National Disparities Research Articles

Total burden of hepatitis B and C attributed to injecting drug use in 204 countries and territories from 1990 to 2021: Analyses based on the Global Burden of Disease Study 2021

This study assesses the global, regional, and national burden of hepatitis B (HBV) and hepatitis C (HCV) related to injecting drug use (IDU) from 1990 to 2021. Data from the global burden of disease study 2021 were analyzed to quantify deaths, age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and age-standardized DALYs rates (ASDR) due to HBV and HCV from IDU across 204 countries. Trends was evaluated using estimated annual percentage change. Analyzing the association between ASDR and SDI using a loess regression model. From 1990 to 2021, the global burden of deaths and DALYs due to HBV and HCV attributed to IDU showed an increasing trend, especially among males, whose mortality rates were significantly higher than females. In 2021, global deaths due to HBV from IDU were 13,050.8, with an ASMR of 0.15 per 100,000 and an ASDR of 5.3, both showing an increasing trend with estimated annual percentage changes (EAPCs) of 1.09 and 0.96, respectively. HCV deaths reached 231,764.4, with an ASMR of 2.68 (EAPC: 0.38) and a relatively stable ASDR trend (EAPC: 0.01). Although raw death rates for HCV have increased, the ASMR and ASDR have remained stable or slightly declined, highlighting different trends across sexes and regions. India had the highest national deaths, while the highest ASDRs were in the Republic of Moldova (HBV) and Mongolia (HCV). South Asia recorded the highest regional deaths for both HBV and HCV. Positive correlations between ASDRs for HBV and HCV with SDI were observed. The burden of HBV and HCV due to IDU has increased from 1990 to 2021, especially among males, with significant regional and national disparities. Targeted drug prohibition interventions and policies are needed.

Service evaluation of an early pregnancy loss support clinic in an inner London early pregnancy unit

BackgroundEarly pregnancy loss (EPL) can have profound implications for physical and psychological health. In the UK, significant variation in service provision exists for women affected by EPL. There is very little guidance on what hospital-based follow-up support services should entail, and how these can be implemented and integrated into current care provision to meet the needs of women who experience EPL. This service evaluation (SE) reports on an Early Pregnancy Loss Support Clinic (EPLSC) in an inner-city Hospital Trust.MethodsThis SE gathered both quantitative and qualitative feedback from women to assess the value of a locally implemented Early Pregnancy Loss Support Clinic (EPLSC). Quantitative feedback was collected using the Short Assessment of Patient Satisfaction (SAPS) questionnaire and the Visual Anxiety Scale (VAS-A), both administered to women attending the EPLSC. Qualitative feedback was collected through semi-structured interviews and focused on four pre-determined themes based on EPL literature - physical health, mental health, role of the bereavement midwife and overall service user experience. Quantitative feedback was summarised using descriptive statistics, while qualitative feedback was analysed using framework analysis.ResultsA total of 127 women were invited to the EPLSC, with 110 (87%) attending, and 17 (13%) not attending their appointment. SAPS scores ranged from 21 to 28, indicating that women were either satisfied or very satisfied with the care they received at the EPLSC. Results from VAS-A scores showed that 76 (69%) women reported a decrease in anxiety immediately after attending the EPLSC, compared to 8 (7%) who reported no change or a small increase in anxiety. Qualitative findings highlighted women’s concerns around future fertility, the importance of emotional support and the value of connecting with the bereavement midwife.ConclusionAn EPLSC that focuses on providing emotional support and reassurance, particularly regarding future fertility, is important to women. Further rigorous evaluation of national disparities in EPL follow-up is urgently needed to assess the gaps in clinical care delivery.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

Abstract Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objectives To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. Methods Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. Results IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. Conclusions Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days. Key messages • Mortality patterns refer to the internal variability of the crisis’ effect and to persistent spatial regional inequalities appealing to the need for attention in policymaking. • The relevance of considering the political economy of global health finance and macroeconomic volatility as a major influence on the association of mortality rates with socioeconomic indicators.

Associations between people experiencing homelessness (PEH) and neurodegenerative disorders (NDDs): A systematic review and meta-analysis.

Homelessness represents a widespread social issue globally, yet the risk of neurodegenerative diseases (NDDs) associated with people experiencing homelessness (PEH) has not received sufficient attention. Therefore, this study aimed to explore the risk of NDDs among PEH and its variation across countries and regions through meta-analysis and systematic review. Searching from databases such as PubMed and Web of Science, relevant research articles on PEH and NDDs were identified. After multiple screening, eight articles were selected for meta-analysis. Statistical methods and models were used to evaluate the association between PEH and NDDs, stratified by disease type and country. We found that PEH had a 51% higher risk of NDDs (OR = 1.51 (95% CI: 1.21, 1.89)) compared with those with stable housing. Specifically, PEH had a significantly higher risk of developing multiple sclerosis (OR = 4.64 (95% CI: 1.96, 10.98)). Alzheimer's disease and related dementias (ADRD) (OR = 1.93 (95% CI: 1.34, 2.77)), dementia (OR = 1.69 (95% CI: 1.26, 2.27)), and cognitive impairment (OR = 1.07 (95% CI: 0.98, 1.16)) were all at higher risk. Furthermore, country and regional differences were observed, with countries such as Iran (OR = 4.64 (95% CI: 1.96, 10.98)), the Netherlands (OR = 2.14 (95% CI: 1.23, 3.73)), the United States (OR = 1.66 (95% CI: 1.25, 2.22)), and Canada (OR = 1.06 (95% CI: 1.01, 1.10)) showing a higher risk of NDDs among the PEH. The study emphasizes the significant NDD risks among PEH, providing novel perspectives on this issue and shedding light on national disparities influenced by variations in healthcare systems and social environments. This will be beneficial for academia and government to prioritize the health of PEH with NDDs, aiming to mitigate disease incidence and economic burdens while preserving social stability and upholding basic human rights.

Supplemental Material for National Disparities Favoring Males Are Reflected in Girls’ Implicit Associations About Gender and Academic Subjects

Supplemental Material for National Disparities Favoring Males Are Reflected in Girls’ Implicit Associations About Gender and Academic Subjects

The Revival of Industrial Policies in the EU?

ABSTRACT This article provides an in-depth analysis of the evolution and current state of industrial policies in the European Union (EU) from the 1980s to the present day. We specifically focus on the resurgence of interest in such policies from 2020. We argue that industrial policies in the EU during the second half of the 2020s and into the 2030s will differ significantly from previous decades, while acknowledging challenges in fully understanding their scope and implementation. In particular, it is argued that the lack of a meaningful EU fiscal capacity constitutes the biggest challenge for the design and implementation of effective industrial strategies, which risks exacerbating regional and national disparities in the dual transition.

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

Estimating the impact of enhanced care at minority-serving hospitals on disparities in the treatment of breast, prostate, lung, and colon cancers.

The objective of this study was to quantify disparities in cancer treatment delivery between minority-serving hospitals (MSHs) and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers from 2010 to 2019 and to estimate the impact of improving care at MSHs on national disparities. Data from the National Cancer Database (2010-2019) identified patients who were eligible for definitive treatments for the specified cancers. Hospitals in the top decile by minority patient proportion were classified as MSHs. Multivariable logistic regression adjusted for patient and hospital characteristics compared the odds of receiving definitive treatment at MSHs versus non-MSHs. A simulation was used to estimate the increase in patients receiving definitive treatment if MSH care matched the levels of non-MSH care. Of 2,927,191 patients from 1330 hospitals, 9.3% were treated at MSHs. MSHs had significant lower odds of delivering definitive therapy across all cancer types (adjusted odds ratio: breast cancer, 0.83; prostate cancer, 0.69; nonsmall cell lung cancer, 0.73; colon cancer, 0.81). No site of care-race interaction was significant for any of the cancers (p>.05). Equalizing treatment rates at MSHs could result in 5719 additional patients receiving definitive treatment over 10 years. The current findings underscore systemic disparities in definitive cancer treatment delivery between MSHs and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers. Although targeted improvements at MSHs represent a critical step toward equity, this study highlights the need for integrated, system-wide efforts to address the multifaceted nature of racial and ethnic health disparities. Enhancing care at MSHs could serve as a pivotal strategy in a broader initiative to achieve health care equity for all.

National disparities in residential energy tax credits in the United States

The Inflation Reduction Act (IRA) promises to deliver $270 billion in tax incentives starting in 2023, expanding on the existing $18 billion in federal income tax credits for clean energy investments. Despite the continued investment in clean energy tax credits, not all communities have historically benefited equally from these programs. This work investigates the presence of disparities in the residential energy tax credit (RETC) program, which was recently expanded under the IRA. We use quantile regression models to explore disparities in the participation in and average value received from the RETCs across demographics. Because tax credit programs result in second-tier benefits such as job creation, we compare the relationship between RETC participation and the presence of clean jobs across demographics. We find that rural communities, renter-occupied communities, and communities of color are disproportionately participating less in the RETC. However, we observe that when renter-occupied or communities of color do participate, they see higher average value comparatively as well as more clean jobs associated per tax return with the RETC. While disparities across demographic groups persist in participation in the RETC, these findings suggest that renter-occupied or communities of color see more benefits when they do participate.

523 Measuring the Impact of an Operations Manager on a Study Team

OBJECTIVES/GOALS: Having a strong leader in the form of an operations manager is crucial to lead and motivate teams. They're an additional set of problem-solving eyes to identify and address challenges. This poster demonstrates coordination techniques involved to work with teams of researchers, ensuring effective communication, deadlines met, and impact. METHODS/STUDY POPULATION: Stories, course corrections, publications, presentations and other metrics related to various projects and studies in the Lab will show such as the National Drug Early Warning System (NDEWS), Program to Alleviate National Disparities in Ethnic and Minority Immunizations in the Community (PANDEMIC, CDC), Polysubstance Use Study (PSU), and All of Us Consortium of CTSA/PACER Community Network. Additional data will be collected with project managers and students from each respective project to evaluate the effectiveness of an Operations Manager on the team across all studies in Our Lab. RESULTS/ANTICIPATED RESULTS: By sharing these results, showing the benefit to having an Operations Manager and the stories collected and shared for this poster, course corrections will set an example for future operations managers and their teams to continue to optimize efforts. Tis Could be a Special Interest Group (SIG)-related effort that would facilitate success to many labs. DISCUSSION/SIGNIFICANCE: Operations management focuses on effectively managing resources, ensuring that we meet deadlines, reduce delays, and maximize team productivity. By sharing our experiences, this can be a more standard practice among research labs to have smooth operations, and increase overall reputation of our team among those in the field.

194 Increasing COVID-19 vaccine uptake through community engagement: collaborative efforts among Cooperative Extension and Clinical and Translational Science Institutes

OBJECTIVES/GOALS: The CDC-funded Program to Alleviate National Disparities in Ethnic and Minority Immunizations in the Community intersects two national networks that transform building trust in communities: Cooperative Extension Systems and Clinical and Translational Science Awardees, with the goal of reducing vaccine hesitancy and increasing vaccine uptake. METHODS/STUDY POPULATION: PANDEMIC included North Central Florida; Greater Sacramento, California; Bronx, New York; St. Louis and the Ozarks, Missouri; rural Kentucky; and Minnesota. Our 10 Promising Practices (PPs) focus on the equitable distribution of COVID-19 vaccines and health information, with two detailing collaborative efforts to better achieve health equity: PP3) Bringing Services and Vaccines to People Where They Are & PP5) Creating Coalitions with Trusted Neighborhood Partners. CHWs and Extension Educators, trusted community members, work together to deliver culturally/linguistically diverse health messages in plain language in areas of high vaccine hesitancy and bring vaccines to people where they are. All outreach activities are tracked and categorized by PP affiliation. RESULTS/ANTICIPATED RESULTS: From November 2021 – August 2023, PANDEMIC has administered nearly 11,000 COVID-19 vaccines at over 2,500 outreach events. At events, Community Health Workers (CHWs) listen to community members to assess vaccine perceptions and health needs/concerns. We adapt messaging and outreach initiatives to promote vaccination through data analyses that help us understand perceptions. Responses are calculated for the populations of focus (PoF)–Latino/Hispanic, African American/Black, American Indian/Alaskan Native, Asian, Native Hawaiian/Other Pacific Islander) compared to others (Non-Latino/Hispanic White or unspecified race). Over 16,000 surveys were collected from November 2021 – August 2023 with 60% coming from the PoF. Key differences in perceptions will be shown along with other cross-site metrics. DISCUSSION/SIGNIFICANCE: PANDEMIC offers an innovative model for collaboration among CTSAs and Cooperative Extension Systems to better understand community perceptions and support vaccination efforts and overall health promotion in communities of greatest need, with a focus on racial and ethnic minority communities and underinsured/uninsured populations.

Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations.

Retrospective study with epidemiologic analysis of public Medicare data. This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations. With an aging population and new technologies, lumbar fusion is an increasingly common procedure. There is controversy, however, regarding which indications and techniques achieve optimal outcomes, leading to significant inter-surgeon variation and potential national disparities in care. Medicare billing datasets were supplemented with Census Bureau socioeconomic data for 2013 to 2020. These databases listed lumbar fusions billed to Medicare by location, specialty, and technique. Hotspots and coldspots of lumbar fusion incidence and technique choice were identified with county-level analysis and compared with Mann-Whitney U. A linear regression of fusion incidence and a logistic regression of lumbar fusion hotspots/coldspots were also calculated. Between 2013 and 2020, 624,850 lumbar fusions were billed to Medicare. Lumbar fusion hotspots performed fusions at nearly five times the incidence of coldspots (101.6 to 21.1 fusions per 100,000 Medicare members) and were located in the Midwest, Colorado, and Virginia while coldspots were in California, Florida, Wisconsin, and the Northeast. Posterior and posterolateral fusion (PF/PLF) were the most favored techniques, with hotspots in the Northeast. Combined PF/PLF and posterior interbody fusion was the second most favored technique, predominantly in Illinois, Missouri, Arkansas, and Colorado. The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the non-standardization of lumbar fusion indication has led to both over- and under- treatment across the nation. Level III (Retrospective).

Implementation strategies to screen, refer and link women involved in the carceral system to PrEP for HIV prevention

PurposeWomen involved in the carceral system (CS) experience several conditions that increase their risk for HIV (e.g. high rates of substance use, psychiatric disorders, histories of victimization). The purpose of this study is to explore perspectives on potential strategies to connect women in the CS to pre-exposure prophylaxis (PrEP) services.Design/methodology/approachThis study conducted in-depth interviews with 27 women involved in the CS eligible for PrEP. Using vignettes, interviews explored attitudes, barriers and facilitators toward PrEP screening, referral and linkage facilitated via a CS stakeholder, an mHealth application or providing PrEP service referrals during detention via a navigator.FindingsMost women were, on average, 41.3 years, from racial and ethnic minority groups (56% black/African American; 19% Latinx). Inductive thematic analysis revealed CS involved women expressed mostly positive attitudes toward CS-based PrEP implementation. Younger women were more accepting of and interested in mHealth interventions. Implementation facilitators included leveraging relationships with trusted allies (e.g. “peers”) and existing systems collaborations. Recommended implementation strategies included providing HIV and PrEP-specific education and training for system stakeholders and addressing issues related to privacy, system mistrust and stigma.Originality/valueResults provide a critical foundation for the implementation of interventions to improve PrEP access for women involved in the CS and have important implications for implementation strategies for all adults involved in the CS. Improving access to PrEP among this population may also support progress toward addressing national disparities in PrEP uptake, where women, black and Latinx populations have substantial unmet need.

207 Perceptions of the Vaccinated and Unvaccinated to Inform Translation to Health and Public Health Practice

OBJECTIVES/GOALS: Translating the science of vaccines to health and public health practice requires understanding how vaccine risks and benefits are understood and applying that knowledge to community translation. During the pandemic the lack of this knowledge became apparent. METHODS/STUDY POPULATION: Through the PACER community engagement special interest group of the ACTS, the University of Florida(UF)/Florida State University and 5 other CTSIs community engagement programs received Center for Disease Control and Prevention funding for the Program to Alleviate National Disparities in Ethnic and Minority Immunizations in the Community (PANDEMIC) to translate vaccinations into the community. At UF, HealthStreet’s Community Health Workers, CTSI Mobile Health Vehicle nurses, and Institute of Food and Agricultural Sciences extension agents collaborated to engage adults throughout the North and Central part of the state on their vaccine status and perceptions and to offer them vaccines. RESULTS/ANTICIPATED RESULTS: Through UF, 4,587 people have been interviewed in community settings using the Survey of Perceptions; 25% (1,125) had not received any COVID-19 vaccine. Among differences in perceptions, those vaccinated versus unvaccinated perceived people to be getting vaccines because they cut down on disease spread (28.9% vs. 15.2%), and perceived people NOT to be getting vaccinated because of misinformation/ignorance (27.1% vs. 11.0%) and political beliefs (16.3% vs. 6.7%). Both vaccinated and not perceived lack of trust as a reason to not get vaccinated (41.3% vs 46.4%). When asked what people were doing instead of vaccination, those vaccinated versus unvaccinated responded that people were doing nothing/very little much more often (40.6% vs. 21.8%) but were less likely to say ’trying to stay healthy’ (9.1% vs. 18.9%). DISCUSSION/SIGNIFICANCE: The science of translating from bench through clinical trials and to common health and public health practice requires knowledge of reasons for successful adoption. This survey adds to knowledge of perceptions towards vaccines that inhibit translation and biases toward the vaccine-hesitant.

Carnival in Rome: The Tension of Pope Paul III’s Dual Role Revisited

The papacy’s authority and standing in the sixteenth century were harmed by the Martin Luther Reformation and the sacking of Rome. In order to uphold the legitimacy of the papal theocracy and to restore the papacy’s cultural and intellectual authority, Pope Paul III brought back carnival celebrations in Rome. Paul III, a reformer, maintained an image of the pope as a spiritual leader who was “merciful” and “peaceful” using clever imagery; for instance, staging a “mask” procession which unites people while minimising ethnic and national disparities, thereby fostering a sense of community within the Catholic community. Reinforcing himself as a religious leader, Paul III was careful with the image of the papal monarchy in order to preserve the unity and independence of the Papal States. In the carnival floats, the pope introduced elements of pagan mythology, comparing himself to the consuls of ancient Rome to strengthen the pope’s ties with society. He adopted Janus (the double-faced god) and Apollo (the sun god) to create a secular image of the pope as the patron saint of Rome. On the one hand, the spiritual image of Pope Paul III as a religious leader was prominent in the carnival celebrations, and on the other hand, the secular image of the pope helped to consolidate the authority of the pope and external defendant of the Papal States. The dual spiritual and secular image of the pope underwent constant changes during the celebrations, a process of tension that helped him to overcome, in part, the political and religious challenges of the early modern period and reflected the transitional and dual nature of the Catholic Church at the time.

Spatial Decomposition of Air Pollution Concentrations Highlights Historical Causes for Current Exposure Disparities in the United States.

Racial-ethnic disparities in exposure to air pollution in the United States (US) are well documented. Studies on the causes of these disparities highlight unequal systems of power and longstanding systemic racism-for example, redlining, white flight, and racial covenants-which reinforced racial segregation and wealth gaps and which concentrated polluting land uses in communities of color. Our analysis is based on empirical estimates of ambient concentrations for two important pollutants (NO2 and PM2.5). We show that spatially decomposed concentrations can be used to infer and quantify types of root causes for local- to national-scale disparities. Urban-scale segregation is important yet reflects less than half of the overall national disparities. Other historical causes of national exposure disparities include those that led current populations of Black, Asian, and Hispanic Americans to live in larger cities; those outcomes are consistent with, for example, greater economic opportunity in large cities, land-takings from non-White farmers, and racism in homesteading and between-state migration. Our results suggest that contemporary national exposure disparities in the US reflect a broad set of historical local- to national-scale mechanisms-including racist laws and actions that include, but also extend beyond, urban-scale aspects-and offer a first attempt to quantify their relative importance.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

IntroductionThe study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and...

National trends and disparities in retail food environments in the USA between 1990 and 2014.

To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space. We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile. The contiguous USA between 1990 and 2014. All census tracts (n 71 547). All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time. Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.

National Disparities in Antibiotic Prescribing by Race, Ethnicity, Age Group, and Sex in United States Ambulatory Care Visits, 2009 to 2016.

While efforts have been made in the United States (US) to optimize antimicrobial use, few studies have explored antibiotic prescribing disparities that may drive future interventions. The objective of this study was to evaluate disparities in antibiotic prescribing among US ambulatory care visits by patient subgroups. This was a retrospective, cross-sectional study utilizing the National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was described as antibiotic visits per 1000 total patient visits. The appropriateness of antibiotic prescribing was determined by ICD-9 or ICD-10 codes assigned during the visit. Subgroup analyses were conducted by patient race, ethnicity, age group, and sex. Over 7.0 billion patient visits were included; 11.3% included an antibiotic prescription. Overall and inappropriate antibiotic prescription rates were highest in Black (122.2 and 78.0 per 1000) and Hispanic patients (138.6 and 79.8 per 1000). Additionally, overall antibiotic prescription rates were highest in patients less than 18 years (169.6 per 1000) and female patients (114.1 per 1000), while inappropriate antibiotic prescription rates were highest in patients 18 to 64 years (66.0 per 1000) and in males (64.8 per 1000). In this nationally representative study, antibiotic prescribing disparities were found by patient race, ethnicity, age group, and sex.

Association Between the Coronavirus Disease 2019 (COVID-19) Pandemic and National Disparities in Postpartum Visit Attendance.

This study used data from PRAMS (Pregnancy Risk Assessment Monitoring System) between 2016 and 2020 and found that postpartum visit attendance declined by 5.8 (95% CI -6.4 to -5.2) percentage points in the first 9 months of the coronavirus disease 2019 (COVID-19) pandemic. The greatest declines occurred among non-Hispanic Black individuals (-9.9, 95% CI -11.6 to -8.1 percentage points), individuals aged 19 years or younger (-9.9, 95% CI -13.5 to -6.2 percentage points), and individuals without postpartum insurance (-11.4, 95% CI -14.5 to -8.3 percentage points). Although the pandemic was associated with a decrease in reporting common barriers to attendance, including lack of transportation and not being able to leave work, it introduced new barriers that potentially contributed to widened disparities in postpartum care. A combination of health policy and health system approaches are needed to increase postpartum visit attendance and reduce disparities in use.