Agricultural Economics Research Research Articles

RURAL INHABITANTS IN THE PERSPECTIVE OF LABOUR MARKET CHALLENGES

The study delves into the nuanced challenges rural inhabitants face within the contemporary labour market landscape. As rural areas experience dynamic socio-economic shifts, this research aims to comprehensively understand the intricate intersection between rural livelihoods and emerging labour market trends. Employing a mixed-methods approach, the study investigates the constraints and opportunities in accessing and thriving within the labour market. The methodology includes pointing out the impact of megatrends described within the Horizon 2020 RURALIZATION project on the labour market and reviewing the research topics addressed during the XVII Congress of the European Association of Agricultural Economists 2024. The megatrends identified include an ageing population, the influence of globalisation, the ramifications of urbanisation, environmental stewardship, climate change concerns, efforts to counteract unequal development and rural decline, the surge in food demand, infrastructural considerations, regional accessibility, and connectedness, as well as the evolving patterns of migration. The review of contributions provided to the XVII EAAE Congress underscores the significance of addressing the inflow and outflow of the labour force in agriculture. Delving into specific aspects such as farm succession and the various factors influencing these processes, including the impact of agricultural policies, further solidifies the assertion that labour supply in rural areas holds paramount importance within agricultural economic research.

Rural-urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.

To assess trends and rural-urban disparities in palliative care utilization among patients with metastatic breast cancer. We analyzed data from the 2004-2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as "yes/no." Rural-urban residence, defined by the US Department of Agriculture Economic Research Service's Rural-Urban Continuum Codes, was categorized as "rural/urban/metropolitan." Multivariable logistic regression was used to examine rural-urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. Of 133,500 patients (mean age 62.4 [SD=14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004-2005 to 24.5% in 2008-2019 (7.0% increase per year; p-value for trend <0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p<0.001). After covariate adjustment, patients residing in rural (AOR=0.84; 95% CI: 0.73-0.98) or metropolitan (AOR=0.85, 95% CI: 0.80-0.89) areas had lower odds of having used palliative care than those in urban areas. In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural-urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population.

Understanding inequality in U.S. farm subsidies using large‐scale administrative data

AbstractUsing a large‐scale, individual‐level administrative data set for 2008–2021, we document the inequality in farm program payments across all recipients in the U.S. By examining the relationship between within‐county inequality and demographic characteristics of farmers in a county, we find that there is a positive association between the share of Black operators and within‐county inequality. We also provide suggestive evidence that a substantial portion of racial and gender disparities in farm payments are associated with crop production characteristics. We then utilize name information in farm payment data to infer the race and gender of individual payees. The analysis using approximately 4.9 million payee‐by‐year observations and predicted race and gender information of those payees shows that payments are lower for producers who are Black, Hispanic, and female. Our study provides a comprehensive empirical analysis of the equality of farm subsidy distribution covering most U.S. farm payment programs at a granular level over time. We also provide an empirical approach of utilizing name information from the administrative data that opens up more possibilities for racial and gender inequity research in agricultural economics.

Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia.

The study's purpose was to examine 5-year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts. We performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. Kaplan-Meier method and Cox proportional hazard regression were performed. Among 10,876 CRC patients (31.1% Black patients), 5-year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1-fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25) compared to those living in non-persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2-fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40) compared to those living in non-low education regions. Black patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.

Greenhouse Gas Emissions Efficiency in Polish Agriculture

Analysis of the efficiency of greenhouse gas emissions in agriculture is an important part of agricultural and environmental economics research. The theme is extremely important due to the deepening problem of climate change and the simultaneous need to ensure food security. However, counteracting climate change cannot be achieved at the expense of reducing agricultural productivity. Due to the need to study the economic-environmental relationship in agriculture, the main purpose of this study was to assess the changes in the level and structure of agricultural greenhouse gas emissions and to examine the changes in efficiency of agricultural greenhouse gas emissions. The authors also estimated the relative efficiency of emissions, which allowed for comparing the efficiency of emissions between agriculture and other sectors of the national economy. Analyzing the changes in agricultural emissions efficiency, as well as changes in relative efficiency of emissions, is an indirect way of assessing whether the ongoing trends are consistent with the sustainable development concept and if the country is effective enough in mitigating climate change in relation to its economic performance. The research conducted showed that agriculture has a significant share of greenhouse gas emissions among all sectors of the Polish economy. However, greenhouse gas emissions from agriculture decreased by a total of 23.5% in the years studied. The most significant changes occurred in the context of greenhouse gas emissions from intestinal fermentation. The research also shows that the efficiency of emissions from agriculture more than doubled in the years examined. However, it decreased compared to other sectors of the economy in the country. This study was based on emissions data retrieved from National Inventory Reports prepared by the National Center for Emissions Management and on the Agricultural Statistical Yearbooks of the Central Statistical Office. This paper also proposes some examples of measures that could be taken to reduce agricultural emissions. Some of them include reducing food losses, sustainable use of fertilizers, increasing energy efficiency, and greater use of renewable energy.

The association between food access and frailty among older adults with gastrointestinal malignancies-The CARE Registry.

Food access is associated with higher gastrointestinal (GI) cancer mortality; however, its association with frailty, which is a predictor of premature mortality among older adults with cancer, is less understood. The authors included 880 adults aged 60 years and older who were recently diagnosed with GI cancers and were undergoing self-reported geriatric assessment at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food access was measured using the 2019 US Department of Agriculture Economic Research Service designation low-income, low-access (LILA), classifying census tracts based on income and/or access to food stores at various distances. The primary outcome was frailty on the CARE (Cancer and Aging Resilience Evaluation) Frailty Index, a composite of the proportion of impaired geriatric assessment measures. The authors examined the LILA-frailty association with modified Poisson regression accounting for census-tract clustering. The median patient age was 69 years, 58.1% were men, 22.5% were non-Hispanic Black, 29.2% had colorectal cancer, 28.0% had pancreatic cancer, 70.1% presented with stage III/IV disease, and 34.9% were frail. A higher proportion in LILA areas were non-Hispanic Black (44.1% vs. 10.8%; p<.001) and had less education (high school or less: 48.1% vs. 37.9%; p=.020). Adjusting for age, race and ethnicity, sex, cancer type and stage, and education, an LILA designation was associated with 58% greater odds of worsening frailty status (95% confidence interval, 1.18-2.12). An analysis of LILA subcategories revealed that associations were maintained across all LILA measures. Poor food access was associated with a greater risk of frailty among newly diagnosed older adults with GI cancers before they received systemic treatment. Intervening on local food access, particularly in LILA areas, may be a target for improving rates of frailty and promoting health equity in this population.

Abstract A100: Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in the five public health districts of Georgia including the Clayton, West Central, East Central, Southeast, and Northeast Georgia. Particularly, CRC outcomes are poorer among patients living in low socioeconomic (SES) areas with predominantly Black population in Georgia. We sought to examine 5-year CRC survival rates between White and Black/Other patients and determine whether regional SES status associated with 5-year CRC survival within different race groups in these five regions of Georgia. Methods: We performed a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program. The 2015 United State Department of Agriculture Economic Research Services (USDA ERS) county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. A county is classified by the USDA ERS as a persistent poverty by using 1980, 1990, 2000 censuses and 2007-11 American Community Survey. Five-year CRC survival rates were compared by using Kaplan-Meier method. Cox proportional hazard regression was used to examine the aforementioned associations in different race groups adjusted for demographics (gender, age at diagnosis, marital status, and five Georgia regions) and tumor features (stage, grade, and primary site). Results: Among 11,023 CRC patients (31.9% Black/Other patients), 5-year CRC survival rates were lower among Black/Other patients compared to White patients (65.9% vs. 69.9%; p-value&amp;lt;0.001). Black/Other patients living in low education, low employment, and persistent poverty regions appeared to have lower 5-year survival rates compared to those not living in those regions (59.6% vs. 67.8%, p-value&amp;lt;0.001; 65.4% vs. 66.2%, p-value=0.385; 64.4% vs. 66.5%, p-value=0.089 respectively). In the adjusted analysis, we found that White patients living in regions with persistent poverty were 1.12-fold of increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25; p-value=0.043) compared to those living in non-persistent poverty regions. Among Black/Other patients, those living in regions with low education were 1.19-fold of increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40; p-value=0.033) compared to those living in non-low education regions. Other factors, such as older age at diagnosis, distant stage, and high-grade tumors, were positively associated with CRC death among the entire cohort, regardless of racial groups. Conclusion: In Georgia, we found that Black/Other patients demonstrated the lower CRC survival rates. Region-level SES was associated with CRC survival among White and Black/Other patients. White patients living in regions with persistent poverty, and Black/Other patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection by considering patient’s regional SES status in Georgia. Citation Format: Meng-Han Tsai, Shaoyong Su, Marlo Vernon, Yanbin Dong. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A100.

Survival Outcomes of Rural Patients with Mantle Cell Lymphoma

Background Mantle cell lymphoma (MCL) is a rare and aggressive malignancy, representing approximately 6-8% of all non-Hodgkin lymphomas, and is generally associated with poor outcomes. Patients (pts) with MCL often require intensive up-front treatment with consideration for stem cell transplant consolidation. Due to geographic limitations, pts living in rural areas with MCL may not have access to specialized treatment centers experienced in managing this rare disease. There is a paucity of data available evaluating the impact of rurality in MCL, and it is unknown how population density and access to major metropolitan centers and their healthcare systems may impact survival outcomes. Methods The National Cancer Database was used to identify MCL pts diagnosed from 2004-2020. Demographic and treatment characteristics were compared by county level measures of rurality and urban influence, categorized into metropolitan (metro), non-metropolitan urban (urban), and non-metropolitan rural (rural) counties. These data are provided from the 2013 Department of Agriculture Economic Research service data Rural-Urban Continuum Codes which uses population, population density, and commuting distance to determine these codes. Pts without rurality data or who were not treated at the reporting facility were excluded. Kaplan Meier and adjusted Cox regression survival analysis were used to compare overall survival by rural-urban codes. Results Of the 29,464 pts with MCL identified, 83.4% (N= 24,849) resided in metro counties, 14.6% (N=4,356) resided in urban counties, 1.9% (N=573) resided in rural counties. Non-metro pts were more likely to be male (70.7% male metro vs 73.0% and 72.1% for urban and rural counties, respectively), with similar age at diagnosis across county types (median age of 68 for metro pts and 69 for rural pts). Rural pts had a higher burden of comorbidities, as determined by the Charlson-Deyo comorbidity index (11.3% of rural pts with a score of 2 or greater, compared to 8.7% urban, and 7.9% of metro pts). Pts from metro counties were more likely to have private insurance (38.5% metro vs. 32.4% for urban and 28.6% for rural pts), where non-metro pts were more often uninsured (3.3% of rural, vs 2.4% of metro) or Medicare insured (61.6% rural vs 53.4% of metro pts). Notably, pts were less likely to be managed with active surveillance if they were from a rural county (4.8% vs 6.9% of metro pts), and were more likely to receive systemic disease related therapy at diagnosis (90.6% rural vs 85.2% metro). With a median follow up of 42 months, pts from metro counties had a median overall survival (OS) of 70.6 months (95% confidence interval (CI) 68.6-72.7), which was significantly longer than those from urban (61.1 months [95% CI 56.4-65.9], p&amp;lt;0.001) and rural counties (59.8 months [95% CI 54.0-65.6], p&amp;lt;0.001). The survival disparity was persistent for metro, urban, rural pts at 1-year (81%, 80%, and 78% respectively, p&amp;lt;0.001), 5-years (54%, 50%, 50% respectively, p&amp;lt;0.001) and 10-years (36%, 30%, 29% respectively, p=0.066). When referenced to pts from metro counties on Cox regression, non-metro counties had a greater risk of all-cause mortality, with hazard ratio (HR) of 1.13 (95% CI 1.08-1.18; p&amp;lt;0.001) for urban and 1.14 (95% CI 1.02-1.28; p=0.024) for rural pts. When adjusted for age and Charlson-Deyo comorbidity score this survival disparity persisted, with a HR of 1.12 (95% CI 1.07-1.17), p&amp;lt;0.001 for urban pts and HR 1.05 (95% CI 0.94-1.18), p=0.408, for rural pts, when referenced to pts from metro counties. Discussion We demonstrate a population density-based survival disparity in MCL pts, finding that pts living in more rural counties have worse survival outcomes. Rural pts had a higher comorbidity burden and were more likely to be underinsured. Additionally, they received less active surveillance, which may indicate delays in diagnosis and/or consultation with an oncologist. Given the rapidly evolving treatment landscape of MCL, these data support the need for efforts to improve healthcare access for MCL pts, such as earlier referrals to academic centers with expertise in MCL management, expanded access to telehealth, rural partnerships with academic medical centers, and programs that support patient and family travel.

Improving Agricultural Policy Decisions through Replications

SummaryCurrently, policy decisions are often made based on untested scientific results. Replication studies repeat previously published research and, thus, are an effective way to test the validity and reliability of research studies, as well as to test the potential for generalisations of such studies. Replications can contribute to improved policy decisions and thus more efficient use of resources. To date, very few replications of research in agricultural economics are available and the incentives to engage in replications are low. Moreover, the conditions for replicating studies are poor. For example, published articles often lack full transparency in terms of documentation, data and computer code. This Point de Vue highlights the advantages of striving for conditions that facilitate replication studies and foster such a culture in agricultural economics. Policymakers could explicitly invite and support replications of studies that are key for good policymaking. To this end, they can address both demand‐side and supply‐side problems of replications, for example, by inviting, valuing and supporting replications of policy‐relevant analyses and by providing institutional and legal infrastructure facilitating open science and replications. With this, policy can support the agricultural economics profession, while agricultural economists can support sound policymaking, both reaping the benefits of a more transparent research culture.

A Risk Management Training Program Designed to Empower Urban Women Farmers

Annie’s Project: Farming in New Jersey’s Cities and the Urban Fringe focused on the following five areas of risk identified by the US Department of Agriculture Economic Research Service: financial, production, marketing/price, legal/institutional, and human/personnel. Additional education regarding urban farming topics included securing suitable land, dealing with contaminated soils and alternative growing medias, and securing water for crop production. We delivered a series of six 3-hour evening classes to 23 producers. We administered a retrospective evaluation at the conclusion of the series and distributed an evaluation survey 6 months after training. Both evaluations found that participants increased their understanding of farm risks. Furthermore, they indicated they were better able to manage the impacts of the COVID-19 pandemic on their farm business activities.

Stereotactic Radiotherapy Deserts are Under-Represented among Radiation Oncology Alternative Payment Model Sites

In bundled payment models including the proposed Radiation Oncology Alternative Payment Model (RO-APM), reimbursement favors shorter treatment paradigms like stereotactic radiotherapy (SRT). However, SRT requires specialized equipment, staff, and quality assurance procedures not available across the US. To understand the geospatial distribution of SRT and its impact on bundled payment models, we investigated the interplay between SRT resources with sociodemographic characteristics and oncologic outcomes for an index site of prostate cancer (PC). We constructed an ecologic study model using data from the HRSA Area Health Resources, AMA Physician Masterfile, USDA Agriculture Economic Research Service, Medicare Provider and Service Files, and NIH Cancer State Profiles. SRT use was operationalized as the presence of Medicare SRT billing codes. Sociodemographic variables included county racial distributions, %poverty, and rural vs. urban classification. Provider to patient at risk density (PPRD) was defined as number of radiation oncologists per 100,000 males ≥65 years. PC incidence and death rates were evaluated. Uni- and multivariable logistic regressions examined links between SRT use, proposed RO-APM status, PPRD, sociodemographic variables, and PC oncologic outcomes at the US county level. All listed statistics demonstrated p <0.05. SRT use was identified in 13% of all 3140 counties and in 49% of counties with documented RO providers. In univariable analyses, odds of SRT use was higher in counties that were metro [odds ratio (OR) 19.9] and with higher %Black constituents (OR 6.95); odds decreased with higher %poverty (OR 0.92). Among counties with RO providers, odds of SRT use increased with higher PPRD (OR 1.01). Odds of SRT use was associated with higher PC incidence (1.01) but lower death rates (OR 0.99). SRT use was more common in participating RO-APM counties (OR 2.66); moreover, magnitude and direction of associations between sociodemographic variables and RO-APM participation were similar to those for SRT use. In multivariable analysis, SRT use remained significantly associated with metro status, %Black constituents, PPRD, and PC death rates. Both SRT use and proposed RO-APM participation were most prevalent in metro counties with higher PPRD and %Black populations, likely reflecting presence of densely populated cities with high health resources. If SRT is incentivized in future reimbursement models, then rural, lower resource communities without SRT may be disadvantaged. Lack of association between SRT and PC incidence indicates the presence of "SRT deserts"-counties with high oncologic need but no SRT. To enable visualization of SRT deserts and encourage interventions aimed at reducing disparities in SRT access, our results will be included in an interactive web platform (bit.ly/density maps).

Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic.

Attrition from the emergency medicine workforce has become an issue of central importance to the specialty, with recent research suggesting a 5.3% to 5.7% collective annual attrition rate among emergency physicians prior to the COVID-19 pandemic.1Gettel C.J. Courtney D.M. Janke A.T. et al.The 2013 to 2019 emergency medicine workforce: clinician entry and attrition across the US geography.Ann Emerg Med. 2022; 80: 260-271Abstract Full Text Full Text PDF Scopus (8) Google Scholar Little is known about the effects of the COVID-19 pandemic on emergency physician practice patterns and whether attrition differs by emergency physician characteristics (eg, gender, rurality, and board certification status).2Bennett C.L. Espinola J.A. Ginde A.A. et al.Attrition from emergency medicine clinical practice in the United States, 2020.Acad Emerg Med. 2023; 30: 139-143Crossref Scopus (1) Google Scholar We sought to quantify the impact of the COVID-19 pandemic on attrition from the emergency medicine workforce. We performed a repeated cross-sectional analysis using publicly available 2013 to 2020 Medicare Physician and Other Practitioners data linked by National Provider Identifier to American Board of Emergency Medicine board certification data.3Centers for Medicare & Medicaid ServicesMedicare Physician & Other Practitioners.https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitionersDate accessed: December 17, 2022Google Scholar We included emergency physicians receiving reimbursement for at least 50 evaluation and management services (99281 to 99285) per year from Medicare part B.1Gettel C.J. Courtney D.M. Janke A.T. et al.The 2013 to 2019 emergency medicine workforce: clinician entry and attrition across the US geography.Ann Emerg Med. 2022; 80: 260-271Abstract Full Text Full Text PDF Scopus (8) Google Scholar,4Gettel C.J. Schuur J.D. Mullen J.B. et al.Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.Acad Emerg Med. 2023; 30: 89-98Crossref Scopus (3) Google Scholar Physicians exhibiting attrition were those not identified within the emergency medicine workforce during a given study year (eg, 2020) but who were identified as part of the emergency medicine workforce in the immediately preceding study year (eg, 2019). We calculated the emergency medicine workforce proportion that exhibited attrition annually, specifically assessing the covariates of gender, rurality, and emergency medicine board certification status. We calculated weighted mean attrition proportions for 2014 to 2019 to summarize the pre–COVID-19 period. The study was deemed exempt by the Yale institutional review board. A total of 49,288 unique emergency physicians met the study inclusion criteria between 2013 and 2020, including 35,376 (71.8%) male emergency physicians, 5,627 (11.4%) emergency physicians who practiced in a rural geographic location in at least one of the study years, and 38,916 (79.0%) emergency physicians who were board certified. In 2013, there were 33,177 emergency physicians in the workforce, with 5.3% overall exhibiting attrition (ie, not reimbursed for evaluation and management services in the 2014 study year). Cumulatively, including the pre–COVID-19 study years, the weighted mean attrition proportion was 5.4% between 2014 and 2019. During the COVID-19 pandemic, 8.2% of the emergency medicine workforce in 2019 did not provide services within the 2020 study year. The male and female emergency physicians’ weighted mean attrition proportion was 5.4% and 5.5% between 2014 and 2019, respectively, compared with 8.0% and 8.6% in 2020. The urban and rural emergency physicians’ weighted mean attrition proportion was 5.1% and 8.0% between 2014 and 2019, respectively, compared with 7.9% and 11.3% in 2020. The board-certified and nonboard-certified emergency physicians’ weighted mean attrition proportion was 4.9% and 7.2% between 2014 and 2019, respectively, compared with 7.6% and 10.6% in 2020 (Table).TableAnnual attrition proportion by emergency physician characteristics.YearOverallGenderGeographyEmergency Medicine Board CertificationMaleFemaleUrban∗Rurality was defined using the 2010 primary Rural Urban Commuting Area (RUCA) codes based on the address associated with the clinician’s National Provider Identifier present in the Medicare Physician and Other Practitioners data set. Consistent with the guidance from the US Department of Agriculture Economic Research Service, we categorized clinicians in metropolitan areas (RUCA code 1-3) as urban and clinicians in micropolitan and nonmetropolitan areas (RUCA code 4-10) as rural.Rural∗Rurality was defined using the 2010 primary Rural Urban Commuting Area (RUCA) codes based on the address associated with the clinician’s National Provider Identifier present in the Medicare Physician and Other Practitioners data set. Consistent with the guidance from the US Department of Agriculture Economic Research Service, we categorized clinicians in metropolitan areas (RUCA code 1-3) as urban and clinicians in micropolitan and nonmetropolitan areas (RUCA code 4-10) as rural.Yes†Board-certified status was defined as ever being board certified by the American Board of Emergency Medicine using initial certification dates.No†Board-certified status was defined as ever being board certified by the American Board of Emergency Medicine using initial certification dates.Pre–COVID-1920145.3%5.3%5.3%5.0%7.7%4.7%7.3%(5.1%-5.5%)(5.0%-5.6%)(4.9%-5.8%)(4.8%-5.3%)(6.9%-8.6%)(4.4%-4.9%)(6.8%-7.9%)20155.5%5.5%5.5%5.2%7.8%4.9%7.3%(5.2%-5.7%)(5.2%-5.8%)(5.0%-6.0%)(4.9%-5.5%)(6.9%-8.7%)(4.7%-5.2%)(6.7%-7.8%)20165.5%5.4%6.0%5.2%8.4%4.9%7.5%(5.3%-5.8%)(5.1%-5.6%)(5.5%-6.5%)(4.9%-5.4%)(7.5%-9.3%)(4.7%-5.2%)(6.9%-8.1%)20175.1%5.1%5.0%4.8%7.7%4.6%6.8%(4.9%-5.3%)(4.9%-5.4%)(4.6%-5.5%)(4.6%-5.1%)(6.9%-8.7%)(4.4%-4.9%)(6.3%-7.4%)20185.7%5.7%5.6%5.4%8.2%5.3%7.0%(5.4%-5.9%)(5.4%-6.0%)(5.2%-6.1%)(5.2%-5.6%)(7.3%-9.1%)(5.0%-5.6%)(6.5%-7.6%)20195.3%5.3%5.3%5.0%8.3%4.8%7.1%(5.1%-5.5%)(5.0%-5.6%)(4.8%-5.7%)(4.7%-5.2%)(7.4%-9.3%)(4.6%-5.1%)(6.5%-7.7%)Weighted Mean5.4%5.4%5.5%5.1%8.0%4.9%7.2%(5.2%-5.6%)(5.1%-5.7%)(5.0%-5.9%)(4.9%-5.4%)(7.2%-8.9%)(4.6%-5.2%)(6.6%-7.8%)During COVID-1920208.2%8.0%8.6%7.9%11.3%7.6%10.6%(7.9%-8.5%)(7.7%-8.4%)(8.1%-9.1%)(7.6%-8.2%)(10.3%-12.4%)(7.3%-7.9%)(9.9%-11.13%)Clinicians exhibiting attrition were those not identified within the emergency medicine workforce during a given study year but were identified as part of the emergency medicine workforce in the immediately preceding study year. As an example, 8.2% of the overall 2019 emergency medicine workforce was not identified as part of the 2020 emergency medicine workforce.∗ Rurality was defined using the 2010 primary Rural Urban Commuting Area (RUCA) codes based on the address associated with the clinician’s National Provider Identifier present in the Medicare Physician and Other Practitioners data set. Consistent with the guidance from the US Department of Agriculture Economic Research Service, we categorized clinicians in metropolitan areas (RUCA code 1-3) as urban and clinicians in micropolitan and nonmetropolitan areas (RUCA code 4-10) as rural.† Board-certified status was defined as ever being board certified by the American Board of Emergency Medicine using initial certification dates. Open table in a new tab Clinicians exhibiting attrition were those not identified within the emergency medicine workforce during a given study year but were identified as part of the emergency medicine workforce in the immediately preceding study year. As an example, 8.2% of the overall 2019 emergency medicine workforce was not identified as part of the 2020 emergency medicine workforce. Historically, approximately 1 (5.4%) in 20 emergency physicians annually exhibited attrition from the workforce, with our findings demonstrating an increase to 1 (8.2%) in 12 in 2020. To our knowledge, these findings are the first to provide evidence of the impact of the COVID-19 pandemic on emergency medicine workforce attrition. We also found that the recent attrition has disproportionately occurred among emergency physicians in rural geographic locations and those without emergency medicine board certification. There are several possible explanations and implications for these findings. First, the increased overall attrition rate identified during COVID-19 provides quantitative clinical practice data supporting broader US health care worker data that 1 in 5 physicians intended to leave their clinical practice altogether when surveyed in 2020.5Sinsky C.A. Brown R.L. Stillman M.J. et al.COVID-related stress and work intentions in a sample of US health care workers.Mayo Clin Proc Innov Qual Outcomes. 2021; 5: 1165-1173Abstract Full Text Full Text PDF PubMed Google Scholar Second, a modest increase in attrition was noted within the female emergency physician workforce during the COVID-19 pandemic (8.6%) compared with male colleagues (8.0%); this may be a manifestation of increased rates of burnout and nonclinical responsibilities among female physicians, particularly during the COVID-19 pandemic.6Harry E.M. Carlasare L.E. Sinsky C.A. et al.Childcare stress, burnout, and intent to reduce hours or leave the job during the COVID-19 pandemic among US health care workers.JAMA Netw Open. 2022; 5e2221776Crossref Scopus (13) Google Scholar Third, emergency physicians stratified based on rurality and board certification status exhibited differences in attrition rates pre–COVID-19 and during COVID-19 pandemic. It is possible that stressors, such as the disproportionate economic impact of COVID-19 on rural hospital finances, caused reduced emergency department staffing, leading to attrition. Separately, the protective effect of emergency medicine board certification status on attrition may be explained by board-certified emergency physicians being more likely to be employed within larger, more financially stable health care systems in urban environments. Limitations include a focus on only emergency physicians caring for Medicare beneficiaries, attribution of all 2020 attrition to the COVID-19 time period, and a lack of differentiation between permanent and temporary attrition. In conclusion, the sudden increase in emergency medicine workforce attrition during COVID-19 warrants re-evaluation of the recently projected workforce surpluses and risks increasing disparities in access to emergency physician care.

Digital innovations for sustainable and resilient agricultural systems

Abstract Digitalisation is rapidly transforming the agri-food sector. This paper investigates emerging opportunities, challenges and policy options. We show that digital innovations can contribute to more sustainable and resilient agricultural systems. For example, digital innovations enable increased productivity, reduced environmental footprints and higher resilience of farms. However, these optimistic outcomes of increasing digitalisation of the agricultural sector will not emerge on their own, but this development comes with several challenges, costs and risks, e.g. in economic, social and ethical dimensions. We provide policy recommendations to explore opportunities and avoid risks. Moreover, we discuss implications for future research in agricultural economics.

Association between food insecurity and frailty among older adults with gastrointestinal malignancies: The CARE Registry.

12046 Background: Food insecurity is associated with higher gastrointestinal (GI) cancer mortality, but its association with frailty, a known predictor of premature mortality among older adults with cancer, is less understood. Our objective was to evaluate the association between food insecurity and frailty among older adults with GI malignancies. Methods: In this cross-sectional analysis, we included 424 older adults ≥60y recently diagnosed with GI cancer undergoing self-reported geriatric assessment (GA) at their first pre-chemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food insecurity was the exposure of interest, defined using the 2019 United States Department of Agriculture Economic Research Service (USDA ERS) Low-Income, Low-Access (LILA) measure, which classifies census tracts based on income and/or access to food stores at various distances by urban-rural status. The primary outcome was frailty measured via the CARE Frailty Index, a composite measure based on the proportion of deficits across several GA measures (44 items in total). Frailty was dichotomized as frail or robust/pre-frail. We examined the association between LILA and frailty with modified Poisson regression accounting for census tract clustering. Results: Median age at study participation was 69 (IQR: 64, 76), 56.6% were male, 27.2% were non-Hispanic black, 31.4% had colorectal, 28.1% had pancreatic cancer, and 71.7% presented with stage III/IV disease. LILA versus non-LILA had a higher proportion of participants who were non-Hispanic Black (52.1% vs. 11.0%, p: &lt; 0.001) and lower educated (high school or less: 50.6% vs. 35.0%, p: 0.020). After adjustment for age, race, sex, cancer type and stage, LILA was associated with 37% higher risk of frailty (RR: 1.37, 95% CI: 1.05, 1.80) versus non-LILA. Analysis of LILA sub-categories revealed that the overall effect may be driven by low income + low access at 1 mile for urban/10 miles for rural areas (RR: 1.47, 95% CI: 1.12, 1.94) and low income + low access at 0.5 mile for urban/10 miles for rural areas (RR: 1.39, 95% CI: 1.05, 1.85). Low income + low access at 1 mile for urban/20 miles for rural areas, low income + low access with a vehicle or at 20 miles, low income only, or low access only did not demonstrate a significant difference. Conclusions: Low income and low access to food stores is associated with higher risk of frailty among newly diagnosed older adults with GI cancers prior to systemic treatment. Intervening on food insecurity at the local level, particularly in areas with low income and low access, may be a target for improving rates of frailty among older adults with GI cancers. Future studies are needed to determine causality.

Assessing and Monitoring Nutrition Security to Promote Healthy Dietary Intake and Outcomes in the United States.

The US Department of Agriculture's Economic Research Service leads the federal government in data development and research on food security in US households. Nutrition security is an emerging concept that, although closely related, is distinct from food security. No standard conceptualization or measure of nutrition security currently exists. We review the existing research on nutrition security and how it is informed by the more robust literature on food security and diet quality. Based on this review, we propose a conceptual framework for understanding nutrition security and its relationship to food security. We identify two constructs (healthy diets and nutritional status) and multiple subconstructs that form the basis of nutrition security. The proposed framework and corresponding constructs are intended to provide (a) understanding of how nutrition security arises and how it differs from food security, (b) background on why assessment and monitoring of nutrition security is important, and (c) guidance for a research agenda that will further clarify the meaning of nutrition security and its measurement.

Full‐cost accounting and redefining the cost of food: Implications for agricultural economics research

AbstractFood systems have significant externalities that are not reflected in market prices. A first step to correct parts of these externalities is to make them transparent through “true‐” or full‐cost accounting. Estimates of the external health and environmental costs of food systems at a global level suggest that they may be about two times larger than food valued at market prices, that is, about 20 trillion US$ of externalities versus 9 trillion US$ of food value in the markets. The agricultural economics profession is challenged to move the true cost research agenda forward by identifying realistic pathways for internalizing some of the large food system externalities. Moving from true cost accounting (TCA) to policy action needs to involve citizens and policy‐making bodies because internalizing externalities requires buy‐in. This relates for instance, to policy instruments such as product labeling, nudging, and differential taxes and subsidies to incentivize healthy diets and disincentivize food waste. Agricultural economics will need to accompany the implementation of any true cost approaches with scrutiny in terms of the efficiency, welfare, ecological, and distributional effects of such policies.

Disparities in Time to Diagnosis (TTD) Among Patients with Multiple Myeloma

Introduction: Multiple myeloma (MM) is one of the most diagnosed hematologic malignancies in the United States. Despite improvements in therapy, health disparities persist with regard to income, race and ethnicity, and gender (Fiala et. al. Cancer 2017; Waxman et. al. Blood 2010; Boyd et. al. Cancer Epidemiol Biomarkers Prev 2011). One potential reason for these disparities is a delay in diagnosis. The time to diagnosis (TTD), measured by the time interval between clinical suspicion and pathologic confirmation, is prolonged for vulnerable patient populations with solid malignancies, and is thought to contribute to worse survival. Less is known about whether such diagnostic delays exist among patients within hematologic malignancies. Here, we aim to determine whether there are disparities in TTD among patients with MM by income, race or ethnicity, or gender. Methods: We extracted data on patients with a bone marrow biopsy (BMB) confirmed diagnosis of MM between May 2003 - May 2022 from the University of Washington's electronic medical record (EMR). The primary outcome measure was whether the BMB was performed within 14 days after the initial detection of a monoclonal protein in the serum or urine. Predictor variables include race, ethnicity, gender, and insurance as identified in the EMR, as well as estimated median household income using patient zip code and data from the U.S. Department of Agriculture Economic Research Service. Performance status was not uniformly collected in the EMR, thus the Charlson Comorbidity Index (CCI) was utilized as a proxy for health status and calculated by extracting comorbidities from the EMR. Except for age and income, which were measured as continuous variables, the predictor variables were dichotomized. We assessed whether the predictor variables were associated with the primary outcome measure. We utilized bivariate analyses to identify measures with p < 0.20 for inclusion in a multivariate logistic regression model. Results: Of the 171 patients eligible for this analysis, the median age was 64.6 years (35.6 - 101.0); 69 (40.4%) identified as female and 43 (25.2%) identified as a racial or ethnic minority. The vast majority (159; 93.0%) spoke English as their primary language and resided in a metropolitan region (155; 90.6%). Most patients were married (109; 67.3%) and insured either via commercial insurance (83; 50.0%), Medicare (54; 32.5%), or Medicaid (15; 9.0%). The median CCI was 5 (2-11). The median annual household income was $93,589 ($46,678 - $102,624) (Table 1). Of the predictor variables, age, gender, residence, and CCI were associated with the primary outcome measure in the bivariate analysis and were included in the multivariate model. In the multivariate analysis, only age and gender were associated with TTD. Elderly patients (OR 0.95 [C.I. 0.91-0.99]) and female patients (OR 0.45 [C.I. 0.23-0.89]) were less likely to receive a BMB within 14 days of detecting the initial monoclonal protein in the urine or serum (Table 2). Conclusions: Although there were no differences in time to biopsy by race or ethnicity, our study did identify disparities by gender and age. Advancing age and female gender were associated with a decreased odds of receiving a BMB within 14 days of the preceding lab abnormality. While we are unable to confirm the reason for the delay, systematic reviews assessing delayed TTD in solid malignancies have found that patient factors such as fear, provider factors such as miscommunication, and systemic factors such as lack of coordination of patient records all may contribute to diagnostic delay (Reece et. al. BMC Cancer 2021). Additionally, patient-physician gender discordance has been associated with reduced rate of cancer screenings (Malhotra et. al. Cancer Epidemiol Biomarkers Prev 2017) and may also be relevant to disparities in TTD among patients with hematologic malignancies. Although neither age nor gender specific delays in TTD have been systematically assessed, patient, provider, and systemic factors likely all contribute. This is the first study to our knowledge examining disparities in TTD among patients with MM. Further studies need to be conducted to elucidate reasons for delays and the potential impact on more distal outcomes such as survival. Additional work to characterize disparities among patients with MM is necessary to develop effective and equitable interventions to reduce those correctable discrepancies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research.

Food insecurity, the insufficient or uncertain access to enough food, affected 14.8% of US households with children in 2020 and is associated with adverse physical, mental, and behavioral health across the lifecourse. 1 Coleman-Jensen A Rabbit MP Gregory CA et al. Household Food Insecurity in the United States in 2020, ERR-298. U.S. Department of Agriculture Economic Research Service, 2021 Google Scholar National healthcare organizations have recommended that clinicians screen patients for food insecurity and other social risk factors (Figure). In our study, “Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic,” we evaluated a natural experiment that occurred at one clinic that converted from clinicians verbally asking a 2-item food insecurity questionnaire to parents/caregivers responding on a written form. 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar We found that changing from a verbal to written screen resulted in an immediate and significant increase in the proportion of families who reported food insecurity (10.4% vs 16.3%). 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar In this progress report, we consider our results in light of the published literature since we submitted our manuscript in May 2019 and discuss the increased focus on social inequities, growing investment in integrating social care, areas for future research, and potential challenges with social risk screening.

Credibility crisis in agricultural economics

AbstractWe provide empirical evidence of research practices that can undermine the credibility of empirical research in agricultural economics. We find that, in four popular journals, most studies are underpowered, a characteristic that, when coupled with publication bias, yields unreliable and exaggerated effect sizes. This problem is exacerbated by selective reporting of statistically significant results and multiple hypothesis testing without any adjustments to statistical inferences. Survey respondents self‐report engaging in practices that are consistent with these empirical findings. Addressing these problems in agricultural economics will require that editors, reviewers, and donors change the norms and incentives for authors.

Exploring the Growth of Agricultural Productivity in AFRICA: A Färe-Primont Index Approach

The effort to increase agricultural productivity continues to receive interest in Africa as low productivity levels, poverty and food insecurity remain or even increase. This study used the Färe-Primont Index to estimate agricultural total factor productivity growth for 49 African countries. Panel data consisting of 833 observations for the period 2000 to 2016 were obtained from the United State Department of Agriculture Economic Research Service database. The results show that the average growth rate for agriculture in Africa is 0.73% per annum. The sector experienced increased growth after the Maputo Declaration, which was sustained during the global financial crisis. West Africa experienced the largest growth while Southern Africa suffered a substantial decline. The study also discovered that growth differed between countries indicating that customization of the Comprehensive Africa Agriculture Development Programme into regional and country-specific policy interventions is important to boost agricultural productivity. Finally, the growth was achieved through technical change, while efficiency change constrained growth. Policy-makers should increase investment in agricultural extension services, education and training to enhance managerial capacity (efficiency change) because improved managerial capacity could increase agricultural growth and thereby increase food security and alleviate poverty in Africa.