Regional Disparities Research Articles

Inter‐prefectural and urban–rural regional disparities in rectal cancer and rectal resections: A Japanese nationwide population‐based cohort study from 2014 to 2019

AbstractAimThis observational study aimed to elucidate the regional disparities in rectal cancer (RC) and rectal resections (RRs) across Japan.MethodsThe annual incidence of RC, and number of all RRs and board‐certified surgeons by the Japan Society for Endoscopic Surgery were examined by prefecture in Japan from 2014 to 2019. The surgical approaches were broken down by open and laparoscopic. Disparities in 47 prefectures and urban–rural disparities were evaluated using the Gini coefficient and unpaired t‐test.ResultsThe annual national average incidence of RC was 50 127 and the number of all RRs was 39 903. Gini coefficients for RC, and laparoscopic and all RRs were <0.2, indicating low inequality. There was no significant difference between urban and rural prefectures in the number of RRs, despite a significantly higher incidence of RC in rural prefectures and a significantly higher number of board‐certified surgeons in urban prefectures (p < 0.05).ConclusionRC and laparoscopic and all RRs exhibited minimal inter‐prefectural disparities. The urban–rural analysis revealed significant differences in the incidence/number of RC and board‐certified surgeons between urban and rural prefectures, despite minor differences in RRs regardless of approach. This pattern suggests a potential migration of surgical services from rural to urban areas. This preliminary study is expected to contribute to a basic epidemiological database for RC and RRs.

Mortality attributable to ambient PM2.5 exposure across regions in China from 2005 to 2020

BackgroundChina has implemented rigorous clean air policies since 2013 to address PM2.5 pollution particularly affecting economically developed regions. The Fusion relative risk model was recently developed to better capture the association between long-term PM2.5 exposure and mortality risk, but it has not been used in China. MethodsWe estimated cause-specific PM2.5 attributable deaths among adults (≥ 25 years) across China over 2005–2020 at a 0.1° × 0.1° spatial resolution using the Fusion model, and also adopted the Global Exposure Mortality Model (GEMM) for comparison. We investigated 31 provinces and targeted five mega city clusters: Beijing–Tianjin–Hebei cluster (BTH), Yangtze River Delta cluster (YRD), Pearl River Delta cluster (PRD), Cheng–Yu cluster (CY) and Middle reaches of the Yangtze River cluster (MYR). ResultsThe Fusion model estimated PM2.5 attributable deaths increased from 2.38 million (95 % UI: 2.06-2.64) in 2005 to 2.68 million (95 % UI: 2.33-2.95) in 2013 (12.6 %), then declined by 11.6 % to 2.37 million (95 % UI: 2.04-2.65) in 2020. Ischemic Heart Disease (IHD) and Stroke contributed most to the total attributable deaths (33.4 % and 35.0 % in 2020). Compared with the GEMM, the Fusion model generated higher attributable mortality estimates for IHD, Stroke and Chronic Obstructive Pulmonary Disease, but lower estimates for Lung Cancer and Lower Respiratory Infections. PM2.5 attributable deaths were clustered in densely populated and highly polluted regions, with Henan and Shandong bearing the highest mortality burden among the 31 provinces. PM2.5 attributable deaths in BTH, YRD, PRD, CY and MYR declined by 5.3 %, 11.5 %, 18.0 %, 25.4 % and 18.6 % respectively over 2013–2020, with greater declines in attributable mortality rates (18.9 %, 23.8 %, 33.8 %, 27.3 % and 24.1 %). ConclusionsFuture clean air policies in China should consider regional disparities and continue prioritizing highly polluted and densely populated urban areas, including the five mega city clusters.

Diagnostic and therapeutic practice for HFpEF across continents and regions: An international survey.

This study aims to evaluate the worldwide variations in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF), using an HF survey distributed internationally to physicians, including both cardiologists and non-cardiologists. A group of HF specialists designed an independent, academic web-based survey focusing on HFpEF care and diagnosis, which was distributed via scientific societies and various social networks between 1 May 2023 and 1 July 2023. The survey included 1459 physicians (1242 cardiologists and 217 non-cardiologists) from 91 countries, with a mean age of 42 (34-49) years and 61% male. Most physicians (89.2%) defined HFpEF as left ventricular ejection fraction ≥50%. Significant regional variations were observed in HFpEF management (P<0.001 for all comparisons unless stated otherwise). Cardiologists managed 63.1% of HFpEF patients overall, with significant variability across regions (P < 0.001). The estimated HFpEF prevalence was highest in Eastern Asia and Western Europe and lowest in Africa and South America. Diagnostic practices varied: natriuretic peptide use ranged from 70%-74% in Africa to 95%-97% in Southern/Western Europe. Echocardiographic parameters showed regional differences, with diastolic stress testing used most in South-Eastern Asia (47% vs. 13-36% elsewhere). HFpEF scoring systems were most common in South-Eastern Asia (78%) and least in Africa (30.1%). Coronary artery disease screening approaches differed, with Eastern Asian physicians more likely to always perform routine angiograms (52%) compared with Northern Europeans (12%). Treatment preferences also varied regionally. Sodium glucose co-transporter-2 inhibitors (SGLT2i) was the preferred first-line treatment (45%-70% across regions), followed by diuretics. In an ideal setting, 52% would primarily use SGLT2i, 33% loop diuretics, and 22% beta-blockers. Drug availability differed significantly: SGLT2i was most available (88% overall), while ARNI was least available (61%). South America and Middle Eastern/Northern Africa reported lower availability of guideline-directed therapies. Multidisciplinary HF programmes were most common in Asia (70%) and least in Africa (24%). The perceived benefit of atrial flow regulator devices also showed significant regional differences. There are considerable global variations in the diagnosis and management of HFpEF. Most physicians favour SGLT2i despite regional disparities in health care resources and guideline adherence. Harmonized practices and improved access to comprehensive care can enhance outcomes of HFpEF patients worldwide.

Carbon sink efficiency of Chinese mollusk mariculture

Chinese mollusk mariculture plays a key role in boosting ocean carbon sink capacity through biological processes, supported by large-scale production. However, its full potential remains underutilized due to the absence of comprehensive efficiency evaluations. This interdisciplinary study applies a three-stage approach to assess the carbon sink efficiency of Chinese mollusk mariculture, with a focus on regional variations across nine coastal provinces from 2012 to 2022. The results show that environmental variables and statistical noise distort efficiency scores, leading to overestimation in six provinces and underestimation in three. After adjusting for these influences, regional disparities in efficiency become more apparent. High-production provinces such as Shandong, Fujian, and Guangdong exhibit higher efficiency, while low-production provinces like Hainan show diminished performance. Although there is a positive correlation between production volume and carbon sink efficiency, further improvements are constrained by the sector's low profitability. To address this, we propose two strategies: (1) reallocating subsidies from capture fisheries to mollusk mariculture, and (2) accelerating carbon trading between mollusk mariculture and other industries. These measures could enable the global mollusk mariculture to enhance both its carbon sink capacity and efficiency, contributing to food security and climate change mitigation.

S2006 Temporal Trends and Regional Disparities in the Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) From 1980 to 2021: An Analysis of GBD Study 2021

S2006 Temporal Trends and Regional Disparities in the Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) From 1980 to 2021: An Analysis of GBD Study 2021

Trends in Lower Respiratory Infections Mortality in Children under 14 from 1990 to 2019: Analysis of the Global Burden of Disease Study 2019

BackgroundLower respiratory infections (LRIs) remain a leading cause of mortality among children, yet previous studies have primarily focused on children under 5 years of age as a whole, with limited research on more specific age groups. This study aimed to analyze the trends in mortality associated with lower respiratory infections (LRIs) among children under 14 years of age from 1990 to 2019, with particular attention to regional and age-specific disparities. MethodsWe collected annual lower respiratory infection (LRI) deaths and mortality rates for six age groups of children under 14 years from 1990 to 2019 using data from GBD 2019. Estimated annual percentage changes (EAPCs) were calculated by fitting a linear regression model to quantify temporal trends. Additionally, EAPCs for 12 risk factors by Socio-Demographic Index（SDI） and age group were calculated to assess their impact on changes in LRI mortality. ResultsGlobally, LRI-related deaths among children under 14 years decreased by 68.81%, from 2,290,115 (95% UI 2,001,328 to 2,687,160) in 1990 to 714,315 (95% UI 588,975 to 875,975) in 2019. The most substantial reduction was observed in East Asia, with an EAPC of -9.68 (95% CI -9.98 to -9.38). The highest mortality occurred in the 28 to 364 days age group, with significant risk factors including child wasting (26.81%), household air pollution from solid fuels (16.14%), and low birth weight (10.15%). In the low and lower-middle SDI regions, there was an upward trend in mortality due to ambient particulate pollution among children aged 10 to 14 years. ConclusionDespite a significant global decline in LRI mortality among children under 14 years from 1990 to 2019, regional disparities persist. Addressing these inequalities and considering the developmental stages of children are crucial for further reducing child mortality rates.

The green trade benefits and horizontal ecological compensation from the perspective of embodied carbon emissions: A case study of the Yellow River Basin, China

The horizontal ecological compensation plays an important role in balancing the interests of all parties and coordinating regional development in the basin. However, the mechanism of ecological compensation based on embodied carbon emissions is still poorly understood. Here, taking the Yellow River Basin as the research area, we use the multi-regional input-output (MRIO) model to measure the embodied carbon transfers between its seven urban agglomerations in 2012 and 2017 from the viewpoint of value-added trade benefits. Further, for the first time, the green trade benefits and ecological compensation amounts are analyzed. The results indicate that: (1) The transfer of trade-embodied carbon among the urban agglomerations in the basin showed obvious spatial heterogeneity and geographic proximity effects, and trade-embodied carbon outflows (inflows) had a pattern of "highest in the midstream, second in the downstream, and lowest in the upstream". (2) The industry composition of the urban agglomerations in relation to embodied carbon outflows (inflows) was similar, mainly in the service and heavy manufacturing industries. (3) The spatial pattern of green trade benefits in the basin had shifted from "high in the north and low in the surrounding area" to "high in the east-central part and low in the west". (4) The pattern of ecological compensation in the basin had shifted from the upstream surplus, the middle and downstream deficit to the midstream deficit, and the upstream and downstream surplus. Therefore, we recommend improving energy structures in high-demand urban agglomerations by adopting clean energy, focusing on decarbonization and energy efficiency in resource-rich regions. Additionally, promoting low-carbon economies, especially in the service and heavy manufacturing industries, implementing differentiated emission reduction strategies, and optimizing carbon compensation mechanisms considering regional disparities and resource endowments are crucial. It is expected that the study can enrich the scientific basis of horizontal ecological compensation and increase the fairness of regional carbon emission rights allocation.

Analysis of China’s carbon financial Development’s impact on reducing emissions using the BCC and Malmquist models

This study evaluates the impact of China’s carbon finance development on carbon emission reduction and its role in promoting low-carbon economic growth. We construct an evaluation index system and employ Systematic Cluster Analysis (SCA) and Data Envelopment Analysis (DEA) methods to analyze the carbon finance markets in five representative Chinese provinces (autonomous regions). Utilizing the DEA-BCC model and DEA-Malmquist index, we conducted an in-depth analysis of the carbon emission reduction effects between 2022 and 2023. Our findings reveal that while China’s carbon finance development significantly contributes to carbon emission reduction, there are considerable regional disparities in effectiveness. Beijing and Guangdong achieved DEA efficiency, whereas Jilin, Ningxia, and Xinjiang experienced efficiency losses, suggesting a need for structural optimization. The study provides insights into challenges and potential improvements in China’s carbon finance sector and offers policy recommendations for enhancing market mechanisms, technological innovation, and social engagement to support China’s carbon peak and neutrality goals.

Rise of Digital Authoritarianism? Exploring Global Motivations Behind Governmental Social Media Censorship

Social media has been a crucial online space, yet our comprehension of government censorship remains limited by insufficient research. This study addresses this scholarly gap by probing two key inquiries: censorship's motives and evolutionary course. An analysis of 360 censorship incidents from 2006 to 2023 across 76 countries examines three primary rationales: political, social, and security, with political motives prevailing. The reasons for censorship vary across platforms and years, with political and social factors predominantly impacting Facebook and YouTube, while security concerns notably affect TikTok and Telegram. Regional disparities in censorship underscore the prevalence of political motives in Asia and Africa, social factors in South Asia and the MENA region, and security concerns in North America, Europe, and Oceania—the entirety of the Western world. The escalating social media censorship, particularly driven by political and social considerations since 2015, underscores a broader trend of dwindling democracy and burgeoning digital authoritarianism globally. We presume that a nation's democratic environment indicates its social media censorship practices, suggesting the nexus of local and global politics with technology complicates the understanding of social media censorship.

Racial, Ethnic, and Regional Disparities of Post-Acute Service Utilization After Stroke in the United States.

Post-acute care is critical for patient functional recovery and successful community transition. This study aimed to understand the current racial, ethnic, and regional disparities in post-acute service utilization after stroke. This retrospective cross-sectional study included patients hospitalized for ischemic stroke and intracerebral hemorrhage in 2017-2018 using the National Inpatient Sample. Discharge destinations were classified as follows: (1) facility including inpatient rehabilitation, skilled nursing facility, and facility hospice; (2) home health care (HHC), including home health and home hospice; and (3) home without HHC. Multinomial logistic regression was used to study the odds of discharge to a facility over home and HHC over home without HHC by race, ethnicity, insurance, and census division, adjusting for clinical factors and survey design. Among the 1,000,980 weighted ischemic stroke admissions, 66.9% were White, 17.6% Black, 9.5% Hispanic, 3.1% Asian American/Pacific Islander, and 0.4% Native American. Relative to private insurance, uninsured patients had the lowest adjusted odds of facility over home discharge (0.44; 95% CI 0.40-0.48) and HHC discharge over home without HHC (0.79; 95% CI 0.71-0.88). Compared with White patients, only Hispanic patients with Medicare/Medicaid insurance or self-pay had lower odds of facility over home discharge (adjusted OR 0.80 and 0.75, respectively; 95% CI 0.76-0.84 and 0.63-0.93). Uninsured Hispanic patients also had lower odds of HHC discharge over home without HHC than White patients (0.74; 95% CI 0.57-0.97). Facility discharge rate was the highest in East North Central (39.2%) and lowest in Pacific (31.2%). HHC discharge rate was the highest in New England (20.2%) and lowest in West North Central (10.3%), which had the highest home without HHC discharge (46.1%). Compared with New England, other census divisions had lower odds of facility over any home discharge with Pacific being the lowest (adjusted OR, 0.66; 95% CI 0.60-0.71) and HHC over home without HHC discharge with West North Central being the lowest (adjusted OR, 0.33; 95% CI 0.29-0.38). Similar patterns were observed in intracerebral hemorrhage. Significant insurance-dependent racial and ethnic disparities and regional variations were evident in post-acute service utilization after stroke. Targeted efforts are needed to improve post-acute service access for uninsured patients especially Hispanic patients and people in certain regions.

Association between physicians’ maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study

ObjectivesWith physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core...

Understanding excess mortality in 2022: The dual impact of COVID-19 and heatwaves on the Italian elderly population

In this study, we employ a comprehensive approach to model the concurrent effects of the COVID-19 epidemic and heatwaves on all-cause excess mortality. Our investigation uncovers distinct peaks in excess mortality, notably among individuals aged 80 years and older, revealing a strong positive correlation with excess temperatures (ET) during the summer of 2022 in Italy. Furthermore, we identify a notable role played by COVID-19 hospitalizations, exhibiting regional disparities, particularly during the winter months. Leveraging functional data regression, we offer robust and coherent insights into the excess mortality trends observed in Italy throughout 2022.

Exploring the role of regional capacity in human resource development in Indonesia

The role of local government in regional development planning is an essential topic in the context of sustainable local development. This study aimed to analyze the role of local governments in regional development planning and their impact on the effectiveness and sustainability of development at the local level. The research method used is a qualitative approach with data collection techniques through in-depth interviews, participatory observation, and document analysis related to regional development policies and regulations. This research was conducted in several districts/cities in certain regions, considering diverse geographical, social, and economic contexts. The results showed that the role of local governments in regional development planning is vital in coordinating various interests, resources, and related actors. Local governments act as regulators, facilitators, and implementers in determining the direction, policies, and allocation of development resources. In addition, community and private-sector involvement is also recognized as an integral part of democratic and inclusive planning processes. The impact of the role of local governments in regional development planning can be seen in increasing the effectiveness of development programs, increasing community participation, reducing regional disparities, and improving the community’s quality of life. Nevertheless, challenges such as corruption, lack of interagency coordination, and political uncertainty remain obstacles that must be overcome. This study concludes that the role of local governments in regional development planning is a critical factor in achieving sustainable regional development. Therefore, measures are needed to strengthen institutional capacity, increase transparency, and strengthen public participation to ensure sustainable and inclusive development planning at the local level.

The human side of cancer care in Japan: barriers and challenges

Abstract Among the core concepts of psycho-oncology, “addressing the human aspects of cancer” is one of the most important. In particular, the enhancement of physicians' empathic communication is welcomed in Japan. In 2006, the enactment of the Cancer Control Act in Japan promoted psychosocial and palliative care to anyone. Thus, the designated cancer hospitals adopted a palliative care team, including a psycho-oncologist, as well as a communication skills training program practicing empathic communication. The Cancer Registry data have suggested regional disparities in suicides among patients with cancer in Japan, suggesting fragile regions of psycho-oncology. How can we deliver empathic communication to patients across the country, and how far will technological innovation, including AI, produce innovative support? Although constant efforts are needed to move closer to solutions, the human side of cancer must not be changed; however, clinical practice must continue to change over time.

S551 Unraveling Regional Disparities in Early-Onset Colorectal Cancer Mortality Across the United States Between 2000 - 2022

S551 Unraveling Regional Disparities in Early-Onset Colorectal Cancer Mortality Across the United States Between 2000 - 2022

Global and national burden of type 2 diabetes mellitus attributable to PM2.5 air pollution: An analysis of the GBD study from 1990 to 2019.

Epidemiological studies have established a link between air pollution and an elevated risk of type 2 diabetes mellitus (T2DM). This study aims to measure the impact of T2DM related to fine particulate matter (PM2.5) pollution by examining death rates and disability-adjusted life years (DALYs) from 1990 to 2019 in the United States of America. Using data from the Global Burden of Disease (GBD) database, we examined death and DALY rates per 100,000 populations in T2DM patients, specifically focusing on ambient particulate matter pollution (APMP) and household air pollution (HAP). We assessed average annual percentage change (AAPC) across various age and gender groups, states, and socio-demographic index (SDI) categories. Our findings reveal a significant decline in death rates and DALYs in the United States of America over the last 30 years, with more pronounced decreases among females and older adults. Despite national progress, state-level variations indicate complex interactions between environmental regulations, healthcare access, and socio-economic factors. Some states, such as Oregon, Idaho, and Alaska, exhibited increased AAPC. Our study emphasizes the need for targeted policies and interventions to reduce PM2.5 exposure and further address regional disparities, ensuring continued improvement in public health outcomes.

Green Economy from a Regional Perspective – a Polish Case Study

The article presents the elaboration and specification of the green economy concept, where resource scarcity, global climate change and environmental degradation are paving a new path towards sustainable development. The article addresses the issue of implementing the principles of green economy at the regional level. The implementation of a green economy at a regional level provides an excellent space for scientific deliberations. The aim of the research is to identify and assess the level of regional disparities in green economy development across Polish regions using a synthetic measure. The basis for the analysis was a set of substantively and statistically analyzed diagnostic variables from the years 2012-2022. The synthetic indicator of the green economy was calculated for every Polish region (NUTS 2) and the regions were ranked based on their score from highest to lowest. As a result of the analysis, the regional polarization and the ordering of regions in Poland in terms of the synthetic metric - green economy development - were discussed. Keywords: green economy, green growth, sustainable development, taxonomic methods.

TCT-803 Regional Disparities in Amputation Rates and Outcomes Across the United States: A National Inpatient Sample Analysis

TCT-803 Regional Disparities in Amputation Rates and Outcomes Across the United States: A National Inpatient Sample Analysis

Price-Predicting Model: Predictions for All Sailboats

Sailboat pricing is a nuanced field, significantly influenced by vessel age, geographical location, and brand reputation. To address this complexity, we leveraged the XGBoost algorithm, a powerful machine learning tool, and refined it through Bayesian optimization to create a highly accurate model for predicting sailboat prices. Our analysis revealed significant regional disparities, with sailboats from Europe, the USA, and the Caribbean commanding varying market valuations.&amp;nbsp;When applying this optimized model to the Hong Kong used sailboat market, we were able to generate forecasts with improved accuracy, though still with room for enhancement. Notably, the Lagoon brand stood out as a consistent high performer, underscoring the importance of brand reputation in sailboat pricing.&amp;nbsp;To provide actionable intelligence, we have synthesized a comprehensive analysis that integrates our research findings and predictive strategies.&amp;nbsp;This analysis presents clear visualizations alongside concise interpretations, thereby constituting a pivotal resource for informed decision-making within the local market context.

Does the impact of credit rating downgrade on bond returns vary by region: Empirical evidence from China

Utilizing trading data from corporate and enterprise bonds that experienced credit rating downgrades between 2012 and 2022, this study employs event study methodology and regression analysis to examine the regional differences in the impact of credit rating downgrades on bond pricing and the mechanisms behind these effects. The study found that, during the window period when the bond credit rating is downgraded, there is a significant difference in the cumulative abnormal return of bonds between the eastern and non-eastern regions. Heterogeneity analysis indicates that bonds with higher credit ratings and those issued by non-state-owned enterprises are more significantly affected by credit rating downgrades. This study provides empirical evidence of regional disparities in the impact of credit rating downgrades, and proposes a theoretical mechanism whereby differences in the degree of marketization influence these effects through varying expectations of government implicit guarantees. The findings offer a theoretical foundation for optimizing decision-making by participants in the Chinese bond market.