Zip Code Of Residence Research Articles

Geographical Mapping of COVID-19 Testing Rates in St. Louis: Influence of the Socioeconomic Index and Race on Testing in the Early Phase and Peak of the COVID-19 Pandemic

Purpose: This study aimed to explore how race and the socioeconomic index (SES) of residential zip codes influenced COVID-19 testing rates in St. Louis during the early and peak phases of the pandemic. Method: An ecological study was conducted using COVID-19 testing data from March to November 2020 in St. Louis City, including 16,915 tests from 30 residential zip codes. Geographical mapping identified areas lacking testing, descriptive statistics characterized testing rates by race and SES, and robust linear regression modeled the association between testing rates and race, controlling for SES. Results: The overall testing rate was 303.97 per 10,000 population. Testing rates among Blacks, Whites, American Indians/Alaskan Natives, and Asians were 374.26, 247.77, 360.63, and 242.41 per 10,000, respectively. Higher rates were observed in low- and middle-SES zip codes compared with high-SES areas. Adjusted for SES, testing rates per 10,000 were higher by 125 (1.25%), 448 (4.48%), and 32 (0.32%) among Blacks, American Indians/Alaskan Natives, and Asians compared with Whites. Testing rates decreased by 56 (0.56%) per unit SES improvement. There was statistically significant SES finding and that of the difference between American Indians/Alaskan Natives and Whites. Geographical mapping showed higher rates in the inner core and lower rates in the periphery of St. Louis. Conclusions: Race and SES influence testing rates. Targeted interventions are needed in areas with low testing rates in St. Louis.

Greenness moderates the relationship between self-rated social standing and depression among older adults in the Canadian longitudinal study on aging

IntroductionGreenness is considered to be a health-promoting feature of both natural and built environments and has the potential to influence mental health outcomes. However, most studies to date have neglected to address whether greenness differentially affects mental health outcomes for individuals across the socioeconomic spectrum. Our study explored if greenness is a moderating factor in the relationship between socioeconomic status (SES) and mental health using data from the Canadian Longitudinal Study on Aging (CLSA).MethodsA cross-sectional design was used to compare mental health outcomes between individuals with different levels of SES and residential greenness. We used self-rated social standing as a measure of SES and depression score measured using the Centre for Epidemiologic Studies 10-Item Depression Scale (CESD-10) as a measure of mental health. Greenness was measured using the annual maximum Normalized Difference Vegetation Index (NDVI) within a 1,000 m buffer area of participants' residential postal code locations.ResultsThere was a statistically significant moderating effect of greenness for the relationship between self-rated social standing and depression score. As greenness increased, individuals with lower self-rated social standing had the greatest decreases in depression score.DiscussionThe results of our study suggests that targeting greening interventions at individuals and communities with low SES may reduce depressive symptoms overall, as well as decrease socioeconomic inequalities in depression.

Urban Trail Exposure in Winnipeg, Canada: Longitudinal Cohort Development for a 20-Year Difference-in-Differences Analysis of a Natural Experiment with Varied Duration of Exposure Times

ObjectiveDevelop a cohort to evaluate a real-world experiment of the built environment on the incidence of disease, accounting for movement of people, postal codes, incidence of disease and changing demographics. ApproachThe City of Winnipeg, Canada built multi-use trails in 2010-2012. We used the administrative data housed at the Manitoba Centre for Health Policy to evaluate the effect of this change in the built environment on the incidence of cardiovascular disease events (CVDE) and risk factors (CVDRF) before (2000-2009) and after (2012-2019) the trails were built. The Manitoba Health Insurance Registry contains postal code and demographic information on nearly all city residents and was utilized for cohort creation and person-time exposure. Individuals’ residential postal codes were linked to geo-spatial data to determine proximity to built trails at 400m, 800m and 1200m. Semi-annual postal code changes accounted for movement within/outside city limits or exclusion from the cohort. Diagnoses from hospital abstract and physician visit data and outpatient prescription dispensations were used to access prevalence and incidence of a CVDE composite measure of congestive heart failure, ischemic heart disease and stroke and a CVDRF composite measure of diabetes, dyslipidemia and hypertension. Conclusions and ImplicationsLeveraging a diverse set of administrative databases, we built a cohort evaluate the effect of building multi-use trails in Winnipeg on the reduction on CVDE and CVDRF. This demonstrates how administrative data can be used to evaluate natural, real-world experiments with minimal direct data measurement or public intrusion, resulting in actionable results to inform public policy.

Socioenvironmental Factors are Associated With Dopamine Transporter Availability in Healthy Individuals but not in Parkinson's Disease.

Social factors can influence the brain's dopaminergic function. This study investigated the relationship between socioenvironmental factors and dopamine transporter (DaT) availability in healthy individuals (n = 74) and those with Parkinson's disease (PD) (n = 240). All single photon emission computed tomography (SPECT) DaT data and clinical data used in this study were obtained from the Parkinson's Progression Markers Initiative (PPMI) dataset. Socioenvironmental data was obtained from Social Explorer analyses of the American Community Survey (2014-2018) using the residential ZIP codes of the subjects available in the PPMI dataset. Participants resided in 302 ZIP code tabulation areas across 38 U.S. states. In healthy individuals, DaT signals were significant and negatively correlated in the caudate with median household income (r = -0.27, P = 0.02) and educational level of the living area (r = -0.23, P = 0.04), but not significant in the putamen (r = -0.21, P = 0.08; r = -0.11, P = 0.37 respectively). Also, there was a significant positive correlation between DaT signals in caudate and poverty rates (r = 0.29, P = 0.01), but not in the putamen (r = 0.16, P = 0.19) in healthy subjects. No significant associations were observed in the PD group for any variables. The study findings suggest that socioenvironmental factors, such as median household income, education level, and poverty rate, are significantly associated with DaT availability in the caudate of healthy individuals but not in those with PD. This indicates that PD might disrupt the connection between the social environment and dopaminergic function. These results underscore the importance of considering socioenvironmental variables when studying dopaminergic function in the human brain.

Social determinants of health and somatic growth in preterm infants and children with chronic lung disease.

Bronchopulmonary dysplasia (BPD), a common complication of prematurity, is associated with impaired lung function and increased morbidity in childhood. These children display heterogeneous somatic growth patterns which may ultimately impact their risk for later respiratory disease. We aim to understand the relationship between socioenvironmental exposures and growth in this population. A retrospective longitudinal cohort study was conducted using participants (n = 616) enrolled in the Johns Hopkins Outpatient BPD Registry. Growth measurements between 0 and 36 months of age were obtained. Somatic growth measurements, both corrected and uncorrected for gestational age, were converted to z-scores using Center for Disease Control and Prevention normative data. Using a participant's residential zip code, we utilized the 2019 Area Deprivation Index (ADI), the Childhood Opportunity Index (COI) 2.0, and neighborhood food insecurity data from the Maryland Food Bank. Linear regression analysis was performed employing individual socioenvironmental measures as independent variables and growth z-scores as dependent variables in univariate analysis. Univariate analysis was repeated adjusting for gestational age, BPD severity, and the presence of a gastrostomy tube (GT). Of the three measures analyzed, national COI (nCOI) showed a significant association with mean weight z-scores, mean ADI showed some association with mean weight z-scores, and the percentage of a community experiencing food insecurity showed no association with mean weight z-scores. After adjusting for gestational age, BPD severity, and presence of a GT, children living in areas of greater opportunity (higher nCOI values), had significantly lower weight z-scores at 12 months corrected and at 24 and 36 months uncorrected CONCLUSIONS: Our findings suggest that the COI 2.0, a multidimensional measure, captures more facets of an individual's social environment, as compared to the singular nature of a measure of food insecurity. There are several potential explanations for the phenomenon seen, and further understanding of this dynamic is crucial for designing effective interventions and policies to better address inequities in outcomes.

Association of Community-Level Social Vulnerability With Clinical Trial Discussion and Participation Among Cancer Survivors.

Community factors and structural barriers may contribute to disparities and underrepresentation in cancer clinical trials. We evaluate the influence of community-level social determinants of health, as measured by the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), on disparities in cancer clinical trial discussion and participation. We performed a cross-sectional analysis of the 2021 Health Information National Trends Survey-SEER, a representative survey of cancer survivors sampled from three SEER registries. The primary outcomes included patient-reported clinical trial discussion and participation. The primary exposure was county-level SVI, linked to each survey respondent by ZIP code of residence and categorized into quintiles. Survey-weighted bivariate comparisons and multivariable logistic regression were performed to evaluate the association between SVI and clinical trial discussion and participation, adjusting for age, sex, race and ethnicity, education, income, and cancer stage. We identified 1,220 respondents residing in 153 counties with a median SVI of 0.41 (IQR, 0.27-0.62), representing a population of over 400,000 cancer survivors on weighted analysis. Of the cohort, 15.1% reported clinical trial discussion and 7.7% reported clinical trial participation. Patients who are most socially vulnerable (fifth quintile of SVI) had significantly lower odds of clinical trial discussion (odds ratio [OR], 0.36 [95% CI, 0.15 to 0.87]; P = .02) and clinical trial participation (OR, 0.15 [95% CI, 0.03 to 0.75]; P = .02) compared with patients who are least socially vulnerable (first quintile of SVI). These findings suggest interventions to identify socially vulnerable communities for expansion of clinical trial opportunities and infrastructure may be an impactful strategy toward improving diversity and representation in cancer clinical trials.

Feeling Connected to Nature Attenuates the Association between Complicated Grief and Mental Health.

Complicated grief (CG) predicts decreased mental health over time. Furthermore, feeling connected to nature (CN) is positively associated with beneficial mental health outcomes, such as psychological wellbeing and perceived psychological resilience. Thus, we hypothesized that CN moderates the association between general grief or CG and negative mental health for bereaved people. Further, we hypothesized that one's physical exposure to nature-that is, estimated time spent in nature and greenness (i.e., vegetation) surrounding one's residential area-might moderate the association between general grief or CG and negative mental health for bereaved people. To test these hypotheses, we conducted a cross-sectional study. We sampled 153 participants who experienced the death of a close other by COVID-19 infection. Participants reported CG, general grief, anxiety symptoms, depression symptoms, CN, estimated time spent in nature, and residential area postal code via a single online survey. We estimated greenness surrounding participants' residential areas using their self-reported five-digit U.S. postal code. Cross-sectional analyses indicated that, as predicted, CN attenuated the association between CG and depression, trended toward moderating the association between CG and anxiety, and did not moderate the associations between general grief and depression or anxiety. Other variables related to the experience of nature-the estimated time an individual spends in nature and the greenness surrounding one's residential area-did not moderate the association between general grief or CG and depression or anxiety. We thus conclude that a sense of feeling connected to nature-not simply spending more time in nature or being surrounded by nature-may serve an important role in the mental health status of people experiencing complicated grief, perhaps because CN replenishes general belonging when someone significant has passed away.

Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States.

In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. DERR1-10.2196/59846.

Association between Heat Vulnerability Index and Stroke Severity.

Socioeconomically disadvantaged neighborhoods are particularly vulnerable to heat-related illnesses. We aim to investigate the association between the heat vulnerability index (HVI), an established neighborhood-level metric of heat-related mortality risk, and acute ischemic stroke (AIS) severity. We conducted a retrospective analysis of consecutive AIS admissions to a comprehensive stroke center between 2012 and 2021. Stroke severity was defined upon admission based on the National Institutes of Health Stroke Scale (NIHSS). Demographic, socioeconomic, and clinical characteristics were extracted from electronic health records. HVI status was assigned using residential ZIP codes. Multivariable logistic regression analyses were performed. Of 3429 AIS admissions, 1123 (32.8%) were from high-HVI (scores 4-5) neighborhoods and 868 (25.3%) had severe stroke (NIHSS score ≥ 10). In the multivariable regression model with stepwise selection, a high HVI was independently associated with severe stroke (adjusted odds ratio: 1.40 [95% confidence interval 1.16-1.69]). The association between a high HVI and severe stroke underscores the importance of targeting policy interventions to mitigate heat-related illness in socioeconomically disadvantaged neighborhoods.

Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease: A Retrospective Cohort Analysis From the National COVID Cohort Collaborative.

Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post-COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post-COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort. This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality. Among the 86,467 SARS-CoV-2-infected persons with AIRD, we observed a higher risk for two-year post-COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19-1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post-COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower. Rural residence in people with AIRD was independently associated with higher two-year post-COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.

Ambient air pollution and survival in childhood cancer: A nationwide survival analysis.

Particulate matter consisting of fine particles measuring 2.5 microns or less in diameter (PM2.5), a component of air pollution, has been linked to adverse health outcomes. The objective of this study was to assess the association between ambient PM2.5 exposure and survival in children with cancer in the United States. Individuals aged birth to 19 years who were diagnosed with cancer between January 1, 2004, and December 31, 2019, were selected from the National Cancer Database. The association between the annual PM2.5 level at the patient's zip code of residence at the time of diagnosis and overall survival was evaluated using time-varying Cox proportional hazards models (crude and adjusted for diagnosis year and age). To address concerns that exposure to air pollution is correlated with other social determinants of health, the authors tested the association between PM2.5 levels and survival among sociodemographic subgroups. Of the 172,550 patients included, 27,456 (15.9%) resided in areas with annual PM2.5 concentrations above the US Environmental Protection Agency (EPA) annual PM2.5 standard of 12 μg/m3. Residing in these high-pollution areas was associated with worse overall survival (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 1.012-1.10). Similarly, when PM2.5 was evaluated as a linear measure, each unit increase in PM2.5 exposure was associated with worse survival (aHR, 1.011; CI, 1.005-1.017). Exposure to PM2.5 at levels above the EPA standards was also significantly associated with worse overall survival among sociodemographic subgroups. Exposure to PM2.5 was significantly associated with worse overall survival among children with cancer, even at levels below EPA air quality standards. These results underscore the importance of setting appropriate air quality standards to protect the health of this sensitive population. The authors investigated how living in areas with high air pollution (defined as particulate matter consisting of fine particles measuring 2.5 microns or less in diameter; PM2.5) affects the overall survival of children with cancer in the United States. The results indicated that children living in areas with higher PM2.5 levels, and even at levels below prior and current US Environmental Protection Agency standards, had lower survival rates than children living in areas with lower levels of PM2.5. This finding emphasizes the need for stricter air quality standards to better protect children, particularly those with serious health conditions like childhood cancer.

Social Determinants of Hepatitis C Virus Infection in the United States, 2016-2021.

This cross-sectional study assessed hepatitis C virus (HCV) antibody and RNA test results performed from 2016 to 2021 at a large US clinical reference laboratory. When individual patient factors (ie, income, education, and race/ethnicity) were not available, estimates from the US Census were linked to the residential zip code. The final analytic cohort comprised 19,543,908 individuals with 23,233,827 HCV antibody and RNA test results. An analysis of progressively increasing poverty quintiles demonstrated an increasing trend in both HCV antibody positivity (from 2.6% in the lowest quintile to 6.9% in the highest, P < 0.001 for trend) and HCV RNA positivity (from 1.0% to 3.6%, P < 0.001 for trend). Increasing levels of education were associated with a decreasing trend in both HCV antibody positivity (from 8.4% in the least educated quintile to 3.0% in the most, P < 0.001 for trend) and HCV RNA positivity (from 4.7% to 1.2%, P < 0.001 for trend). Persistent differences in positivity rates by these social determinants were observed over time. HCV antibody and RNA positivity rates were nearly identical in predominantly Black non-Hispanic, Hispanic, and White non-Hispanic zip codes. However, after adjustment for all other factors in the study, residents of predominantly Black non-Hispanic and Hispanic zip codes were significantly less likely to test positive for HCV RNA (adjusted odds ratios [AOR]: 0.51, 95% confidence interval [CI]: 0.51-0.52; AOR: 0.46, 95% CI: 0.46-0.46, respectively). These findings may benefit targeted intervention initiatives by public health agencies.

Ambient Air Pollution Exposure and Adverse Outcomes Among Medicare Beneficiaries With Heart Failure.

Exposure to fine particulate matter (<2.5 um, particulate matter with an aerodynamic diameter <2.5 microns [PM2.5]) has been implicated in atherogenesis. Limited data in animal studies suggest that PM2.5 exposure leads to myocardial fibrosis and increased incidence of heart failure (HF). Whether PM2.5 is associated with adverse outcomes in patients with preexisting HF has not been widely studied. In this retrospective cohort study, Medicare patients hospitalized with first HF between 2013 and 2020 were identified from the Medicare Provider Analysis and Review Part A 100% files. Patients were linked with integrated estimates of ambient PM2.5 obtained at 1×1 km using the zip code of participants' residence. The study outcomes were all-cause death, HF, and all-cause readmissions burden. A total of 2 599 525 patients were included in this study, with 6 321 731 person-years of follow-up. Mean PM2.5 was 7.3±1.7 μg/m3. Each interquartile range of PM2.5 was associated with 0.9% increased hazard of all-cause death, 4.5% increased hazard of first HF readmission, 3.1% increased risk of HF hospitalization burden, and 5.2% increase in all-cause readmission burden, after adjusting for 11 sociodemographic and medical factors. Subgroup analyses showed that the effects were more pronounced at levels <7 μg/m3 and in patients aged <75 years, Asians, and those residing in rural areas. Ambient air pollution is associated with higher risk of adverse events in Medicare beneficiaries with established HF. These associations persist below the National Air Quality Standards (12 μg/m3), supporting that no threshold effect exists for health effects of air pollution exposure.

Pre-injury methamphetamine use is associated with increased length of hospital stay in rural orthopaedic trauma patients

ObjectivesThe primary focus of this study is to determine if rural methamphetamine positive patients experience longer hospital length of stays compared to urban methamphetamine positive patients following an orthopaedic trauma. MethodsPatients presenting with traumatic orthopaedic injuries and urine drug screen were categorized into urban, suburban, and rural cohorts found in the Rural Urban Commuting Area codes based on home residence zip codes. Demographic, injury, hospital stay, and follow-up data were collected from the medical records. Comparisons between cohorts were determined by Chi square, Fisher exact, unpaired t-Tests, or ranked sum tests. DesignA retrospective cohort analysis. SettingAcademic Level I Trauma Center. Patient selection criteriaPatient records were examined between January 2013 to January 2023 for a traumatic orthopaedic injury and a urine drug screen result at the time of presentation to an academic Level I trauma center. Outcome measures and comparisonsMethamphetamine use status, patient age at time of admission, sex, marital status, insurance status, home zip code, orthopaedic injury location, complications, if the patient underwent surgery for orthopaedic injuries, admission date, discharge date, and discharge location were measured. Results249 patients met inclusion criteria for this analysis. Methamphetamine positive patients are significantly more likely to be younger, more likely to have surgery for orthopaedic injuries, experience a medical complication, or be discharged to home or a rehabilitation facility compared to methamphetamine negative patients. Urban patients experienced a shorter length of stay compared to suburban and rural patients, regardless of methamphetamine use status. Patients with Medicare, military, workers compensation, or commercial insurance are significantly more likely to attend follow-up appointments than patients with Medicaid or self-pay. ConclusionsMethamphetamine positive patients overall do not experience a longer length of hospital stay compared to methamphetamine negative patients. Rural methamphetamine positive patients experience a longer length of hospital stay compared to urban methamphetamine positive patients.

Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders

Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

Socioeconomic area deprivation index is not associated with postoperative complications following revision total hip and knee joint arthroplasty

IntroductionRevision hip and knee total joint arthroplasty (TJA) carries a high burden of postoperative complications, including surgical site infections (SSI), venous thromboembolism (VTE), reoperation, and readmission, which negatively affect postoperative outcomes and patient satisfaction. Socioeconomic area-level composite indices such as the area deprivation index (ADI) are increasingly important measures of social determinants of health (SDoH). This study aims to determine the potential association between ADI and SSI, VTE, reoperation, and readmission occurrence 90 days following revision TJA. Methods1047 consecutive revision TJA patients were retrospectively reviewed. Complications, including SSI, VTE, reoperation, and readmission, were combined into one dependent variable. ADI rankings were extracted using residential zip codes and categorized into quartiles. Univariate and multivariate logistic regressions were performed to analyze the association of ADI as an independent factor for complication following revision TJA. ResultsDepression (p = 0.034) and high ASA score (p < 0.001) were associated with higher odds of a combined complication postoperatively on univariate logistic regression. ADI was not associated with the occurrence of any of the complications recorded following surgery (p = 0.092). ASA remained an independent risk factor for developing postoperative complications on multivariate analysis. ConclusionAn ASA score of 3 or higher was significantly associated with higher odds of developing postoperative complications. Our findings suggest that ADI alone may not be a sufficient tool for predicting postoperative outcomes following revision TJA, and other area-level indices should be further investigated as potential markers of social determinants of health.

Fine Particulate Matter Components and Risk of Rheumatoid Arthritis: A Large General Canadian Open Cohort Study.

Exposure to fine particulate matter (PM2.5) has been linked to many diseases. However, it remains unclear which PM2.5 chemical components for these diseases, including rheumatoid arthritis (RA), are more harmful. This study aimed to assess potential associations between PM2.5 components and RA and quantify the individual effects of each chemical component on RA risk. An open cohort of 11,696,930 Canadian adults was assembled using Ontario administrative health data from January 2007 onward. Individuals were followed until RA onset, death, emigration from Ontario, or the end of the study (December 2019). Incident RA cases were defined by physician billing and hospitalization discharge diagnostic codes. The average levels of PM2.5 components (ammonium, black carbon, mineral dust, nitrate, organic matter, sea salt, and sulfate) for 5 years before cohort entry were assigned to participants based on residential postal codes. A quantile g-computation and Cox proportional hazard models for time to RA onset were developed for the mixture of PM2.5 components and environmental overall PM2.5, respectively. We identified 67,676 new RA cases across 130,934,256 person-years. The adjusted hazard ratios for the time to RA onset were 1.027 and 1.023 (95% confidence intervals 1.021-1.033 and 1.017-1.029) per every decile increase in exposures to all seven components and per 1 μg/m3 increase in the overall PM2.5, respectively. Ammonium contributed the most to RA onset in the seven components. Exposure to PM2.5 components was modestly associated with RA risk. Public health efforts focusing on specific components (eg, ammonium) may be a more efficient way to reduce RA burden.

Public Health Surveillance in Electronic Health Records: Lessons From PCORnet.

PCORnet, the National Patient-Centered Clinical Research Network, is a large research network of health systems that map clinical data to a standardized data model. In 2018, we expanded existing infrastructure to facilitate use for public health surveillance. We describe benefits and challenges of using PCORnet for surveillance and describe case studies. In 2018, infrastructure enhancements included addition of a table to store patients' residential zip codes and expansion of a modular program to generate population health statistics across conditions. Chronic disease surveillance case studies conducted in 2019 assessed atrial fibrillation (AF) and cirrhosis. In April 2020, PCORnet established an infrastructure to support COVID-19 surveillance with institutions frequently updating their electronic health record data. By August 2023, 53 PCORnet sites (84%) had a 5-digit zip code available on at least 95% of their patient populations. Among 148,223 newly diagnosed AF patients eligible for oral anticoagulant (OAC) therapy, 43.3% were on any OAC (17.8% warfarin, 28.5% any novel oral anticoagulant) within a year of the AF diagnosis. Among 60,268 patients with cirrhosis (2015-2019), common documented etiologies included unknown (48%), hepatitis C infection (23%), and alcohol use (22%). During October 2022 through December 2023, across 34 institutions, the proportion of COVID-19 patients who were cared for in the inpatient setting was 9.1% among 887,051 adults aged 20 years or older and 6.0% among 139,148 children younger than 20 years. PCORnet provides important data that may augment traditional public health surveillance programs across diverse conditions. PCORnet affords longitudinal population health assessments among large catchments of the population with clinical, treatment, and geographic information, with capabilities to deliver rapid information needed during public health emergencies.

P-758 Perinatal deaths to women dispensed clomiphene citrate: A study within a whole of population birth cohort

Abstract Study question Is the risk of stillbirth and neonatal death increased in pregnancies where clomiphene citrate was dispensed 3 months before or after time of conception? Summary answer The risk of stillbirth and/or neonatal death is 45% higher in pregnancies among women dispensed clomiphene citrate compared to unexposed women independent of confounders. What is known already Clomiphene citrate (CC) has been used for ovulation induction since 1967, despite prior evidence of fetotoxicity in humans and animals. CC has since been linked to fetal growth restriction, preterm birth, &amp; congenital anomalies, which are independent risk factors for perinatal death. However, few studies have been large enough to provide data on infrequent adverse events. In high-income countries, maternal obesity is the greatest risk factor for perinatal death followed by advanced maternal age. These factors also contribute to infertility, but can be measured reliably and incorporated into safety studies to estimate patient and treatment effects. Study design, size, duration This is a whole of population cohort study involving 147,524 pregnant women and 242,079 births occurring from July 2003 to December 2015 in South Australia, assembled by linking records from the state-wide perinatal registry with Commonwealth government data on pharmaceutical dispensing. All post-20 week pregnancies have mandatory reporting. Clomiphene citrate dispensing by pharmacists resides in a single national database. Participants/materials, setting, methods Using de-identified pregnancy outcome data in South Australia, the prevalence of stillbirth (&amp;gt;20 weeks gestation) and neonatal death were examined in relation to clomiphene citrate exposure. Women were considered exposed if a prescription for clomiphene citrate was dispensed from three months before the conception window to end of first trimester. Dates for the conception window were derived from gestational age at birth (weeks), in turn based on date of last menstrual period and ultrasound scan. Main results and the role of chance There were 3,458 singleton pregnancies where women were exposed to clomiphene citrate, with 41 stillbirths and neonatal deaths recorded, a prevalence of 11.9 per 1000. For non-exposed pregnancies, the corresponding prevalence was 8.2 per 1000. In singleton pregnancies among women dispensed clomiphene citrate, compared to those without this exposure, stillbirth and neonatal death were increased by 45% (odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.06 – 1.98). This association was strengthened after adjustment for maternal characteristics that were potential confounders: age, socio-economic status (based on postcode of residence), Aboriginal ethnicity, born outside Australia in low or middle income country, parity, smoking, pre-existing diabetes or hypertension, pregnancy-induced hypertension and pre-eclampsia (OR = 1.59, 95% CI 1.16 – 2.18). Obesity data was available from 2007 onwards and a restricted analysis including this variable saw an increased effect (OR = 1.79, 95% CI 1.19 – 2.72). It is implausible that a further unmeasured patient related factor could reverse this effect. The observed effect is also conservative as there were 200 multiple pregnancies in which women were exposed to clomiphene citrate, which were excluded as the number of deaths in offspring was too infrequent for robust stratified statistical comparisons. Limitations, reasons for caution Data reflect pharmacy dispensing, not consumption, although women are highly motivated to take this drug and over 5% of pregnancies were multiples, consistent with extensive use. Subfertility itself increases the risk of perinatal death and further analyses are underway to distinguish effects of the drug from indication for use. Wider implications of the findings Clomiphene citrate may not be as safe as presumed. This may partly be a consequence of variability in clinical prescribing and supervision, or the known variability in patient response to the drug. Our result is conservative as we excluded twins. It is supported by animal data and basic pharmacology. Trial registration number Not applicable

Long-term air pollution exposure and the risk of primary graft dysfunction after lung transplantation

Background: Primary graft dysfunction (PGD) contributes substantially to both short and long-term mortality after lung transplantation but the mechanisms that lead to PGD are not well understood. Exposure to ambient air pollutants is associated with adverse events during waitlisting for lung transplantation, and chronic lung allograft dysfunction but its association with PGD has not been studied. We hypothesized that long-term exposure of the lung donor and recipient to high levels of ambient air pollutants would increase the risk of PGD in lung transplant recipients. Methods: Using data from 1428 lung transplant recipients and their donors enrolled in the Lung Transplant Outcomes Group (LTOG) observational cohort study, we evaluated the association between the development of PGD and zip-code based estimates of long-term exposure to six major air pollutants (ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, PM2.5 and PM10) in both the lung donor and the lung recipient. Exposure estimates used daily EPA air pollutant monitoring data and were based on the geographic centroid of the each subject’s residential zip code. Associations were tested in both univariable and multivariable models controlling for known PGD risk factors. Results: We did not find strong associations between air pollutant exposures in either the donor or the recipient and PGD. Conclusions: Exposure to ambient air pollutants, at the levels observed in this study, may not be sufficiently harmful to prime the donor lung or the recipient to develop PGD particularly when considering the robust associations with other established PGD risk factors.