Micropolitan Areas Research Articles

Adherence to COVID-19 vaccination recommendations and vaccine hesitancy in US blood donors.

General vaccination rates have been falling globally despite unequivocal health benefits. Noncompliance can result from access barriers and/or hesitant attitudes. Few studies have investigated the prevalence and determinants of noncompliance with COVID-19 vaccination in blood donors. We surveyed blood donors on COVID-19 infection and vaccination history, barriers and motivations for COVID-19 vaccination, and comorbidities. We estimate the prevalence of noncompliance, the prevalence of hesitancy toward COVID-19 vaccines, and investigate associated factors using multivariable models. From December 2021 to December 2022, 33,610 survey respondents were included. Of these, 24% had not been vaccinated for COVID-19 or had missing vaccination information, and 99% of those who reported reasons for being unvaccinated declared at least one of three hesitant attitudes presented in the survey (safety concerns; personal/cultural/religious beliefs; being young and not worrying about being vaccinated). Among noncompliant donors, <2% reported access barriers. In the multivariable model addressing factors associated with vaccine noncompliance, younger age, male gender, White/Caucasian race, absence of comorbidities, residency in a State with less restrictive COVID-19 policies, and living in micropolitan or rural areas were identified as significant predictors. Younger age and White/Caucasian race were independently associated with vaccine hesitancy among noncompliant donors. We found high rates of noncompliance with COVID-19 vaccination in blood donors, mostly driven by vaccine hesitancy. Understanding vaccine adherence among blood donors-a relatively highly educated and healthy population, with good healthcare access and usually motivated by altruism-could provide key information on determinants of vaccine noncompliance that may be harder to overcome.

How Does Innovation-Collaboration Network Structure Influence Regional Economic Resilience?

This paper examines whether different structures of co-patenting networks affect regional economic adaptation and adaptability in divergent ways. Adaptation differentiates from adaptability by recovering in a pre-shock growth path, while adaptability entails forging a new growth path. Focusing on computer, electronic, and electrical equipment manufacturing industries in U.S. metropolitan and micropolitan areas from 1990 to 2012, the study reveals that complete networks, characterized by closely connected nodes, promote adaptation but weaken adaptability. In contrast, coalitional networks, featuring loosely connected subgroups, enhance adaptability but hurt adaptation. The study contributes to regional economic resilience literature by empirically demonstrating the trade-off relationship between adaptation and adaptability from network structures’ perspective. Practically, the study helps policy makers to effectively allocate stimuli, such as grants and tax incentives, to develop targeted co-patenting networks to improve adaptation or adaptability.

Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State.

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival. Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality. Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]). Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Disparities in Spatial Access to Sleep Health Care in the United States: A Population-Based Geospatial Analysis

ObjectivesTo examine spatial access to sleep health care in the United States and investigate associations with demographic and socioeconomic characteristics, thereby identifying high-risk communities with limited spatial access to sleep health service. DesignA cross-sectional population-based geospatial analysis. Settings and ParticipantsResidents in US Census tracts across the 48 contiguous states, Alaska, and Hawaii. MethodsThe 2020 American Community Survey 5-year estimates, 2010 rural-urban commuting area codes, 2020 Area Deprivation Index, and sleep care provider locations from the National Provider Identifier file were used to assess the spatial access and related demographic/socioeconomic characteristics. Spatial access was measured by spatial access ratio using enhanced 2-step floating catchment area methods. The associations were investigated using logistic regression analysis and multivariate linear regression analysis. ResultsA total of 45.8 million residents experienced low spatial access to sleep health care. Spatial access decreased in rural and high Area Deprivation Index areas, and in areas characterized by higher population with uninsured status, vehicle unavailability, internet unavailability, cognitive difficulties, and hearing difficulties. With a 10% increase in the percentage of the racial minority (non-white) population, metropolitan census tracts experienced an increase in spatial access (3.268%), whereas micropolitan (−1.526%) and rural (−4.493%) areas experienced a decrease in spatial access. Similar findings were observed within the ethnic minority (Hispanic or Latino) population. Conclusions and ImplicationsDisparities exist in spatial access to sleep health care across the United States, especially for disadvantaged individuals. Racial/ethnic minorities exhibit contrasting spatial access patterns in urban and rural areas, with those in rural areas facing more challenges in spatial access to sleep health care.

Advanced Practice Providers in Burn Care, 2013-2022.

This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Patterns of care and outcomes for hepatocellular carcinoma and pancreatic cancer based on rurality of patient’s residence in a rural midwestern state

BackgroundAlthough advancements in surgical planning and multidisciplinary care have improved the survival of patients with hepatopancreatic cancers in recent years, the impact of the rurality of patient residence on care received and survival is not well known. We aimed to assess the association between the rurality of a patient’s residence and cancer-specific survival outcomes among patients with hepatocellular carcinoma (HCC) and pancreatic cancer (PC) in Iowa, hypothesizing that patients in rural areas would experience lower survival. MethodsAdult patients diagnosed with HCC or PC between 2010 and 2020 were identified using the Iowa Cancer Registry. Chi-square tests were used to compare categorical variables by rural/urban status. Logistic regression was used to examine factors associated with receiving surgery. Multivariable-adjusted Cox proportional hazards regression was used to determine associations with cancer-specific mortality. ResultsOf 1877 patients with HCC, 58%, 27%, and 16% resided in metropolitan, micropolitan, and rural areas, respectively. Approximately 70% of patients in rural areas traveled ≥50 miles for definitive care. Additionally, those residing in rural areas had the highest proportion of patients receiving definitive care at non-Commission on Cancer (CoC) centers (12.6% metro vs 14% micro vs 22.2% rural, P < .001). In a multivariable-adjusted analysis of patients with stage I to III disease, definitive care at a non-CoC center was independently associated with lower odds of surgery (odds ratio [OR] = 0.23; 95% CI, 0.12–0.45; P < .0001) and higher mortality risk (OR = 1.39; 95% CI, 1.07–1.79; P = .01), though rural residence was not. For PC, 5465 patients were diagnosed, and 51%, 28%, and 20% resided in metropolitan, micropolitan, and rural areas, respectively. Similar to HCC, although rural residence was neither associated with odds of surgery nor with mortality risk, receiving definitive care at non-CoC accredited centers was associated with significantly lower odds of receiving surgery (OR = 0.17; 95% CI, 0.11–0.26; P < .0001) and higher mortality risk (OR = 1.48; 95% CI, 1.23–1.77; P < .0001). ConclusionRural residents with hepatopancreatic cancer have the highest proportion of patients receiving definitive care at non-CoC centers, which is associated with lower odds of receiving surgery and higher odds of mortality. This highlights the importance of standardizing complex cancer care and the need to foster collaboration between specialized and non-specialized centers.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013–2021

This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to2021. Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Community level factors and racial inequities in delivery hospitalizations involving severe maternal morbidity in the United States, 2016–2019

The objective of this study was to evaluate the racial and ethnic disparities in delivery hospitalizations involving severe maternal morbidity (SMM) by location of residence and community income. We used the 2016 to 2019 Healthcare Cost and Utilization Project National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations with SMM. Using logistic regression models, we examined the association between race and ethnicity and delivery hospitalizations involving SMM. In adjusted analyses, the models were stratified by location of residence and community income and adjusted for patient and hospital characteristics. In rural areas, non-Hispanic Black women (AOR 1.50; 95% CI 1.25–1.79) and women of other races (AOR 1.32; 95% CI 1.03–1.69) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. In micropolitan areas, non-Hispanic Black women (AOR 1.88; 95% CI 1.79–1.97), non-Hispanic Asian/Pacific Islander women (AOR 1.54; 95% CI 1.16–2.05), and women of other races (AOR 1.31; 95% CI 1.03–1.67) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. Non-Hispanic Black women also had increased odds of experiencing a delivery hospitalization involving SMM in communities with the lowest income (quartile 1) (AOR 1.59; 95% CI 1.49–1.66), middle income (quartiles 2 and 3) (AOR 1.81; 95% CI 1.72–1.91), and highest income (AOR 2.09; 95% CI 1.90–2.29) when compared to non-Hispanic White women. We found that location of residence and community income are associated with racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM.

Geo-demographic trends in nontraumatic subarachnoid hemorrhage-related mortality among older adults in the United States, 1999-2020.

Nontraumatic subarachnoid hemorrhage (ntSAH) often results from a ruptured aneurysm and correlates with significant morbidity and mortality, particularly among the older population. Despite its impact, limited comprehensive studies evaluate the longitudinal trends in ntSAH-related mortality in older adults in the United States (US). The authors conducted a retrospective analysis using the CDC WONDER database from 1999 to 2020, analyzing Multiple Cause-of-Death Public Use death certificates to identify ntSAH as a contributing factor in the death of adults aged 65 years and older. We calculated age-adjusted mortality rates (AAMR) and annual percent change (APC) to examine trends across demographic variables such as sex, race/ethnicity, urbanization, and states/census region. A total of 78,260 ntSAH-related deaths (AAMR 8.50 per 100,000 individuals) occurred among older adults in the US from 1999 to 2020. The overall AAMR for ntSAH decreased from 9.98 in 1999 to 8.67 in 2020 with an APC of -0.7% [95% CI (-1.0, -0.3)]. However, the authors observed a noticeable rise from 2013 to 2020 with an APC of 1.7% [95% CI (0.8, 2.6)]. Sex, racial, and regional disparities were evident with higher mortality rates for ages 85 or greater (crude mortality rate 16.6), women (AAMR 9.55), non-Hispanic Asian or Pacific Islander (AAMR 12.5), and micropolitan areas (AAMR 8.99), and Western US (AAMR 8.65). Mortality from ntSAH increases with age, affects women disproportionately, and occurs more often in an inpatient setting. These findings necessitate targeted, multi-dimensional health policies and clinical interventions. Specialties beyond neurosurgery can utilize this data for improved risk stratification and early treatment. Policymakers should focus on equitable resource allocation and community-level interventions to mitigate these trends effectively.

Regional economic impact of university research expenditures

ABSTRACT Governments around the world provide significant funds for research activities at higher education institutions. Despite universities’ increased emphasis on external research funds and increased national funding for university research, little is known about the economic impacts specific to research expenditures. We use IMPLAN, an input-output model, to analyze the local economic impacts of externally sponsored university research expenditures in two geographic areas using a technological university in the Midwestern United States as a case study. For the rural micropolitan area, we find that one million dollars in university external research expenditures is associated with $711,000 in value added, 10 jobs, and $159,000 in tax revenue. The effects per million dollars of expenditures are typically larger in the medium metropolitan area; one million dollars in university external research expenditures is associated with $945,000 in value added, 9 jobs, and $164,000 in tax revenue. We also estimate value added, employment, and tax multipliers of 1.67, 1.86, and 1.74 for the micropolitan area and 2.02, 2.25, and 2.09 in the medium metropolitan area. Last, we show that 15-18% of generated tax revenue goes to the state and 75–77% goes to the federal government. Our results highlight the local and statewide economic returns to national public policy to invest in university research activities and how characteristics of the local economy influence the magnitude of those returns. The variation in the impacts also suggests that policy makers should be aware of differences across both geographic areas and impact measures (e.g. employment versus output).

Health care access barriers among metropolitan and nonmetropolitan populations of eight geographically diverse states, 2018.

Nonmetropolitan populations face frequent health care access barriers compared to their metropolitan counterparts, but differences in the number of these barriers across groups are not known. Our objective was to examine the differences in health care access barriers across metropolitan, micropolitan, and noncore populations. We used Behavioral Risk Factor Surveillance System data from the optional "Health Care Access" module to perform a cross-sectional analysis examining access barriers across levels of rurality using bivariate analyses and Poisson models. Access barriers were operationalized as a count ranging from 0 to 5, reflective of the number of financial barriers and nonfinancial barriers. Micropolitan and noncore respondents had lower educational attainment, were older, and were less racially/ethnically diverse than metropolitan respondents. They also reported more barriers, including lacking health insurance, medical debt, and foregoing care or medication due to cost. These barriers were most pronounced in non-Hispanic Black, Hispanic, and American Indian/Alaska Native nonmetropolitan populations, compared to their White counterparts. In adjusted analysis, micropolitan respondents reported more barriers compared to metropolitan (prevalence rate ratio=1.06; 95% confidence interval: 1.02-1.10) as did women, racial/ethnic minority populations, and those with less education. Micropolitan populations experience more barriers to health care, and nonmetropolitan respondents report more cost-related barriers than their metropolitan counterparts, raising concerns on health care disparities and financial burdens for these underserved populations. This underscores the need to mitigate these barriers, particularly among those in micropolitan areas and minorized populations.

Esophageal cancer in the United States: A 21-year mortality analysis (1999-2020).

e23258 Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first five years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends that are undergoing substantial transformations on a global scale, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. Methods: The mortality trends among adults with EC were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where EC was presented as a contributing or the underlying cause of death. Code C15 “Malignant Neoplasms of Esophagus” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Results: Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999-2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). CMRs also increased with advancing age and were greatest in individuals over the age of 85 years. AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and non-metropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile. Conclusions: Over the last two decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Effectiveness of implementing evidence-based approaches to promote physical activity in a Midwestern micropolitan area using a quasi-experimental hybrid type I study design.

Much evidence-based physical activity (PA) interventions have been tested and implemented in urban contexts. However, studies that adapt, implement, and evaluate the effectiveness of these interventions in micropolitan rural contexts are needed. The study aimed to evaluate the effectiveness of the Active Ottumwa intervention to promote PA in a micropolitan community. Between 2013 - 2019, we implemented Active Ottumwa in a micropolitan setting, and subsequently implemented and evaluated its effectiveness using a Hybrid Type I design. In this paper, we describe the intervention's effectiveness in promoting PA. We collected PA data over 24months from a cohort of community residents using accelerometers and PA data from two cross-sectional community surveys administered in 2013 and 2018, using the Global Physical Activity Questionnaire. From the cohort, we found significant change in PA over 24months (P = 0.03) corresponding to a 45-min daily decrease in sedentary activity, a daily increase of 35-min in light PA and 9min in moderate-to-vigorous PA. There was a statistically significant (P = 0.01) increasing trend at the population-level in the moderate-to-vigorous composition of 7min between the two cross-sectional assessments (95% CI: 0.1%-1.34%). The study demonstrates that the adapted evidence-based PA interventions in a micropolitan context is effective.

Mobile Health and Chronic Care: Using GIScience to Assess Health Care Accessibility among Broadband Subscribers in Nebraska’s Micropolitan and Rural Areas

Individuals with chronic health conditions such as cancer, diabetes, or heart disease have persistent needs for health care. Those residing in remote or rural locations and inflicted with long-term conditions have a more difficult time accessing critical care and ultimately a lower quality of life compared to those with similar ailments in more densely populated places. Mobile health (mHealth) has emerged as an alternative method for health care delivery for those living in rural or micropolitan areas who lack adequate health care options. Increased reliance on technology to provide mHealth options has increased efforts to evaluate differences in internet speeds, particularly among rural broadband customers. Drawing from the GIScience toolbox, a closest facility (CF) analysis is employed to compare network travel times to providers and broadband customer locations in Nebraska’s micropolitan and rural areas. Comparing network travel times to facilities for customers with recorded internet speeds demonstrates the extent to which differences exist between the two categories (micropolitan and rural) and who uses—or does not use—broadband technology for mHealth options. This study highlights GIScience’s ability to use technology to solve spatial problems.

A Typology of Micropolitan Areas in the United States

In 2003, the U.S. Census Bureau created a new census designation known as micropolitan statistical areas to better differentiate between metropolitan and nonmetropolitan areas. This article uses hierarchical clustering and discriminate analysis to create a typology of micropolitan areas using U.S. census data on demographic, housing, and economic characteristics. The regional concentration ratio (RCR) is then used to determine whether a cluster type is over- or underrepresented at the census division. The analysis revealed a three-cluster solution with: (1) a middle- class cluster overrepresented in the East North Central and West North Central divisions; (2) a poor, minority cluster overrepresented in the South Atlantic, East South Central, West South Central, and Mountain divisions; and (3) a high human capital cluster overrepresented in the New England, Mountain, and Pacific divisions. Of micropolitan areas, 59.8 percent were considered middle-class; 28.1 percent were poor, minority; and 12.1 percent were high human capital. The nine-cluster solution further refined cluster categories.

Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States.

A shortage of neurology clinicians and healthcare disparities may hinder access to neurologic care. This study examined disparities in geographic access to neurologists and subspecialty multiple sclerosis (MS) care among various demographic segments of the United States. Neurologist practice locations from 2022 CMS Care Compare physician data and MS Center locations as defined by the Consortium of Multiple Sclerosis Centers were used to compute spatial access for all U.S. census tracts. Census tract-level community characteristics (sex, age, race, ethnicity, education, income, insurance, % with computer, % without a vehicle, % with limited English, and % with hearing, vision, cognitive, and ambulatory difficulty) were obtained from 2020 American Community Survey 5-year estimates. Rural-urban status was obtained from 2010 rural-urban commuting area codes. Logistic and linear regression models were used to examine access to a neurologist or MS Center within 60 miles and 60-mile spatial access ratios. Of 70,858 census tracts, 388 had no neurologists within 60 miles and 17,837 had no MS centers within 60 miles. Geographic access to neurologists (spatial access ratio [99% CI]) was lower for rural (-80.49%; CI [-81.65 to -79.30]) and micropolitan (-60.50%; CI [-62.40 to -58.51]) areas compared with metropolitan areas. Tracts with 10% greater percentage of Hispanic individuals (-4.53%; CI [-5.23 to -3.83]), men (-6.76%; CI [-8.96 to -4.5]), uninsured (-7.99%; CI [-9.72 to -6.21]), individuals with hearing difficulty (-40.72%; CI [-44.62 to -36.54]), vision difficulty (-13.0%; [-18.72 to -6.89]), and ambulatory difficulty (-15.68%; CI [-19.25 to -11.95]) had lower access to neurologists. Census tracts with 10% greater Black individuals (3.50%; CI [2.93-10.71]), college degree holders (-7.49%; CI [6.67-8.32]), individuals with computers (16.57%, CI [13.82-19.40]), individuals without a vehicle (9.57%; CI [8.69-10.47]), individuals with cognitive difficulty (25.63%; CI [19.77-31.78]), and individuals with limited English (18.5%; CI [16.30-20.73]), and 10-year older individuals (8.85%; CI [7.03-10.71]) had higher spatial access to neurologists. Covariates for access followed similar patterns for MS centers. Geographic access to neurologists is decreased in rural areas, in areas with higher proportions of Hispanics, populations with disabilities, and those uninsured. Access is further limited for MS subspecialty care. This study highlights disparities in geographic access to neurologic care.

Migration of young adults in micropolitan counties

ABSTRACT Nonmetropolitan U.S. counties have historically lagged metropolitan areas in population and employment growth. Population projections indicate that they will face a shrinking workforce in the future, although, immigration and domestic migration by young adults could help offset this trend. The number of young adults (ages 25 to 44) is projected to increase in the next several decades and thus will be a growing proportion of the workforce. However, whether they will be attracted to rural areas such as micropolitan counties and how these counties can attract them has not received much attention in the community development literature. This article uses OLS regression to examine the determinants of the net migration rate for the 25–44 age group in micropolitan counties between 2000 and 2010, adjusting for geographic, economic, and county-level demographic factors.. The discussion then examines approaches that micropolitan areas can use to attract this age cohort.

Retrospective Review of Pneumothorax Rates in a Rural, Micropolitan Area After Bronchoscopic Lung Volume Reduction

Retrospective Review of Pneumothorax Rates in a Rural, Micropolitan Area After Bronchoscopic Lung Volume Reduction

Critical Elements of Care Coordination for Older Persons in Rural Communities: An Evaluation of the Iowa Return to Community Service Demonstration.

We evaluated the Iowa Return to Community, a service demonstration designed to coordinate care and reduce preventable healthcare utilization among at-risk older persons living at home in rural communities. During 2021, 262 older persons elected to participate in the IRTC program. Individuals who participated were more likely to live in micropolitan areas (OR = 2.30, 95% CI 1.34-3.95) relative to metropolitan locations. Individuals who used recommended services were more likely to be men (OR 3.65, 95% CI 1.16-11.51) and more likely to live in rural (OR 17.48, 95% CI 1.37-223.68) and micropolitan areas (OR 3.17, 95% CI 1.00-10.05). However, prevention of health care use corresponded more with consistent and prolonged IRTC program engagement rather than volume of service use. The IRTC constitutes a population aging and rural health strategy to reduce unnecessary health care use while supporting individual preferences to remain at home.