannabis use, of whom 55.2% and 44.0% reported hazardous use and cannabis-tobacco dual use. Discrimination and emotion regulation were unrelated to cannabis use outcomes among men. Conclusions: Given high rates of discrimination experiences among SMYAs, emotion regulation skills training may empower SMYAs, particularly women, to cope with discrimination without using cannabis.

Road Salt Legacies: Quantifying Fluxes of Chloride to Groundwater and Surface Water Across the Chicago Metropolitan Statistical Area

AbstractFreshwater chloride concentrations have been increasing in North American surface waters for decades, largely driven by increases in the use of road salt, which is commonly applied as a deicer. In Chicago, thousands of tons of road salt are applied to roadways each winter, and increases in surface water chloride concentrations have been noted across the region since the mid‐1960s. While much of the applied salt runs directly off to nearby waterways during snowmelt events, some percolates to groundwater, affecting public supply wells and increasing the amount of chloride released to streams as baseflow during the non‐salting season. In the present study we have developed a spatially distributed chloride mass balance across the Chicago Metropolitan Statistical Area (CMSA) for a 30‐year period (1990–2020) to better our understanding of long‐term chloride fluxes and storage. Our results show that inputs of road salt to the region increased by 33% between 1990 and 2020. During this same period, riverine chloride loads across the region increased by 60%. Despite these increases in riverine chloride export, we find that chloride is accumulating in CMSA groundwater at a rate of ∼480 ktons year−1. We show that shallow aquifers, &lt;30 m, exhibit only seasonal chloride storage, without long‐term accumulation. In contrast, at depths below 30 m, we find chloride concentrations to be increasing over time, indicating that legacy chloride is accumulating at deeper depths in CMSA groundwater. The present results highlight the importance of legacy chloride to long‐term water quality dynamics in North American cities.

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Rheumatoid arthritis (RA) has severe functional and economic consequences. The implications of the Patient Protection and Affordable Care Act (ACA) and demographic factors for access to surgical treatment are unclear. To investigate factors associated with time to RA hand surgery, surgical incidence, and cost after implementation of the ACA. This cross-sectional study used insurance data from the IBM MarketScan Research Databases from 2009 through 2020 to compare time to surgery, surgical incidence, and treatment cost for RA of the hand before and after ACA implementations. Included patients were 18 years or older with a new diagnosis for RA of the hand and at least 1 procedural code for arthroplasty, arthrodesis, tenolysis, tendon repair, or tendon transfer. Patients with coexisting inflammatory arthritis diagnoses were excluded. Demographic variables analyzed included patient sex, age at index date, residence within or outside a metropolitan statistical area (MSA; hereafter urban or nonurban), insurance and health plan type, Social Deprivation Index, Elixhauser Comorbidity Index score, and Rheumatic Disease Comorbidity Index. Data analysis occurred from October 2022 to April 2023. Surgery for RA of the hand during the pre-ACA (before 2014) vs post-ACA (2014 or later) periods. Time to surgery, surgical incidence, and cost of treating RA in patients undergoing hand surgery for RA. Among 3643 patients (mean [SD] age, 57.6 [12.3] years) who underwent hand surgery for RA, 3046 (83.6%) were women. Post-ACA passage, 595 (86.2%) patients who resided in urban areas had a significantly lower time to surgery than those who did not (-70.5 [95% CI, -112.6 to -28.3] days; P < .001). Among urban patients, the least socially disadvantaged patients experienced the greatest decrease in time to surgery after ACA but the change was not statistically significant. For all patients, greater social disadvantage (ie, a higher SDI score) was associated with a longer time to surgery in the post-ACA period; for example, compared with the least socially disadvantaged group (SDI decile, 0-10), patients in SDI decile 10 to 20 waited an additional 254.0 days (95% CI, 65.2 to 442.9 days; P = .009) before undergoing surgery. Compared with the pre-ACA period, the mean surgical incidence in the post-ACA period was 83.4% lower (162.3 vs 26.9 surgeries per 1000 person-years; P < .001), and surgical incidence was 86.3% lower in nonurban populations (27.2 vs 3.7 surgeries per 1000 person-years; P < .001) but only 82.8% lower in urban populations (135.1 vs 23.2 surgeries per 1000 person-years; P < .001). Per capita total costs of all treatment related to RA of the hand decreased in the post-ACA period but the change was not statistically significant. Insurer-paid costs were lower in the post-ACA period but the change was not statistically significant. Out-of-pocket expenses did not change. Findings of this cross-sectional study suggest that after ACA passage, disparities exist in access to timely, cost-effective hand surgery for RA. Increased access to surgical hand specialists is needed for nonurban residents and those with greater social deprivation, along with insurance policy reforms to further decrease out-of-pocket spending for RA hand surgery.

Improving the Understanding of the U.S. Urban Racial Geography and Its Temporal Change Using the Racial Landscape Method

Racial landscape (RL) is an innovative methodology for studying racial geography that offers several advantages over current approaches. This article aims to highlight two key features of RL that have the potential to significantly impact the discipline. First, the RL approach introduces a fundamentally different method for assessing segregation compared to existing methods. The RL method allows us to calculate segregation for any arbitrary area without the need for subdivisions, diversity measures, reference regions, or reliance on census geography. Importantly, by using data from fifty-one Metropolitan Statistical Areas (MSAs) across the United States, we demonstrate that the RL’s segregation metric produces comparable rankings of segregation among MSAs when compared to existing segregation indexes. Thus, although the RL expands the scope of problems where segregation can be quantified, it remains compatible with current segregation assessment practices. Second, we use data from the core parts of four selected MSAs in 1990 and 2020 to showcase how high-resolution RL-based racial maps can be employed for spatially explicit visual analyses of racial change. We discuss the potential impact of RL on the field, particularly in relation to segregation assessment and the evaluation of spatially explicit models of racial dynamics.

Lasting Impact of the COVID-19 Pandemic on Care and Prevention of Sexually Transmitted Infections in the Midwest.

The COVID-19 pandemic reduced the general accessibility of health services. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g., reduced hours, limited walk-in availability, decreased testing capacity), changes that may result in permanent change in STI service availability. At the same time, systems were driven to innovate in ways that could benefit patients. This study aimed to describe how the COVID-19 pandemic changed STI clinical services, with a focus on long-term impacts. In July 2022, a phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louis metropolitan statistical area. Sexually transmitted infection testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or nursing staff member. Of the 75 locations that were interviewed, 12 (16%) had not returned to prepandemic capacity and operations as of July 2022. Five sites had closed completely since the pandemic began, 3 of which are in the northwestern region of the metropolitan statistical area. Most (58.6%) of the open clinics had added telehealth appointments. Sexually transmitted infection testing sites decreased during the pandemic with lasting impact in one area of the Midwest. Resources to support STI infrastructure should be expanded. Maintaining updated information on STI care providers in the region can aid future assessments.

Актуальные проблемы развития регионов России: экономика и демография

The subject of the study is the relationship between Russian regions and the federal center based on the analysis of the degree of effectiveness of subsidies provided to them from the federal budget. The purpose of the work is to establish the expediency of expanding the legal framework of the subjects of the Russian Federation to solve their demographic and economic problems and ensure sustainable growth. The influence of partial financing of national projects on solving demographic and economic problems is considered, and the need to take into account the peculiarities of the region in conducting regional policy is shown. The concept of a "chronically lagging region" has been introduced. It is shown that by reducing the supermortality of men of working age, compensation for more than 80% of the population loss is possible. The reduction of male supermortality in Russia has been identified as a priority task of financial, budgetary and health policy. It is noted that the differentiation of the population by wealth in poor regions is greater than the national average. It is concluded that in Russian statistics it is necessary to identify metropolitan statistical areas that do not coincide with the existing metropolitan statistical area, on the basis of which the growth of large cities takes place. Initiatives have been put forward to hold annual negotiations between federal and regional governments on the size of transfers and to reconsider the consideration of a healthy environment as a national and territorial, and not only as a global public good.

Evidence of cloud and rainfall modification in a mid-sized urban area – A climatological analysis of Augusta, Georgia

Cloud and rainfall distributions in urban spaces have implications for planning, hydrological response, reservoir management, renewable energy generation, transportation, and agricultural productivity. Studies have confirmed that large urban areas can initiate or modify precipitation, but there are still questions about the role of city size and atmospheric interactions. The majority of case study approaches have focused on large cities or urban clusters and have largely ignored small to moderate sized cities. Herein, an analysis of the Augusta, Georgia metropolitan statistical area is conducted. Using a gridded, daily multi-sensor precipitation dataset and satellite-based cloud cover climatology, the warm seasons (June, July, and August) covering the period from 2002 to 2019 were analyzed using spatial comparisons within an upwind-downwind framework and z-score statistics. Such methodologies have been published for larger urban areas. We confirmed that a moderate-sized city like Augusta, Georgia and neighboring Aiken, South Carolina is associated with spatial patterns consistent with the “urban rainfall effect” (URE) and possibly an “urban cloud effect” (UCE). Contextual analysis of other local mesoscale signatures related to nearby water bodies are also provided as a sanity check on process identification.

The Uneven Depression: Michigan&amp;apos;s Economic Development at the City and Metropolitan Level (1960–2020)

The article is focused on the inner economic and geographic differences in the state of Michigan that emerged as its core automotive industry weakened from the late 1950s to the present. The study is based on data on the population of cities and the GDP of metropolitan statistical areas. Chronologically, the study is divided into three periods (1960–1970s, 1980–1990s, and 2000–2010s) that differed markedly in the overall dynamics of Michigan&amp;apos;s economic development. It is shown that pronounced growth was usually observed only in those centers whose economies were not based on traditional automobile production.

Assessment of freight accessibility in New York City: A spatial-temporal approach

Freight transportation is critical to metropolitan regions' economic competitiveness and long-term viability. However, it is one of the activities that produce the most negative externalities, including greenhouse gas emissions. The study of the relationship between freight transportation, land use, and demand management is critical for promoting enlightened policies that increase the social benefits of supply chains while avoiding their undesirable effects, such as climate change. Nonetheless, the tools available to public planners for incorporating freight transportation into their analyses are limited. In this context, this paper aims to highlight the impact that freight demand management strategies and freight-efficient land uses can have on increasing urban freight accessibility. In this study, the authors suggest a freight accessibility framework based on two measures of accessibility (an isochrone-based model and a gravity-based model) to analyze the spatiotemporal variation of freight accessibility in the New York City metropolitan statistical area for four sectors—retail trade, accommodation and food services, transportation and warehousing, and e-commerce. The results indicate that accessibility measures provide valuable insights towards policymaking, particularly to policies that target land use (e.g., location of warehouses), and policies that aim to shift the traffic of freight vehicles to periods with less traffic congestion.

THE SPILLOVER EFFECTS OF COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL: A STUDY FROM CALIFORNIA

Abstract In 2016, Medicare implemented the Comprehensive Care for Joint Replacement (CJR) program to test whether paying hospitals a bundled payment for 90 days of an episode of care for lower extremity joint replacement (LEJR), the most common surgery for Medicare beneficiaries, can improve care coordination and quality in traditional Medicare (TM). Unlike most Medicare alternative payment models, CJR participation was randomly assigned across Metropolitan Statistical Areas (MSAs). Hospitals in selected MSAs were required to participate in the program, while hospitals in other MSAs were paid in the usual fee-for-service manner. Taking advantage of this random assignment, we examined CJR’s direct effects on TM patients and spillover effects on Medicare Advantage (MA) and non-Medicare patients in California. Using California’s Patient Discharge Data (PDD) from 2014 to 2017and event study and difference-in-differences models, we studied changes in adjusted length of stay and home discharge rates before and after program implementation in hospitals in treated versus control MSAs. We found that the CJR program affected not only TM patients, but also untargeted MA and non-Medicare patients. Both TM and non-Medicare patients in treated hospitals experienced shortened length of stay (-3.9% &amp; -1.3%, p&amp;lt;0.05) and increased likelihood of discharge home (3.4%, 2.3%, p&amp;lt; 0.001) relative to those in untreated hospitals after program implementation. MA patients experienced an increase in not only home discharge rates (4.7%, p&amp;lt; 0.001) but also length of stay (2.5%, p&amp;lt; 0.01). Programs designed to affect Medicare costs have the potential to affect the care of patients not covered by the program.