Zip Code Research Articles

Geographically varying associations between personality and pro-environmental behaviors across the USA

Comprehensively evaluating the relationship between personality and pro-environmental behaviors (e.g., speaking with friends/strangers about environmental issues, attending pro-environmental rallies, and recycling) with both broad and fine conceptualizations of personality (i.e., higher-order factor, lower-order factor, and nuance levels) while also accounting for geographically varying associations is critical for developing an understanding of why people may behave pro-environmentally in various geographical contexts. To examine this, we (1) tested the utility of the SAPA Personality Inventory-5 (SPI-5) factors, SPI-27 lower-order interstitial factors, and SPI-135 nuances/items for predicting pro-environmental behaviors and cross-validated these models, (2) evaluated how the relationship for higher-order and lower-order personality factors with pro-environmental behaviors vary across geographic locations in the United States at the ZCTA (ZIP Code Tabulation Area) level using multilevel modeling, and (3) assessed how geographically varying slopes related to average levels of pro-environmental behaviors within ZCTAs. We found an empirically identified selection of thirty SPI-135 items predicted pro-environmental behaviors better than the SPI-5 and SPI-27 collectively, and that the full SPI-135 items had the highest predictive utility. Additionally, in ZCTAs with higher average levels of pro-environmental behaviors, stronger associations between higher levels of agreeableness, extraversion, neuroticism, and openness with higher levels of pro-environmental behaviors were observed.

Follow-up Trends in Patients Undergoing Modified Wendler Glottoplasty.

After modified Wendler glottoplasty (mWG), close follow-up with laryngologist and speech-language pathologist (SLP) is thought to be essential to achieve best outcomes. This study presents a case series of patients undergoing mWG at a single institution to identify factors associated with trends in post-operative follow-up. Retrospective review of trans women patients who underwent mWG between March 2018 and July 2023 was performed. Demographic data, pre-operative care, and post-operative course were reviewed. Lost to follow-up (LTFU) was defined as a failure to return to the office or schedule a follow-up appointment as recommended, for ≥2 months after last visit. Logistic regressions were utilized to identify possible factors associated with being LTFU. Eight (50%) of 16 patients met LTFU criteria. Patients were considered not LTFU if they completed care (n = 3, 19%) or were still undergoing care (n = 5, 31%). Patients with chronic diseases were less likely to become LTFU (p = 0.03). Those lost to follow-up had more no-show visits (p = 0.04). Total number of gender-affirming surgeries, distance from hospital, socioeconomic status of residential zip code, race/ethnicity, other psychological history, and patient-reported outcome measure scores did not affect LTFU rates. Fifty percent of patients were LTFU after modified Wendler glottoplasty. Even one no-show visit increased risk of being LTFU, whereas the presence of chronic diseases was protective against this. This study illustrates that increased efforts are needed following mWG to better understand the factors associated with being LTFU and to facilitate patients' ability to complete post-operative care successfully. 4 Laryngoscope, 2024.

Coastal Real Estate Vibes: An Analysis of the Association Between Coastal Residential Ownership and the Resident Occupant’s Risk Tolerance

This study examines the association between the location, relative to the coast, of an individual’s primary residence and the homeowners’ risk tolerance. Utilizing data from the 2021 National Financial Capability Study and employing a probit model, we analyzed how varying risk tolerance levels affect the likelihood of owning a home in a coastal ZIP code. The respondent’s risk tolerance was classified as high, medium, or low according to their self-reported willingness to take financial risks. Our results suggest that individuals with lower risk tolerances are less likely to own a home within a coastal ZIP code. Specifically, homeowners with medium-risk tolerance are 2.91% less likely, and those with low-risk tolerance are 3.17% less likely to own a primary residence in a coastal ZIP code when compared to those with high-risk tolerance. These results are statistically and economically similar when using a logit model. These findings are both statistically significant and align with economic theory. The analysis also included various demographic and socioeconomic factors, finding that age, income, and certain employment statuses influence coastal homeownership. This research contributes to the understanding of home ownership location choices and risk tolerance. Our results provide policymakers with insights into the risk characteristics of individuals who prefer coastal areas as their primary residences. This information can inform future policy decisions by highlighting the societal and economic implications of regulations related to residential coastal development.

Ambient beta particle radioactivity and lung cancer survival: Results from the Boston Lung Cancer Study

BackgroundExposure to ionizing radiation is known to increase the risk of lung cancer. However, studies on the effect of environmental radiation associated with ambient particle air pollution on lung cancer survival are limited. We investigated the association between ambient beta particle radioactivity (PR-β) after a diagnosis and lung cancer survivals. MethodsThe Boston Lung Cancer Survival (BLCS) cohort consisted of histologically confirmed patients enrolled at Massachusetts General Hospital (MGH) and the Dana-Farber Cancer Institute (DFCI) in Boston, U.S. The primary outcomes included overall survival, 5-year survival, and 3-year survival probability. We estimated ambient PR-β exposure at the ZIP code of residence from 2001 through 2017. Cox-proportional hazards models were constructed to estimate hazard ratios (HRs) for the associations between ambient PR-β and survival outcomes while controlling for covariates. ResultsThe analysis included 2795 patients with complete information, with 97,330 person-months of follow-up. The interquartile range (IQR) increase in PR-β was significantly associated with worse overall survival (HR:1.63, 95% CI:1.52, 1.76), 5-year survival (HR:1.33, 95% CI:1.23, 1.44), and 3-year survival (HR:1.22, 95% CI:1.12, 1.33) while adjusting for covariates, including age at diagnosis, sex, race, smoking, stage, histology, and adjusted gross income. Similar associations were found while additionally adjusting for the estimated residential radon exposure. In addition, the survival associated with PR-β exposure was significantly worse for patients in the early stages (HR:2.16, 95% CI:1.84, 2.52). ConclusionThe findings from this study provide new evidence suggesting that environmental exposure to radioactive particles after lung cancer diagnosis may have a pronounced effect on survival, particularly in patients with early stages.

Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.

This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs. Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA. Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures. Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.

Sociodemographic Predictors of Keratoconus (Severity, Treatment, and Progression) in a Tertiary Center in New York City.

To identify sociodemographic factors as predictors of keratoconus severity, progression, disease outcomes, and appropriate management in a tertiary care ophthalmology institute in the New York City metropolitan area. This is a retrospective chart review. Patients with keratoconus presenting at a tertiary eye institute in an urban setting seen between 2015 and 2022 were included. Sociodemographic data including age, sex, race, ethnicity, income derived from zip code, insurance coverage, and preferred language were recorded. These sociodemographic factors were analyzed as possible predictors of keratoconus severity at presentation (Amsler-Krumeich grades III and IV): patients presenting with acute hydrops, patients receiving corneal cross-linking or corneal transplant, patients showing 1 or more diopters of increase of Kmax during their follow-up, and patients having longer time between the provider's recommendation of corneal cross-linking and the time of the procedure. The retrospective review included 634 patients with a clinical diagnosis of keratoconus. Factors associated with severe keratoconus at presentation in the multivariate analysis were non-White (P < 0.001), lowest income (Q1) (P = 0.018), Q2 income (P = 0.012), and having Medicaid/Medicare coverage (P = 0.021). Medicaid/Medicare coverage was the only factor associated with acute hydrops (P < 0.001), and younger age was the only factor associated with disease progression (P < 0.001). Younger patients and patients with commercial insurance coverage were more likely to receive corneal collagen cross-linking (P < 0.001 and P < 0.001, respectively), whereas patients with Medicaid/Medicare coverage, lowest income, and non-White race were more likely to receive corneal transplantation (P = 0.012, P = 0.062, and P = 0.028, respectively). Medicaid/Medicare was the only factor associated with delay in receiving corneal collagen cross-linking (P = 0.013). Our study demonstrates that there are sociodemographic predictors of keratoconus disease severity, progression, and the type and the time of treatment the patients received. This confirms eye health disparities among patients with keratoconus.

Spike and Slab Regression for Nonstationary Gaussian Linear Mixed Effects Modeling of Rapid Disease Progression

ABSTRACTSelect measures of social and environmental determinants of health (referred to as “geomarkers”), predict rapid lung function decline in cystic fibrosis (CF), defined as a prolonged decline relative to patient and/or center‐level norms. The extent to which hyper‐localization, defined as increasing the spatiotemporal precision of geomarkers, aids in prediction of rapid lung decline remains unclear. Linear mixed effects (LME) models with specialized covariance functions have been used for predicting rapid lung function decline, but there are few options to properly incorporate spatial correlation into the covariance functions while inducing simultaneous variable selection. Our innovative Bayesian model uses a spike and slab prior for simultaneous variable selection and offers additional advantages when coupled with nonstationary Gaussian LME modeling. This model also incorporates spatial correlation through an additional random effect term that accounts for spatial correlation based on ZIP code distances. We validated the model with simulations and applied it to real CF data from a Midwestern CF Center. We demonstrate how a combination of demographic, clinical, and geomarker variables can be selected as optimal predictors using Bayesian false discovery rate controlling rule. Our results indicate that incorporating spatiotemporal effects and geomarkers into this novel Bayesian stochastic LME model enhances the dynamic prediction of rapid CF disease progression.

Evaluating Outcomes for Women with Metastatic Breast Cancer: Palliative Care Consultations, Hospital Charges, and Length of Stay.

Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges. Methods: Patients diagnosed with metastatic breast cancer between 1998-2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression. Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code. Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer.

Spatial Patterns of Emergency Dental Care Utilization: Assessing the Influence of Social Vulnerability and Dental Provider Availability.

Our aim was to examine the association between emergency dental care use and dental providers' availability and ZIP code social vulnerability index. This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.

The association of socioeconomic status with semen parameters in a cohort of men in the United States.

Socioeconomic differences are present within the population of men who experience infertility and seek treatment. To study the association of socioeconomic status with semen parameters in a group of men using mail-in semen analyses. The records of 11,134 men that used mail-in semen analyses from a fertility company were identified. Their demographic information, semen parameters, and ZIP codes were collected. Area deprivation index (ADI) was used as a proxy for socioeconomic status and was calculated for each individual using their ZIP codes in order to measure their level of socioeconomic deprivation. A higher ADI signifies a more deprived area. The association between ADI and the semen parameters of this group was measured using linear regression analysis adjusted for age. 11,134 men were included in the study with a median age of 35 years (interquartile range (IQR): 32-40) and a median ADI of 83 (IQR: 68-97). The cohort had a median sperm concentration of 31 million/mL (IQR: 14-59), median total sperm count of 123 million (IQR: 57-224), median total motile sperm of 35 million (IQR: 9-95), median total motility of 32% (IQR: 15-52), progressive motility of 22% (IQR: 9-38), and morphology percent normal of 4% (IQR: 2-7). Higher ADI, indicating lower socioeconomic status, was negatively associated with various semen parameters, including sperm concentration, total sperm count, total motile sperm, and total and progressive motility. Men who live in more deprived areas are more likely to have worse semen parameters. Further research is needed to thoroughly examine the impact of socioeconomic status on male fertility. A comprehensive approach that targets upstream social, economic, and healthcare factors can possibly alleviate the negative association of socioeconomic status with fertility and semen parameters.

Characterization of pediatric low vision and socioeconomic determinants of health at an academic center: a 5-year analysis

PurposeTo investigate the demographics, eye surgeries, and social determinants of health in pediatric patients with low vision in one or both eyes. MethodsThis is a cross-sectional study of children 3-18 years of age examined at an academic eye center from 2014 to 2019. Low vision was present if one eye had a distance best-corrected visual acuity (BCVA) of <20/70. ZIP code was used to estimate patient income via a public third-party database. ResultsOf 47,571 children examined during the study period, 882 had at least one eye with low vision. Of the 882, 88 (10%) had BCVA of <20/400 in at least one eye, and 228 patients (26%) had bilateral low vision. The most common cause of low vision was refractive/strabismic amblyopia (n = 304). The severest forms of vision loss (BCVA<20/200) were predominantly due to retinal dystrophies or detachment (n = 91). Three hundred patients (34%) had undergone at least one ophthalmic surgery—predominantly extraocular muscle procedures in eyes with mild visual loss and vitreoretinal surgeries in those with more severe loss. The severity of vision loss was significantly associated with a higher likelihood and number of surgeries (P < 0.0001). Income and insurance coverage did not have a significant association with BCVA or the likelihood of surgery. ConclusionsRefractive and strabismic amblyopia are the predominant causes of reduced worse-eye vision in children, and retinal diseases commonly caused severe vision loss. The type and number of surgeries correlate with the severity of vision loss. We did not find any association of income and insurance type with studied outcomes.

Environmental Impact of Overtreatment of Distal Radius Buckle Fractures

Introduction: Pediatric buckle fractures are common. Current literature supports a single provider visit with education and removable wrist brace/bandage, without additional follow-up visits. Potential overtreatment through casting and follow-up visits may impose a substantial environmental burden through waste generated from casts and vehicular CO2 emission. This study seeks to estimate the national environmental impact of buckle fracture overtreatment through geospatial analysis extrapolated from a review of buckle fracture treatment at our institution. Methods: A retrospective chart review was performed to determine incidence and treatment of buckle fractures at our institution between 2018 and 2022. All radiographs were reviewed to confirm appropriateness for inclusion. Data were collected for treatment, follow-up frequency, cast utilization, and patient home ZIP code. Buckle fracture incidence was computed using the total pediatric population served by our institution, derived from United States (US) Census data. Treatment was assumed to occur at the office of the nearest orthopedic surgeon, identified through the National Provider Identifier Registry. For cast waste estimation, we collected and weighed discarded short-arm casts from our institution and used the number of patients treated in a cast to estimate total waste. CO2 emissions were estimated to be 411 g of CO2 per mile, and mileage was calculated for round-trip distance to the nearest orthopedic surgeon and multiplied by the estimated number of unnecessary visits. Travel for the initial visit was not considered overtreatment and was not included. Results: Annually, the United States sees an estimated 66,495 buckle fractures, with 62.5% overtreated with casting. The average short-arm cast weighed 0.498 lbs ± 0.133. When additional visits occurred, there were an average of 1.2 additional visits. Each year, overtreatment of pediatric buckle fractures in the United States generates an estimated 9.4 tons of cast waste and 405.4 tons of CO2. Conclusion: Overtreatment of buckle fractures has a significant measurable environmental impact.

Psychosocial Dimensions of Pain Disparities in Youth Diagnosed with Unspecified Abdominal Pain in an Emergency Department

Diagnosis ambiguity, paired with pain care inequities experienced by marginalized groups may increase risk for ongoing pain and impairment in children diagnosed with unspecified abdominal pain in the pediatric emergency department (PED). This cross-sectional study examined psychological, caregiver, cultural, and socio-ecological factors associated with pain-related impairment in an ethnically and socioeconomically diverse population diagnosed with unspecified abdominal pain in a PED. The sample included 111 children 8-17 years old (59.8% female, 72.7% Latinx) and their caregivers. Exclusion criteria included an Emergency Severity Index <2, psychiatric complaint, or not fluent in English or Spanish. Children completed the PROMIS Pain Interference Scale and reported pain intensity, pain duration, and pain catastrophizing. Caregivers reported language preference, pain catastrophizing, trait anxiety, and child internalizing symptoms. Area Deprivation Index quantified socio-ecological deprivation according to 9-digit zip code. Multivariable logistic regression analyses identified independent associations with likelihood of reporting severe levels of pain-related impairment. Approximately 35.3% of children reported severe levels of pain-related impairment. In logistic regression analysis, an increased likelihood of endorsing severe pain-related impairment was associated with pain for >1 month (OR=9.19, p=.044), higher child pain catastrophizing (OR=1.23, p<.001), caregiver Spanish language (OR=11.11, p=.044), and clinically significant caregiver trait anxiety (OR=58.16, p=.004). Results highlight the incidence of severe pain-related impairment in children diagnosed with unspecified abdominal pain in a PED. Moreover, findings underscore the importance of screening pain-related impairment and caregiver anxiety, and addressing language barriers in this PED population. PerspectiveThis paper highlights the incidence of severe pain-related impairment among pediatric patients diagnosed with unspecified abdominal pain in a pediatric emergency department (PED). Results could inform early assessment and targeted interventions in the PED to prevent outcome disparities.

Disparities in 1-Year Follow-up Rates After Proximal Humerus Fractures Treated With Open Reduction and Internal Fixation

Background: Proximal humerus fractures (PHFs) impose a serious burden on patients and are commonly treated with open reduction and internal fixation (ORIF). Several factors influence functional outcomes in treating PHFs. This study aims to evaluate how social determinants of health affect postoperative follow-up rates of patients treated with ORIF for PHF. Methods: A single-center retrospective review included 92 patients treated with ORIF for PHF. Loss to follow-up was defined as failing to return after the last advised follow-up. Patient zip codes were used to determine median household income as determined by the US Department of Housing and Urban Development (HUD) and the Federal Reserve and social disadvantage using the Social Deprivation Index (SDI). Results: A significant difference was observed in 12-month loss to follow-up rates between HUD and SDI subgroups. No difference was found in 6-month loss to follow-up rates or the reasons that patients were lost to follow-up among HUD, Federal Reserve, and SDI subgroups. Conclusion: Patients from areas of greater socioeconomic deprivation exhibited the highest 12-month loss to follow-up rates, emphasizing the importance of targeted interventions, such as in-house social workers and improved visit reminders, to address postoperative attrition and enhance patient care.

Community and Patient Features and Health Care Point of Entry for Pediatric Concussion

Many recent advances in pediatric concussion care are implemented by specialists; however, children with concussion receive care across varied locations. Thus, it is critical to identify which children have access to the most up-to-date treatment strategies. To evaluate differences in the sociodemographic and community characteristics of pediatric patients who sought care for concussion across various points of entry into a regional health care network. This cross-sectional study included children seen for concussions across a regional US health care network from January 1, 2017, to August 4, 2023. Pediatric patients aged 0 to 18 years who received an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification code for concussion were included. The study took place at emergency department (ED) and outpatient (primary care [PC] and specialty care [SC]) settings. Age at visit, biological sex, parent-identified race and ethnicity, payer type, median income and percentage of adults with a bachelor's degree for home zip code, and overall and subdomain Child Opportunity Index (COI) score based on patient address. The association of exposures with point of entry of ED, PC, and SC were examined in both bivariate analysis and a multinomial logistic regression. Overall, 15 631 patients were included in the study (median [IQR] age, 13 [11-15] years; 7879 [50.4%] male; 1055 [6.7%] Hispanic, 2865 [18.3%] non-Hispanic Black, and 9887 [63.7%] non-Hispanic White individuals). Race and ethnicity were significantly different across settings (1485 patients [50.0%] seen in the ED were non-Hispanic Black vs 1012 [12.0%] in PC and 368 [8.7%] in SC; P < .001) as was insurance status (1562 patients [52.6%] seen in the ED possessed public insurance vs 1624 [19.3%] in PC and 683 [16.1%] in SC; P < .001). Overall and individual COI subdomain scores were also significantly different between settings (overall COI median [IQR]: ED, 30 [9-71]; PC, 87 [68-95]; SC, 87 [69-95]; P < .001). Race, insurance status, and overall COI had the strongest associations with point of entry in the multivariable model (eg, non-Hispanic Black patients seen in the ED compared with non-Hispanic White patients: odds ratio, 2.03; 95% CI, 1.69-2.45). In this cross-sectional study, children with concussion seen in the ED setting were more likely to be non-Hispanic Black, have public insurance, and have a lower Child Opportunity Index compared with children cared for in the PC or SC setting. This highlights the importance of providing education and training for ED clinicians as well as establishing up-to-date community-level resources to optimize care delivery for pediatric patients with concussion at high risk of care inequities.

Estimation of HIV prevalence at the ZIP code-level in Atlanta, Georgia: Bayesian prediction modeling using passive surveillance data and social determinants of disease spreading

ObjectiveThis study aims to predict the number of undiagnosed HIV cases at the ZIP Code-level in Atlanta, Georgia, based on publicly available information. Study designStatistical modeling. MethodsWe fitted a Bayesian hierarchical Binomial model to county-level estimates of the passive-surveillance-system. The denominator was the true total HIV cases arising from a Negative Binomial distribution. The trial probability, known as ascertainment probability, depended on socio-economic determinants of HIV, retained via feature-selection algorithms. Data were obtained from CDC's HIV report for End of the HIV Epidemic and the American Community Survey. The prediction model was assessed out-of-sample in Georgia counties. We combined socio-economic data with the posterior predictive distribution of the coefficients to predict the mean ascertainment probability and total HIV cases at the ZIP Code-level. These estimates were spatially smoothed and aggregated at the county-level for secondary validations. ResultsThe county-level model showed good mixing properties and predictive accuracy. The mean ascertainment probability calibrated to the ZIP Code-level varied from 78.4% (95% credible interval: 24.4%–99.3%) to 93.8% (95%CI: 80.6%–99.8%). Further, the predicted undiagnosed HIV cases ranged between 12 (95%CI: 6–19; ZIP Code 30322) to 1603 (95%CI 1209–1968; ZIP Code 30318). ConclusionsOur findings provide a more complete picture of the relative burden of HIV across ZIP codes. Such information can be used by Local Health Departments to identify underserved areas and allocate resources accordingly. Furthermore, our methodological approach can be applied to complement the information obtained from passive surveillance, especially when more resource-intensive approaches are not available or are unfeasible to employ.

Quantifying post-disaster community well-being: A case study of Hurricane Harvey

Natural hazards such as hurricanes affect various aspects of the community members’ lives and their post-disaster well-being by causing significant disruptions in the key community activities in the immediate recovery phase. Furthermore, natural hazards leave behind short-term socio-economic impacts such as stress, anxiety, huge recovery expense, and lack of affordable housing. There is a need for incorporating both immediate and short-term impacts of natural hazards when measuring disaster recovery. This study aims to address this need by introducing community well-being as the metric for the recovery of communities from natural disasters. From this perspective, community resilience is defined as the capability of community to reach its pre-disaster state of well-being, in a timely and efficient manner. The study leverages Bottom-Up Spillover Theory and the existing literature to introduce a community well-being model. This model quantifies how the functionality of infrastructure systems can affect various aspects of community well-being based on 6 domains, 17 sub-domains, and 51 indicators. The indicators were quantified using survey data and 211-call data for the City of Houston, and data on the impact of Hurricane Harvey at the zip code level. The results showed that various dimensions of well-being were affected heterogeneously and followed different recovery patterns. The proposed framework can serve decision makers as a dashboard for identifying the well-being domains and sub-domains that should be addressed to enhance post-disaster well-being in the immediate-to short-term. Furthermore, the study introduces the phone call data as an inexpensive and timely replacement for multiple rounds of survey questionnaires for quantifying community well-being.

Tenant Right-to-Counsel and Adverse Birth Outcomes in New York, New York

In 2017, New York, New York, launched the United States' first right-to-counsel program, guaranteeing lawyers to low-income tenants in select zip codes, which was associated with reducing eviction risk by half. Given documented associations between evictions during pregnancy and adverse birth outcomes, the right-to-counsel program may be associated with improved birth outcomes. To measure associations between zip code-level right-to-counsel access and risk of adverse birth outcomes, including preterm birth and low birth weight, among infants born to Medicaid-insured birthing parents. This retrospective cohort study leveraged the staggered rollout of New York's right-to-counsel program from January 2016 to February 2020 as a natural experiment using a population-based sample of live births to Medicaid-insured birthing parents residing in New York, New York. Data were analyzed from February 2022 to September 2024. Zip code right-to-counsel status 9 months prior to birth. Adverse birth outcomes were measured using individual birth records from the New York Bureau of Vital Statistics. Outcomes included dichotomous indicators of low birth weight (<2500 g), preterm birth (<37 weeks' gestation), and a composite of both. Difference-in-differences linear probability models controlled for year, month, and zip code and included clustered standard errors. Among 260 493 live births (mean [SD] birthing parent age, 29 [6] years) from January 2016 to February 2020, 43 081 births (17%) were to birthing parents residing in zip codes where right-to-counsel was available during pregnancy. Exposure to right-to-counsel during pregnancy was associated with statistically significant reductions in infants' probability of adverse birth outcomes, with reductions of 0.73 (95% CI, 0.06-1.41) percentage points in low birth weight, 0.91 (95% CI, 0.10-1.71) percentage points in preterm birth, and 0.96 (95% CI, 0.09-1.84) percentage points in the composite outcome in treated vs untreated zip codes. This cohort study found that right-to-counsel was associated with reduced risk of adverse birth outcomes among Medicaid-insured birthing parents. These findings suggest that eviction prevention via right-to-counsel may have benefits that extend beyond the courtroom and across the life-course.

Delays in Treatment for Temporal Encephaloceles and Cerebrospinal Fluid Leaks.

Lateral skull base defects (LSBD) pose a diagnostic challenge; however, early recognition and treatment are important to avoid sequelae. This study examines the impact of health care disparities associated with time to diagnosis and treatment for patients with LSBD. Multi-institutional retrospective cohort study at four U.S. tertiary centers from 2000 to 2022. Adult patients with a primary diagnosis of CSF leak or encephalocele were included. Multivariate regressions used to analyze how age, sex, race/ethnicity, insurance, language, zip code, distance to medical center, referral patterns, diagnostic workup, and clinical course affected time to diagnosis and treatment. In 127 patients with LSBD, mean time to treatment of CSF leak or encephalocele was 13.9 months. On average, patients waited 10.6 months from initial assessment to diagnosis and saw 2 providers prior to diagnosis. Approximately 91% (115) of patients had a CT scan, and 75% (95) had an MRI. Imaging did not influence time to treatment. Older age, public insurance, and number of providers seen were associated with delays. Non-English speakers (5% of 127) encountered treatment delays, although this was not statistically significant. Fifty-eight (46%) people had private insurance. The average traveled distance for care was 62.6 miles. Clinical presentation, race, zip code, imaging, myringotomy, beta-2 transferrin, and ED workup were not found to be associated with delays to care. There are significant delays in diagnosis and management of LSBD. Referral patterns did influence care. Health care disparities did not impact care; however, disparities and language barriers need to be studied further to determine contributions to delays in care.

Atrial Fibrillation in young patients: Insights from the National Inpatient Sample

Abstract Background The burden of atrial fibrillation (AF) in young patients is not well characterized. We aimed to study trends in AF burden and management over time in patients aged 18-45 years. Methods We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the United States National Inpatient Sample (NIS) data from 01/01/2008 to 12/31/2019. We collected data on clinical and socioeconomic features including demographics, comorbidities, ZIP Code income, resource utilization, and various clinical outcomes. Quartile classification of the median household income of the zip code of the patient’s residence was used to classify socioeconomic status. Results The rate of AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p&amp;lt;0.001) (Figure 1). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in black patients compared to other ethnicities (20.4 for black vs. 15.6 for white vs. 8.5 Hispanic per 100,000) (Figure 2). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p&amp;lt;0.001), and the utilization of catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p&amp;lt;0.001) (Figure 1). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p &amp;lt;0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3%) and catheter ablation (6.1% vs. 3.3%, p &amp;lt;0.001) compared to black patients. Patients in the highest socioeconomic status quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p&amp;lt;0.001) and catheter ablation (8.0% vs. 3.7%, p&amp;lt;0.001) compared to patients in the lowest socioeconomic status quartile. Conclusions We found significant differences in inpatient AF burden across different patient populations. We identified differences in inpatient AF management based on sex, ethnicity, and socioeconomic status. Further research is needed to better understand these differences, their impact on clinical outcomes, and strategies to improve healthcare disparities.