Zip Code Research Articles

Pediatric firearm injuries and socioeconomic vulnerability before and during the COVID-19 pandemic

BackgroundPediatric firearm injuries disproportionately affect groups experiencing socioeconomic disadvantage. Firearm injuries increased during the COVID-19 pandemic, but the impact on communities by degree of socioeconomic disadvantage is unknown. We examined the association between socioeconomic vulnerability and change in pediatric firearm injuries before versus during the pandemic. MethodsThis was a secondary analysis of a multicenter retrospective study comparing pediatric injuries pre- (March 17, 2019-December 31, 2020) versus during (March 15, 2020 – December 31, 2020) the COVID-19 pandemic. The parent study included injury-related visits to one of 40 Pediatric Emergency Departments in patients <18 years old. We examined firearm injuries as a proportion of all injuries. Deprivation Index (DI) was assigned using home zip code and divided into quartiles based on the distribution of DI in our total population, with deprivation increasing from quartile 1 (Q1, least deprivation) to quartile 4 (Q4, most deprivation). Kruskal-Wallis and Chi-square tests were used to compare variables of interest. Interrupted time series analysis was used to estimate pandemic effects on firearm injuries by DI quartile. ResultsThere were 1231 visits for firearm injuries. Mean DI was higher among firearm-injured than non-firearm-injured patients (0.43 vs. 0.35, p < 0.0001). Firearm injuries increased in proportion to all injuries pre- vs during pandemic (0.16 % vs 0.27 %, p < 0.0001). On interrupted time series analysis, the proportion of firearm injuries increased for Q2, Q3, and Q4. On subgroup analysis by intent, assault injuries as a proportion of all injuries increased from pre- to during COVID-19 for Q2 (3.32 % vs 6.94 %, ARD 3.62 %, 95 % CI 1.03, 6.20), Q3 (2.71 % vs 7.01 %, ARD 4.30, 95 % CI 1.99, 6.61), and Q4 (5.97 % vs 17.40 %; ARD 11.42, 95 % CI 0.19, 0.33). Unintentional injuries and injuries in youth 10–17 years old increased for Q2, Q3, and Q4. ConclusionsThe increase in pediatric firearm injuries during the COVID-19 pandemic impacted youth in all but the lowest deprivation quartile. Efforts at curbing gun violence should identify and amplify protective effects in under-resourced communities.

Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database.

The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events. All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes. 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001). DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.

Association between fine particulate matter and eczema: A cross-sectional study of the All of Us Research Program and the Center for Air, Climate, and Energy Solutions.

The prevalence of eczema has increased with industrialization. Industrial practices generate ambient air pollution, including fine particulate matter of diameter ≤ 2.5μm (PM2.5). Studies investigating the relationship between PM2.5 and eczema in the US are scarce. The objective of this study was to determine the risk of eczema with PM2.5 exposure in a diverse national cohort of American adults. In this cross-sectional study, eczema cases in the All of Us Research Program were linked via three-digit zip code to average annual PM2.5 concentrations from the Center for Air, Climate, and Energy Solutions. Eczema cases and controls were compared using Pearson's χ2 test for categorical variables and one-way analysis of variance for continuous variables. The relationship between PM2.5 and eczema was assessed via logistic regression adjusting for demographic factors, smoking, and atopic comorbidities. Individuals with eczema (n = 12,695) lived in areas with significantly higher PM2.5 concentrations than did individuals without eczema (n = 274,127) (0.83 x 10 μg/m3 v. 0.81 x 10 μg/m3, P < .001). PM2.5 concentration was significantly associated with eczema in univariable analysis (odds ratio 1.97, 95% confidence interval 1.77-2.19, P < .001), and in multivariable analyses, both controlling for demographics and smoking status (odds ratio 2.21, 95% confidence interval 1.98-2.47, P < .001) and with the addition of atopic comorbidities (odds ratio 2.38, 95% confidence interval 2.12-2.67, P < .001). The odds of eczema increased with greater PM2.5 concentration in this large, diverse, adult American cohort. Ambient air pollution is an environmental hazard that influences inflammatory skin disease, suggesting possible targeted interventions.

Treatments and Patient Outcomes Following Stroke Center Expansion

It is unclear how certified stroke center expansion contributes to improved access to stroke treatment and patient outcomes, and whether these outcomes differ by baseline stroke center access. To examine changes in rates of admission to stroke centers, receipt of thrombolysis and mechanical thrombectomy, and mortality when a community gains a newly certified stroke center within a 30-minute drive. This cohort study compared changes in patient outcomes when a community (defined by area zip code) experienced a stroke center expansion relative to the same community type that did not experience a change in access. Medicare fee-for-service beneficiaries with a primary diagnosis of acute ischemic stroke who were admitted to hospitals between January 1, 2009, and December 31, 2019, were included. The data analysis was performed between October 1, 2023, and September 9, 2024. New certification of a stroke center within a 30-minute driving time of a community. The main outcomes were rates of admission to a certified stroke center, receipt of thrombolytics (delivered using drip-and-ship and drip-and-stay methods), mechanical thrombectomy, and 30-day and 1-year mortality estimated using a linear probability model with community fixed effects. Among the 2 853 508 patients studied (mean [SD] age, 79.5 [8.5] years; 56% female), 66% lived in communities that had a stroke center nearby at baseline in 2009, and 34% lived in communities with no baseline access. For patients without baseline access, after stroke center expansion, the likelihood of admission to a stroke center increased by 38.98 percentage points (95% CI, 37.74-40.21 percentage points), and receipt of thrombolytics increased by 0.48 percentage points (95% CI, 0.24-0.73 percentage points). Thirty-day and 1-year mortality decreased by 0.28 percentage points (95% CI, -0.56 to -0.01) and 0.50 percentage points (95% CI, -0.84 to -0.15 percentage points), respectively, after expansion. For patients in communities with baseline stroke center access, expansion was associated with an increase of 9.37 percentage points (95% CI, 8.63-10.10 percentage points) in admission to a stroke center but no significant changes in other outcomes. In this cohort study, patients living in communities without baseline stroke center access experienced significant increases in stroke center admission and thrombolysis and a significant decrease in mortality after a stroke center expansion. Improvements were smaller in communities with preexisting stroke center access. These findings suggest that newly certified stroke centers may provide greater benefits to underserved areas and are an important consideration when deciding when and where to expand health care services.

Abstract 4123370: Distance to a Cardiac Imaging Center and Likelihood of Imaging Receipt: Defining Imaging Deserts

Background: Cardiovascular imaging is critical for the diagnosis and management of cardiovascular disease. Whether geographic distance to a cardiovascular imaging center (CVIC) impacts access to care is unknown. Methods: We evaluated all Medicare beneficiaries (Fee-for-service and Medicare Advantage) from 2018-2022, excluding those &lt; 65, without continuous Medicare enrollment in the previous year, individuals missing zip code of residence, or CVICs missing zip codes. We estimated distance from the centroid of an individual’s zip code of residence to the centroid of the zip code with the nearest CVIC (defined as &gt; 10 imaging procedures/year). Multivariable regression models were used to estimate likelihood of imaging receipt by distance. Results/Data: A total of 64,260,530 individuals (age 73.0 ± 8 years, 54.6% female, 80.1% White) received care at 3,886 CVICS. The vast majority (95%) lived within 16 miles of a CVIC, but varied considerably by modality with substantially greater distances for cardiac CT, cardiac MRI, and PET (Median [IQR] distance in miles to CVIC, Echo: 3.4 [0.4-7.0]; SPECT: 3.8 [1.3-7.9]; cardiac CT: 8.1 [3.7-21.3]; cardiac MRI: 17.4 [7.3-43.3]; PET: 88.9 [26.2-194.6]). CVICs performing cardiac CT, cardiac MRI, or PET were nearly all in metropolitan locations. Likelihood of imaging receipt was triphasic: lowest within 0-10 miles of a CVIC (mainly metropolitan locations), greater within 10-15 miles, and then increasingly lower beyond 15 miles ( Figure 1 ). Sites beyond the 16-mile threshold were predominantly in the Midwest and West ( Figure 2 ). Conclusions: In this study of 64 million Medicare beneficiaries, 2018-2022, 95% of the US population was found to live within 16 miles of a CVIC, though varied by modality. While those living &gt; 16 miles from a CVIC received less imaging, the lowest use was identified among individuals living in the same zip code as a CVIC, suggesting a possible disconnect between access to imaging care and proximity.

Abstract 4119595: Impact of Environmental Noise and Sleep Health on Pediatric Hypertension Incidence: The ABCD Study

Background: Pediatric hypertension is linked to environmental factors like neighborhood noise disrupting sleep, which is crucial for health. The specific interaction between noise and sleep health in causing hypertension still needs to be explored. Research Question: How does the interaction between neighborhood environmental noise and sleep health affect the incidence of pediatric hypertension? Aims: To estimate the incidence of hypertension in American adolescents and to investigate the individual and joint effects of exposure to neighborhood environmental noise and sleep health on its incidence. Methods: Our analysis involved 3,320 individuals from the Adolescent Brain Cognitive Development (ABCD) study across 21 US cities, followed prospectively from 2018-2020 (T0) to 2020-2022 (T1). We included only those with complete data: Fitbit-tracked sleep, blood pressure, height, neighborhood noise, and relevant covariates (biological sex, ethnicity, pubertal stage, waist circumference). Hypertension was defined as average blood pressure at or above the 95th percentile for age, sex, and height, based on American Academy of Pediatrics guidelines. Sleep health was classified based on daily duration into three categories: healthy (9-12 hours), moderately healthy (1 hour below or above optimal), and low (more than 1-hour deviation). Neighborhood noise exposure was quantified using median anthropogenic noise levels at night, linked to participants’ zip codes. We estimated hypertension incidence and its relative risks (RR, 95% CI), examining the effect (individual and joint) of sleep health and environmental noise on hypertension risk. Results: At Time 1 (T1), the mean age was 13.9 years; 47.6% were girls, and 52.9% were White. Hypertension prevalence in 2018-2020 was 1.7% (CI95% 1.4; 2.1), and the incidence after two years was 2.9% (CI95% 2.4; 3.6). Night noise was 58.4 decibels, 29.9% healthy sleep time (T0); 20.3% healthy sleep time (T1). Adolescents with more favorable healthy sleep showed a lower risk of developing hypertension RR= 0.63 (CI 95% 0.25 to 0.82). We found no association between noisy neighborhoods and no joint effects (neighborhood noise + sleep health) with hypertension incidence. Conclusions: Adequate sleep is associated with a lower risk of hypertension in adolescents. However, no significant link was found between neighborhood noise and pediatric hypertension. This highlights the need for public health efforts to improve sleep quality in youth.

Abstract 4115235: Disparities in Youth Cardiac Screening by Childhood Opportunity Index: Insights from the Heartbytes Database

Intro: The AHA endorses screening youth athletes to identify risk for sudden cardiac arrest (SCA). Rates of SCA can be predicted by social determinants of health (SDOH) such as education level and proportion of Black residents in ZIP Code. The Child Opportunity Index (COI) quantifies neighborhood factors that influence health and development. The link between COI and youth cardiac screening findings and outcomes remains unclear. Hypothesis: Cardiac screening data will differ significantly by COI. Aims: To identify differences in cardiac screening data in children of varying COI. Methods: The HeartBytes Database, including sports exams, self-reported physical activity (PA), and zip codes from Simon's Heart screenings was augmented with COI index zip code data. Chi-squared and logistic regression were used to analyze demographics, cardiac risk factors, and screening results. Data: Screening data of 11,431 youth athletes (median age 14.3 (IQR = 3), BMI 20.6 (4.8), 53.7% male, 70.6% White) was analyzed. The majority of children had very high overall COI (Figure 1). Hypertension, hyperlipidemia, Kawasaki disease, and heart infection were similar across COI levels (p &gt; 0.05). Levels of physical activity varied significantly across levels of overall COI, with the highest levels reported in the lowest COI group (50.4% with &gt; 10 hours PA/week) (Chi-Squared; p = 0.007). Positive screening rates varied significantly by level of COI (p = 0.013) (Figure 2). The overall level of education, health environment, and socioeconomic COI did not predict positive screening outcomes in logistic regression analysis (all p&gt;0.05). Conclusion: Prevalence of cardiac risk factors did not vary significantly across COI levels, however, positive screening rates were highest in moderate and very low COI levels. Simon’s Heart engaged communities across the COI spectrum; however, a majority of children had high or very high COI. Further efforts are needed to expand access to underserved populations of lower COI.

Abstract 4133324: Socioeconomic status, race, and ethnicity in management of pediatric SVT

Introduction: Electrophysiology study and ablation (EPS) is often the preferred approach to management of supraventricular tachycardia (SVT) and/or ventricular pre-excitation (WPW) in older children/adolescents. There are inequities in arrhythmia management in adults, and in other areas of pediatric cardiology, but little is known about disparities in management of SVT in children. Research question: Do racial/ethnic and socioeconomic inequities affect referral for EPS in patients with SVT and/or WPW? Methods: This retrospective observational study utilized the Pediatric Health Information System of 49 children’s hospitals’ administrative data from 2016-2022. We included patients with SVT or WPW seen in the emergency department, admitted for observation, or inpatient. We excluded patients with congenital heart disease. The outcome was having a procedure code for EPS. The childhood opportunity index (COI, scale 1-100) based on zip code was used to measure socioeconomic status (SES). Results: Among 37,818 patients with primary diagnosis of SVT (27620, 73%) or WPW (10198, 27%), 9840 (26%) underwent EPS (Table 1). COI was higher in patients who underwent EPS than those who did not (median 59 [IQR 34,82] vs 57 [IQR 30,81]). In addition, time from initial visit with diagnosis of SVT/WPW to EPS was longer in patients with lower COI (beta= -0.026, p=0.007). Black (21.2%), Hispanic (23.8%), and American Indian (19.8%) patients were less likely to undergo EPS than White (26.5%) and Asian (28.31%) patients and those with other (28.4%) or unknown/missing (35.7%) race (p&lt;0.001, Figure 1). In both subgroups of patients with SVT and WPW, EPS differed by race and COI, and higher COI predicted shorter time to EPS. Conclusions: In this hospital database of pediatric patients, we found disparities in use of EPS for the management of SVT and/or WPW. Patients of minoritized race/ethnicity and lower SES were less likely to undergo EPS.

Abstract 4137053: Association of Childhood Opportunity Index and No Show Rates in a Pediatric Cardiology Clinic.

Introduction: Childhood Opportunity Index (COI) measures access to quality education, safe housing, and healthcare based on zip codes. These scores can influence patient behaviors, such as no-shows (NS), which can affect resource utilization and health outcomes. Objective: To quantify the correlation between COI and NS through odds ratio (OR) in a pediatric cardiology clinic. Methods: Patient data was collected from a single, independent pediatric cardiology practice for all visits between 2019 to 2021. COI was categorized into 3 subdomains; education, health and environment, social and economic according to zipcode from Diversitydatakids. The COI was split into low (&lt;40), moderate (40-60U), and high (&gt;60U). Additional variables included age, insurance type, lead time (time from scheduling to appointment date), and telehealth status. Multiple logistic mixed-effect models, both unadjusted (single predictor) and adjusted (multiple predictors), were used to obtain OR for NS. Results: There were 11,474 total encounters. 92% were completed appointments and 8% were NS. Unadjusted model showed statistical significance (p&lt;.05) with increased odds of NS for low COI education, low COI social and economic, and low COI, compared to high COI as the reference category (Table 1). Adjusted model 2 showed similar significant results for the low COI overall category, while for adjusted models 1 and 3, none of the COI categories were statistically significant. In all 4 models, OR for all age categories, all lead times, and public and mixed insurance types were significant. Conclusion: The unadjusted and adjusted model 2 showed that patients with lower COIs were more likely to NS. Public insurance and longer lead times were indicators of NS while higher ages were indicators for completed appointments. Therefore, efforts need to be made to identify vulnerable patients; younger patients, and those with lower COIs and public insurance; and address barriers such as arranging transport and sending reminders that can help decrease NS. Interestingly, the NS rate was lower than the national average. Future research is needed to assess the impact of NS on patient outcomes.

Abstract 4139115: Genomic, Phenomic, and Geographic Relationships with Leukocyte Telomere Length in the U.S. Yields New Insights for Neoplasms and Cardiometabolic Disease

Background: Leukocyte telomere length (LTL) is an age-related marker strongly associated with neoplasms and cardiometabolic disease. LTL is also intimately linked with clonal hematopoiesis of indeterminate potential (CHIP), a recently described risk factor for cardiovascular disease (CVD). However, population-scale investigations of LTL in diverse backgrounds are limited, and geolocational variance has not been studied. Method: LTL and CHIP were derived using blood-derived whole genome sequencing data from 244,819 diverse U.S. residents in the NIH All of Us Research Program (AoU). We performed association analyses of LTL with CHIP and other available health-related traits, Phecode, as well as geolocation data by ZIP code. Genome-wide association study (GWAS) of LTL in AoU and meta-analysis with UK Biobank were performed. All association tests were adjusted for age, sex, sequencing site, and the first 10 genetic principal components with multiple test corrections. Mediation analysis was adjusted for additional risk factors for CVD. Result: Among 244,819 AoU participants, 146,717 (59.9%) were female with mean (standard deviation) age 51.8 (±16) years. Estimated LTL correlated strongly with age, sex, and genetic ancestry in AoU. Socioeconomic status, lifestyle variables, anthropometry, blood biomarkers (e.g., lipids and glucose), and vital signs were associated with LTL in AoU. Phecode analysis showed LTL is associated with neoplasms and age-related conditions, including CVDs. LTL mediated some of the observed increased coronary artery disease risk among individuals with hematologic malignancies ( P &lt; 2 × 10 -16 ). Significantly longer LTL clustered in the West Coast and Central Midwest ( P = 0.001 and 0.033, respectively), while significantly shorter LTL clustered in the Southeast ( P = 0.001) (Figure). GWAS meta-analyses identified 197 loci, of which 36 (18%) were novel, including ancestry-specific loci. Rare variant aggregation test found 9 novel associated genes. Conclusions: LTL is a marker of biological age that is associated and interacts with neoplasms, CVDs, and its various risk factors, with notable geographic variability within the U.S. Germline genetic analyses of LTL yield new insights into drivers of LTL.

Abstract 4141487: Social Determinants of Health and Outcomes in Patients with Hypertrophic Cardiomyopathy in the Sarcomeric Human Cardiomyopathy Registry (SHaRe)

Introduction: Area-based social determinants of health (SDOH) are associated with higher risk for acquired heart disease. However, the impact of area-based SDOH on clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has not been previously studied. Hypothesis: Residing in an area with lower median household income and a higher social deprivation index (SDI) are independently associated with adverse outcomes in patients with HCM. Methods: This study included 4,483 adult patients with HCM from five Sarcomeric Human Cardiomyopathy Registry (a multi-center prospective registry of patients with HCM) sites in the US followed for a median [IQR] of 4.0 [1.0-8.5] years. The patients’ residential address was geocoded at the zip code level to characterize median household income and SDI. SDI is based on various social factors (such as income and education), with a higher score reflecting more deprivation. Multivariate models, adjusting for sex, age, hypertension and body mass index were used to determine the independent association of household income and SDI on ventricular arrhythmias (VA), heart failure (HF), and an overall composite outcome (VA, HF, atrial fibrillation, death, and stroke). Results: Median age at diagnosis was 48.3 [32.0-60.4] years with 42.0% female. Median household income was $90,000 [60,000-110,000] and median SDI was 25 [10-55]. Adjusted hazard ratios per $10,000 higher income were 0.96 (95% CI 0.93-1.00, p=0.03) for VA, 0.91 (95% CI 0.90-0.93, p &lt;0.01) for HF, and 0.95 (95% CI 0.94-0.96, p &lt;0.01) for the composite outcome. Adjusted hazard ratios per 10 units higher SDI (more deprived) were 1.07 (95% CI 1.03-1.12, p&lt;0.01) for VA, 1.06 (95% CI 1.04-1.08, p &lt;0.01) for HF, and 1.05 (95% CI 1.03-1.06, p &lt;0.01) for the composite outcome. The associations of SDI and income on clinical outcomes were similar regardless of sarcomere gene variant status. Conclusions: Residing in an area with lower median household income and higher SDI were independently associated with adverse outcomes in patients with HCM. These findings extend observations from acquired cardiovascular disease and highlight the need to address adverse SDOH to reduce health disparities and improve outcomes in patients with HCM.

Hepatitis C Infection Confirmation and Fewer Visits Contribute to Improving Treatment Rates in a Predominantly African American Health Center

Background/Objectives: The approval of direct-acting antiviral (DAA) therapy for hepatitis C (HCV) resulted in a highly effective oral treatment for patients. The primary objective of this study was to identify reasons that patients were not treated versus why patients were treated. Identifying potential reasons for the failure to treat can provide a pathway to interventions using evidence-based data. Methods: The electronic medical records in an urban predominately African American (AA) population were searched for all patients with HCV seen at least once in a Gastroenterology or Infectious Disease clinic in 2019. Data collected included demographics, treatment visits, laboratory data, insurance and ZIP codes for median income. Results: Of the 441 patients who were not yet treated at the first 2019 visit, only 43% were treated by July 2020. Insurance and median income were not factors in failure to treat. Patients with an average of four visits were more likely to be treated than those with two or less, suggesting that failure to follow up was a significant factor for patient treatment (42% vs. 8% p &lt; 0.0001). Confirmation of viral infection at first visit was an important factor with respect to treatment (treated 38% vs. not treated 25% p &lt; 0.02). Conclusions: Significant numbers of our patients (57%) failed to be treated after at least one clinic visit. The two critical factors were PCR confirmation prior to the initial visit and the requirement for multiple visits before the initiation of treatment. Since the degree of fibrosis had no impact on treatment, initiating treatment immediately after confirming infection with HCV should improve patient treatment rates and outcomes.

Socioeconomic Factors Associated With Participation in Postmortem Tissue Donation in Pediatric Central Nervous System Tumors.

The gift of postmortem tissue donation is critical to pediatric central nervous system (CNS) research. As a "Center of Excellence" for the Gift from a Child Program, our institution has a well-established postmortem tissue donation program. Our objective was to determine if differences exist between patients who participated in and those that declined research-based autopsy. We performed a single-institution retrospective chart review of pediatric patients with CNS malignancies who died from their disease between January 1, 2021 and December 31, 2022. Individual clinical, demographic, and socioeconomic data were assessed. Population-level data were estimated using Zip Code Tabulation Areas. Descriptive statistics were used to compare categorical data. Among the 23 patient families approached during the study time frame, 8/23 (35%) consented to participation. In the consented (C) versus declined (D) group, there was a higher percentage of White, non-Hispanic/Latino patients by self-reported race (C: 88% vs. D: 55%), and no patients who identified as Asian or Hispanic/Latino (C: 0% and 0% vs. D: 13% and 27%). Of all patients approached, two required interpreters (9%), and both families declined participation. The rate of private insurance was higher in the consented group (C: 75% vs. D: 47%) compared to Medicaid as primary insurance in the declined group (C: 13% vs. D: 53%). CONCLUSIONS: Future research should aim to understand and improve identified disparities to ensure research advancements benefit all children with CNS malignancies. One area we plan to address is improved communication with non-English-speaking families by partnering with our interpreter services.

Abstract 4137823: Influence of Hospital and Cardiac Rehabilitation Facility Proximity on Enrollment Rates Among Medicare Beneficiaries

Background: Participation in cardiac rehabilitation (CR) is enhanced by proximity to CR facilities and communication between inpatient and outpatient settings but may become fragmented when patients are distant from their discharging hospital and nearest CR facility. Research Question: This study investigates how patient distance to both hospitals and CR facilities impacts the rates of CR participation. Methods: This study included 100% Medicare fee-for-service claims for beneficiaries with 12 months of continuous Part A/B coverage who had coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or surgical or transcatheter aortic valve replacements (SAVR or TAVR) between 07/2016-12/2018, excluding patients discharged to hospice or died within 30 days. Google Maps defined travel distances from the patient to hospital and CR facility locations using geographic centroids of ZIP codes, which were then categorized into quartiles. CR enrollment was defined as attending at least one session within one year of discharge. Logistic regression models estimated marginal CR enrollment rates across both hospital and CR facility distance categories adjusting for patient, hospital, and regional factors. Results: The study included a total sample of 501,049 beneficiaries undergoing PCI (62%), CABG (19%), SAVR (7%), and/or TAVR (15%). The median travel distance to the hospital was 18.6 miles (IQR 8.2-43.3 miles) and to the CR facility was 7.7 miles (IQR 2-15.3 miles). A total of 188,963 (37.7%) beneficiaries attended at least one CR session, which varied across categories of distance to hospital (Q1: 36.8% to Q4: 37.5%) and CR facility (Q1: 44.7% to Q4: 30.0%, p&lt;0.01). Adjusted CR enrollment rates improved when beneficiaries lived farther from their admitting hospitals but closer to CR facilities (Figure 1), with the highest enrollment for those located farthest from their admitting hospital but closest to the CR facility (47.5%) and lowest enrollment among those closest to the hospital but farthest from the CR facility (20.6%). Conclusions: Greater distance to the admitting hospital was associated with higher CR enrollment, while greater distance to the CR facility was associated with lower enrollment among eligible Medicare beneficiaries. Addressing geographic barriers to CR participation may require tailored solutions based on patient proximity to hospitals and CR facilities.

Abstract 4124005: Sex, ethnic and social determinants of health differences in high-potency P2Y12 inhibitors prescription among patients with acute coronary syndrome: An analysis of the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry

Background: Sex and racial differences in the outcomes of patients with acute coronary syndrome (ACS) persist and could be related to the differences in management including high-potency P2Y12 inhibitors. Aim: This study aims to examine the contribution of social determinants of health on the association between sex and racial differences in the prescription of high-potency P2Y12 inhibitor upon discharge. Methods: Patients with ACS undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history. Analyses were performed in women and men separately. Results: Among 135,153 patients with ACS who underwent PCI, 59.8% were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed high-potency P2Y12 inhibitor (66.9% vs 72%), and this pattern did not change during the study period (P=0.50) (Figure). There was a significant interaction between sex and race for high-potency P2Y12 inhibitor prescription (P&lt; 0.05). Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men after adjusting for all covariates. Conclusions: In this large contemporary observational analysis of patients with AMI undergoing PCI, women were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities; however, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription. Further efforts should be directed to minimize these sex and racial disparities.

Impact of Environmental Noise and Sleep Health on Pediatric Hypertension Incidence: ABCD Study.

Pediatric hypertension is linked to environmental factors like neighborhood noise disrupting sleep, which is crucial for health. The specific interaction between noise and sleep health in causing hypertension still needs to be explored. We analyzed data from 3320 participants of the ABCD (Adolescent Brain Cognitive Development) study, recruited across 21 US cities and monitored from 2018 to 2020 through 2020 to 2022. Participants with complete data on Fitbit-tracked sleep, blood pressure, height, neighborhood noise, and covariates (biological sex, race and ethnicity, pubertal stage, waist circumference) were included. Hypertension was defined as average blood pressure ≥95th percentile for age, sex, and height. Sleep health was categorized on the basis of daily duration: healthy (9-12 hours), moderately healthy (±1 hour from optimal), and low (≥1 hour deviation). Noise exposure was measured as median nighttime anthropogenic noise levels by zip code. The incidence of hypertension increased from 1.7% (95% CI, 1.4-2.1) in 2018 to 2020 to 2.9% (95% CI, 2.4-3.6) in 2020 to 2022. Adolescents with healthier sleep had a lower risk of developing hypertension (relative risk, 0.63 [95% CI, 0.25-0.82]), while no significant effects were found for neighborhood noise alone or in combination with sleep health. Adequate sleep significantly reduces the risk of hypertension in adolescents, independent of environmental noise exposure. These findings underscore the importance of promoting good sleep hygiene among youth to mitigate hypertension risk.

BIOM-60. UNDERSTANDING THE INTERSECTION OF RACE, SEX, AND GENOMIC PROFILES IN MENINGIOMA PATHOPHYSIOLOGY

Abstract BACKGROUND While meningioma incidence and outcomes vary by sex and race, the potential underlying molecular differences possibly contributing to these disparities are less understood. Herein, we explore the clinical and genomic characteristics of meningiomas across groups characterized by age and sex. METHODS We analyzed adult patients with primary meningiomas resected from 2012 to 2023. Patients underwent whole exome sequencing, and demographic data were categorized into four groups based on self-reported race and sex, which included White females, White Males, Black females, and Black males. The primary analyses involved comparisons of tumor characteristics, socioeconomic status (median zip code income, % with high school diploma, health insurance status, distance from hospital), genomics, and recurrence rates. RESULTS The study included 509 primary meningiomas. White females exhibited low-risk genomic profiles characterized by driver mutations in KLF4 (+/- TRAF7) (p=0.010) and POLR2A (p=0.045), with no associated CNVs (p=0.410). This benign molecular profile correlated with lower WHO grades (p=0.013) and a lower incidence of recurrence (p=0.0003). Black females had meningiomas enriched with Hedgehog pathway mutations (p=0.0035) and a predilection for the anterior skull base (p=0.034), leading to an increased risk of recurrence (p=0.026). White males showed an aggressive genomic profile, including chromosome 1p loss (p=0.025) and 10q loss (p=0.067), associated with a high risk of recurrence (p=0.0002). Black males had meningiomas with chromosome 14q loss (p=0.0002), the highest incidence of high-grade meningiomas (p=0.048), and a 4.5-fold increased risk of recurrence (OR 4.5 [1.6-11.8]; p=0.006). Black males also experienced the worst progression-free survival (HR 5.5 [2.5-12.4]; p&amp;lt;0.0001), independent of WHO grade, extent of resection, and socioeconomic status. CONCLUSIONS Each demographic has a distinct molecular profile that correlates with clinical behavior in a race and sex-specific manner. Black males are disproportionately affected by biologically aggressive meningiomas, leading to higher tumor grade and recurrence rates.

Neighborhood socioeconomic status and postpartum depression among commercial health insurance enrollees: a retrospective cohort study

BackgroundPostpartum depression (PPD) is a prevalent psychological condition. Although the effect of obstetrical and maternal complications on PPD are well described, the impact of neighborhood socioeconomic status (SES) on PPD is relatively unexplored.ObjectivesThis study examined the relationship between neighborhood SES score and PPD.MethodsA summary SES measure for each U.S. zip code was constructed using income, education, and occupational 2021 Census data and linked to national commercial claims for 2017–2023. PPD status using diagnosis codes at outpatient and inpatient visits, and prescription drug use 3, 6, 9, and 12 months postpartum, were determined. Multivariate analysis controlled for potential confounders.ResultsPPD prevalence in commercial claims was 11.48%. Patients with PPD had higher rates of obstetrical (OR: 1.555, p < .0001) and maternal complications (OR: 1.145, p < .0001), and more lifestyle risk factors (OR: 1.113, p < .0001). Comorbidity scores were higher for patients with PPD. Controlling for age and clinical factors, living in a disadvantaged neighborhood was associated with an increased incidence of PPD (OR: 1.137, p < .0001).LimitationsClaims data may include potential inaccurate coding of diagnoses/procedures. Clinical information is limited to conditions and treatments defined by ICD-10-CM codes. Area-based SES measures inevitably misclassify people on both ends of the socioeconomic spectrum (this misclassification is random; direction of bias is known).ConclusionsThe inverse and significant effect of area-based high SES on PPD rates demonstrates that preventive efforts may require interventions focusing on both the patient and the lived environment.

Heat Waves and Adverse Health Events Among Dually Eligible Individuals 65 Years and Older

Extensive research has found the detrimental health effects of heat waves. However, a critical gap exists in understanding their association with adverse health events among older dually eligible individuals, who may be particularly susceptible to heat waves. To assess the association between heat waves and adverse health events among dually eligible individuals 65 years and older. This retrospective time-series study assessed the association between heat waves in warm months from 2016 to 2019 and zip code tabulation area (ZCTA)-day level adverse health events. Dually eligible individuals 65 years and older who were continuously enrolled in either a Medicare fee-for-service plan or a Medicare Advantage plan with full Medicaid benefits from May to September in any given year were identified. All ZCTAs in the US with at least 1 dually eligible individual in each study year were included. Data were analyzed from September 2023 to August 2024. Heat waves, defined as 3 or more consecutive extreme heat days (ie, days with a maximum temperature of at least 90 °F [32.2 °C] and in the 97th percentile of daily maximum temperatures for each ZCTA during the study period). Daily counts of heat-related emergency department visits and heat-related hospitalizations for each ZCTA. The study sample included 5 448 499 beneficiaries 65 years and older in 28 404 ZCTAs across 50 states and Washington, DC; the mean (SD) proportion of female beneficiaries and beneficiaries 85 years and older in each ZCTA was 66% (7%) and 20% (8%), respectively. The incidence rate for heat-related emergency department visits was 10% higher during heat wave days compared to non-heat wave days (incidence rate ratio [IRR], 1.10; 95% CI, 1.08-1.12), and the incidence rate of heat-related hospitalizations was 7% higher during heat wave days (IRR, 1.07; 95% CI, 1.04-1.09). There were similar patterns in other adverse health events, including a 4% higher incidence rate of death during heat wave days (IRR, 1.04; 95% CI, 1.01-1.07). The magnitude of these associations varied across some subgroups. For example, the association between heat waves and heat-related emergency department visits was statistically significant only for individuals in 3 of 9 US climate regions: the Northwest, Ohio Valley, and the West. In this time-series study, heat waves were associated with increased adverse health events among dually eligible individuals 65 years and older. Without adaptation strategies to address the health-related impacts of heat, dually eligible individuals are increasingly likely to face adverse outcomes.

Fine-scale spatial and social patterns of SARS-CoV-2 transmission from identical pathogen sequences.

Pathogen genomics can provide insights into underlying infectious disease transmission patterns, but new methods are needed to handle modern large-scale pathogen genome datasets and realize this full potential. In particular, genetically proximal viruses should be highly informative about transmission events as genetic proximity indicates epidemiological linkage. Here, we leverage pairs of identical sequences to characterise fine-scale transmission patterns using 114,298 SARS-CoV-2 genomes collected through Washington State (USA) genomic sentinel surveillance with associated age and residence location information between March 2021 and December 2022. This corresponds to 59,660 sequences with another identical sequence in the dataset. We find that the location of pairs of identical sequences is highly consistent with expectations from mobility and social contact data. Outliers in the relationship between genetic and mobility data can be explained by SARS-CoV-2 transmission between postal codes with male prisons, consistent with transmission between prison facilities. We find that transmission patterns between age groups vary across spatial scales. Finally, we use the timing of sequence collection to understand the age groups driving transmission. Overall, this work improves our ability to leverage large pathogen genome datasets to understand the determinants of infectious disease spread.