Zip Code Of Residence Research Articles

Association between distance traveled and abortion consideration and completion among people with fetal myelomeningocele.

Due to the small number of centers performing maternal-fetal surgery for fetal myelomeningocele, many people are required to travel significant distances for perioperative counseling at an experienced center. As part of the decision-making process for the management of myelomeningocele, some pregnant individuals are interested in, and may ultimately proceed with, termination of pregnancy. Additional travel for abortion care may compound psychological and financial burdens for pregnant individuals, given the existing barriers to accessing abortion care across the United States. The objective of this study was to evaluate the association between the distance traveled to a fetal care center and the consideration and completion of abortion among patients with fetal myelomeningocele. We performed a retrospective cohort analysis of all singleton myelomeningocele consultations at a single fetal care center in Illinois from 2018-2024. The exposure was the distance traveled to the fetal care center defined as miles from the patient's zip code of residence to the fetal care center. Distance was analyzed in two ways: categorically (dichotomized based on median value) and continuously. The primary outcomes were abortion consideration, ascertained by a nurse during fetal care center intake, and abortion completion. Bivariate and multivariate log-binomial regression analyses were performed. A subgroup analysis was performed by participant state of residence. Statistical significance was considered p < 0.05. There were 133 participants available for the abortion consideration analysis and 157 participants for the abortion completion analysis. Median distance traveled was 39 miles (IQR 15-116 miles). People traveling below the median distance were more likely to identify as Latinx, reside within Illinois, and present at an earlier gestational age when compared with those traveling above the median distance. Distance traveled was independently associated with abortion consideration, after controlling for gestational age at the time of presentation to the fetal care center (aRR 0.44, 95% CI 0.27-0.72). When treating the distance traveled as a continuous outcome, for every mile traveled the risk of considering abortion decreased by 1% (aRR 0.99, 95% CI 0.98-0.99). On subgroup analysis, this finding was persistent only among individuals living in Illinois. There was no significant relationship between the distance traveled to the fetal care center and abortion completion. Increased distance traveled is associated with a lower risk of abortion consideration among individuals presenting to a fetal care center for fetal myelomeningocele consultation. These data emphasize the nuanced relationship between fetal diagnosis and abortion and the importance of providing comprehensive reproductive counseling to patients seeking consultation at a fetal care center.

P-1632. Living in an area with high burden outpatient antibiotic prescriptions, a risk factor for infection by ESBL producing Enterobacterales?

Abstract Background The increase in antibiotic resistance has been linked to antibiotic exposure. However, initiatives of antibiotic stewardship programs have been associated with decrease in antibiotic utilization but without a clear decrease in antibiotic resistance. We hypothesized that patients hospitalized with infections with ESBL producing Enterobacterales (ESBL-PE) live in areas with high outpatient antibiotic exposure. Outpatient antibiotic prescriptions per zip code Antibiotics prescribed in the outpatient setting per zip code of residence of the recipient of the prescription. Methods From March 2022 to March 2023 we evaluated antibiotic utilization in the outpatient setting of a healthcare system in central Georgia. Outpatient settings included urgent cares, emergency rooms, and primary care clinics. We estimated the antibiotic “burden” per zip code based on the residence of each patient receiving a prescription from these outpatient facilities. During the same time period, we obtained all cultures processed in the hospital’s laboratory that isolated an ESBL-PE, and the zip code of residence from each patient’s sample. Number of antibiotics per zip code was the independent variable and number of residents per zip code hospitalized with an ESBL-PE infection was the dependent variable. QGIS v3.8 was used for spatial analysis and SPSS 25 for statistical analysis. Number of cases of an ESBL-PE infection per zip code of patient residence Results There were 61 070 outpatient prescriptions, representing 500 092 days of therapy. Prescriptions were given to residents of over 1000 different zip codes of nearly 20 states. 70% (42719) of these prescriptions were for residents of the state of Georgia, distributed among 634 zip codes. The zip code with the largest antibiotic burden received 4706 prescriptions in a one-year period, representing 161 antibiotic prescriptions per 1000 population. 396 Georgia residents had a culture with an ESBL-PE, and 308 (77.7%) of them were hospitalized for infections due to ESBL-PE. Linear regression model had an R2 of 0.79 with a p-value of &amp;lt; 0.01. Conclusion The geographic reach of antibiotic prescriptions by outpatient facilities is of concern. The antibiotic burden in surrounding communities is higher than areas further away. Living in an area with high outpatient antibiotic prescription burden explained almost 80% of the variance for hospitalization with an infection due to ESBL-PE. Efforts to decrease antibiotic resistance should also include interventions in outpatient facilities. Disclosures All Authors: No reported disclosures

Association of Community Characteristics as Measured by Social Deprivation Index Score with Prenatal Care and Obstetrical Outcomes.

We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. All spontaneously conceived singleton deliveries of nulliparous gravida with residence zip code available (n = 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis (Q1 [n = 1,342], Q2 + 3 [n = 1,752], and Q4 [n = 1,692]) with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method. Among our cohort, gravida in the lowest (least-deprived) SDI quartile (Q1) were older, had lower prepregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravida residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits (mean [standard deviation] 11.17 [2.9]) than those living in Q1 (12.04 [2.3], p < 0.0001). Gravida in Q4 were less likely to receive sufficient PNC compared with those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile. Outer quartile social deprivation was associated with higher proportions of primigravida not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravida are likely important steps toward health equity. · Neighborhood social deprivation was not associated with composite maternal or neonatal morbidity.. · Community-level deprivation was associated with decreased PNC utilization.. · It is important to understand the underlying disparities that lend to suboptimal patterns of PNC.. · Doing so may inform programs that promote favorable birth outcomes in at-risk communities..

Challenges in Geographic Access to Specialized Pediatric Burn Care in the United States.

Geographical access to pediatric burn centers in the US is not well described. Patients may receive care at American Burn Association (ABA)-verified burn centers, unverified burn centers, or non-burn centers. A recent study indicated that most US counties do not have an ABA-verified pediatric burn center within 100 miles. However, access to unverified burn centers that provide care to pediatric burn patients was not considered. We studied access to all pediatric burn centers across different US regions, using American College of Surgeons (ACS) Committee on Trauma-verified pediatric trauma centers as a benchmark. An observational cohort study was conducted using 2022 US Census data. Individuals aged ≤14 years were included. Geographical location was determined by residence ZIP code. Pediatric burn centers were identified from the ABA directory. Pediatric trauma centers were identified by ACS verification status using the ACS Hospitals and Facilities directory. Population access to pediatric burn and trauma centers within 50, 100, and 300 miles of the home ZIP code was assessed. Of US children, 62.1%, 83.5%, and 98.6% live within 50, 100, and 300 miles of a pediatric burn center. Access to ABA-verified pediatric burn centers is lower compared to access to ACS-verified pediatric trauma centers. Overall, the US population has limited access to pediatric burn centers compared to pediatric trauma centers. The services offered and outcomes should be studied to better understand differences in the quality of care provided by verified and unverified centers.

Patients Residing in Areas of Increased Social Vulnerability Are at an Increased Risk for Prolonged Length of Stay and Mortality After Hip Fracture Surgery

Introduction: Patients undergoing hip fracture surgery face notable risks of postoperative morbidity and mortality, and racial and socioeconomic disparities in outcomes exist. This study examined the effect of social vulnerability on outcomes after hip fracture surgery using the CDC's Social Vulnerability Index (SVI). Methods: A retrospective study of 464 patients undergoing hip fracture surgery at a single institution from July 2020 to June 2023 was conducted. Demographics, comorbidities, time to surgery, length of stay (LOS), and postoperative outcomes were compared between patients with low versus high social vulnerability. SVI was calculated based on patient's zip code of residence. The 50th percentile of national SVI scores was used to divide patients into low and high vulnerability groups. Univariate and multivariable analyses were done to compare patient characteristics and outcomes between the groups. The primary outcome of interest was 1-year postoperative mortality. Results: No notable differences were observed in demographics, comorbidities, or procedure performed between the groups. Patients with increased social vulnerability had a higher rate of mortality within 1 year (low vulnerability: 12.2 vs. high vulnerability: 24.0%, P = 0.005) and a shorter time to mortality (340.7 vs. 138.9 days, P &lt; 0.001). Patients with higher social vulnerability had longer LOS (β = 1.12, 95% CI: 0.35-1.88, P = 0.004), were 2.37 times more likely to experience mortality within 1 year (OR = 2.37, 95% CI: 1.30-4.27, P = 0.004), and 1.75 times more likely to experience mortality at any time (OR = 1.75, 95% CI: 1.01-2.99, P = 0.045). Conclusion: Patients residing in areas of increased social vulnerability were more likely to experience a longer LOS, and more likely to die within 1 year, or at any time after undergoing hip fracture surgery, when compared with those living less socially vulnerable regions. These findings highlight the need for interventions aimed at addressing social factors within hip fracture care pathways to mitigate socioeconomic disparities in patient outcomes.

Early Childhood Vaccination Coverage and Patterns by Rural-Urban Commuting Area.

National surveillance efforts have reported rural-urban disparities in childhood vaccination coverage by metropolitan statistical area designations, measured at the county level. This study's objective was to quantify vaccination trends using more discrete measures of coverage and rurality than prior work. Serial, cross-sectional analyses of National Immunization Survey-Child restricted-use data collected in 2015-2021 for U.S. children born 2014-2018 were conducted. ZIP code of residence was merged with rural-urban commuting area codes. Vaccination coverage and patterns, including on-time receipt of recommended vaccines, were assessed using vaccinations recorded from birth through age 23 months. To determine whether trends differed by rurality, an interaction between birth year and RUCA was tested in multivariable regression models. Analyses were conducted in November 2023-January 2024. In nationally representative analyses of N=59,361 children, 87.7%, 7.1%, and 5.3% lived in urban, large rural, or small town/rural areas, respectively. Among children born in 2018, coverage for the combined 7-vaccine series was 71.2% (95% CI=69.6%, 72.9%) in urban, 64.9% (95% CI=58.8%, 71.0%) in large rural, and 62.6% (95% CI=56.2%, 68.9%) in small town/rural areas. There was a positive trend in on-time vaccination in urban areas (adjusted prevalence ratio [aPR] for birth year=1.06; 95% CI=1.05, 1.08). While the trend did not significantly differ for large rural versus urban areas (interaction aPR=1.02; 95% CI=0.96, 1.08), there was less improvement in on-time vaccination in small town/rural areas (interaction aPR=0.93; 95% CI=0.88, 0.99). Increased efforts are needed to eliminate disparities in routine and on-time vaccination for rural children.

CITY LIGHTS OR COUNTRYSIDE NIGHTS? RURALITY’S ROLE ON ANXIETY AND SLEEP IN MID- TO LATE-LIFE

Abstract Anxiety and sleep health associations are well studied but contributing factors (e.g., level of rurality) to health disparities in this relationship are understudied, particularly in aging populations. The present study examined the moderating impact of rurality on associations between anxiety and aspects of sleep health in middle-aged and older adults living in the United States. Cognitively healthy middle-aged and older adults (N=251; Mage=64.7±7.9 years) completed an online survey measuring residence zip code, Pre-Sleep Arousal Scale, Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression scale. Multiple regression and simple slope analyses examined whether rurality (rural vs. non-rural; coded by Delineating Core Based Statistical Areas) moderated associations between anxiety and sleep, controlling for age, sex, education, income, depression, medication usage, and nutritional status (Mini-Nutritional Assessment). Results revealed rurality moderated the association between anxiety and cognitive pre-sleep arousal (R2 change=.014, p=.01) and sleep disturbances (R2 change=.01, p=.04). Higher anxiety was associated with higher cognitive pre-sleep arousal, with an ~2x larger association for rural (B=.64, p&amp;lt;.0001) than non-rural (B=.35, p=.0002) participants. Similarly, higher anxiety was associated with more sleep disturbances for rural (B=.05, p&amp;lt;.001), than non-rural participants. In mid-to-late life, those living in rural areas may be more vulnerable to the impact of higher anxiety on worse sleep compared to those living in non-rural areas. Findings point to the need for a greater understanding of socioeconomic determinants of health and more tailored treatments, with potential emphasis on mitigating barriers impacting rural access to clinical treatments for anxiety and sleep health.

Associations between rural hospital closures and acute and post‐acute care access and outcomes

AbstractObjectiveTo determine whether rural hospital closures affected hospital and post‐acute care (PAC) use and outcomes.Study Setting and DesignUsing a staggered difference‐in‐differences design, we evaluated associations between 32 rural hospital closures and changes in county‐level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30‐day readmissions and mortality and hospitalizations for a fall‐related injury; and (4) population‐level hospitalization and death rates.Data Sources and Analytic Sample100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee‐for‐service Medicare beneficiaries.Principal FindingsWe found that hospitals that closed compared to those remaining open served more minoritized, lower‐income populations, including more Medicaid and fewer commercial patients, and had lower profit margins. Following a closure, quarterly hospitalization rates (111.6 quarterly hospitalizations per 10,000 older adults; 95% CI: 53.4, 170.9) and average hospital lengths of stay increased (0.34 days; 95% CI: 0.13, 0.56 days). We observed no change in the average distance between patients' residential ZIP code and the hospital used (0.29 miles; 95% CI: −1.06, 1.64 miles); average number of standardized ADL limitations at PAC (0.08 SDs from the pre‐closure average; 95% CI: −0.12, 0.28 SDs); or PAC time to start (0.02 days; 95% CI: −1.2, 1.2 days). Among more isolated hospitals, closures were associated with an increase in the likelihood of readmission (0.10 percentage‐points; 95% CI: 0.00, 0.19).ConclusionsClosures were not associated with notably worsened health care access, function, or health, potentially because closures triggered care delivery adjustments involving increased numbers of patients seeking out higher quality care.

Social Determinants of Health Affecting Retinopathy of Prematurity Follow-up Attendance.

To identify social determinants of health (SDOH) associated with follow-up attendance of pre-term infants with retinopathy of prematurity (ROP) after neonatal intensive care unit (NICU) discharge. This retrospective cohort study, conducted at a single academic tertiary care center, included preterm infants screened for ROP from July 2018 to December 2022. Sociodemographic and clinical data were collected from a preexisting NICU database. Residential ZIP code was used to derive community-level SDOH indices. Multivariable logistic regression was used to determine factors associated with ophthalmology follow-up attendance within 8 weeks to 1 year after NICU discharge. Forty-two percent (303 of 723) of patients attended follow-up in the designated interval. Infants with private insurance (odds ratio [OR]: 4.47, 95% CI: 1.98 to 10.1, P < .001), maternal non-Hispanic White identity (OR: 1.80, 95% CI: 1.15 to 2.81, P = .01), ROP treatment history (OR: 3.67, 95% CI: 2.05 to 6.57, P < .001), and longer NICU stay (weeks) (OR: 1.06, 95% CI: 1.03 to 1.08, P < .001) had higher odds of attending follow-up. In an interaction effect, privately insured patients had lower odds of follow-up with each higher quartile of Social Vulnerability Index Racial and Ethnic Minority Status (OR: 0.61, 95% CI: 0.44 to 0.84, P = .002). Social determinants of health, including individual and community-level factors, significantly impact access to ROP follow-up. The identified disparities and overall inadequate follow-up rate suggest a need for targeted interventions to improve vision health equity and follow-up adherence. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Factors impacting sleep center no-show rates post hospital discharge utilizing geospatial coding in Appalachia.

Screening for early detection of sleep-disordered breathing (SDB) in hospitalized patients has been shown to reduce readmission rates. However, post-discharge polysomnography for confirmation of diagnosis is required. We analyzed factors for "no-shows" using geospatial techniques. Data were obtained between September 2019 and September 2023. The outcome for the study was patient's no-show rate (non-compliant) for polysomnography post hospital discharge. Predictors included patient age, gender, BMI, health literacy, distressed community index (DCI) score and distance to sleep center for the patient's zip code of residence. Logistic regression was applied to estimate odds of patient compliance at the patient-level utilizing geospatial mapping technique. Geographically weighted logistic regression was applied to estimate the odds of a zip-code having compliant patients. Of the 1318 hospitalized patients established as high risk for SDB and referred for an overnight sleep study who were able to be geocoded, 228 were compliant and 1130 were non-compliant. In non-spatial regression analyses, health literacy (aOR = 1.06, 95%CI = 1.03, 1.09), age (aOR=0.99, 95% CI=0.98, 0.99), and drive time (aOR=0.95, 95% CI = 0.92, 0.97) were identified as statistically significant predictors of patient compliance. Spatial regression analyses identified areas that had high and low predictive probability of patient compliance, as well as which community level factors were co-occurring in those areas. The findings suggest that both patient-level factors and the community where patients live may impact no-show rates. Health literacy was identified as a key modifiable predictor at the patient level. At the community level, we found that predicted probability of patient compliance varied throughout the state. Efforts should focus on enhancing patient education at the individual level and understanding geographical factors to improve compliance.

Investigating the independent and synergistic associations between neighbourhood greenness and physical activity in relation to perceived mental health among adults in Canada

ABSTRACT The relationships among neighbourhood greenness, physical activity, and mental health are unclear; therefore, we examined the independent and synergistic associations between neighbourhood greenness and self-rated mental health among a nationally representative sample of urban-dwelling adults in Canada (18–79 years) from the 2007–2019 Canadian Health Measures Survey (n = 12,531). We assessed neighbourhood greenness using the Normalized Difference Vegetation Index within a 500-meter radius of participants’ residential postal codes. We measured physical activity using accelerometers and determined adherence to the recommended 150-minutes of moderate-to-vigorous intensity physical activity (MVPA) per week. We used weighted logistic regression models to test whether MVPA guideline adherence was an effect modifier in the association between neighbourhood greenness and self-rated mental health, adjusting for individual and neighbourhood characteristics. Neighbourhood greenness (aOR = 0.89 [0.62, 1.29]) and MVPA adherence (aOR = 1.22 [0.89, 1.69]) were not associated with self-rated mental health, and no interaction were found on the additive (Relative Excess Risk Due to Interaction = -0.45 [−1.24, 0.35], Attributable Proportion = -0.38 [−1.02, 0.26], Synergy Index = 0.28 [0.02, 3.20]) or multiplicative (OR = 0.7 [0.4, 1.3]) scales. Engaging in the recommended amount of MVPA did not change the finding that Canadian adults had similar self-rated mental health regardless of their neighbourhood greenness.

A portrait of older adults in naturally occurring retirement communities in Ontario, Canada: A population-based study.

Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community. We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings. Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex. Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.

Long term exposure to ambient air pollution and hospital admission burden in Scotland: 16 year prospective population cohort study

ObjectivesAir pollution is considered a major threat for global health and is associated with various health outcomes. Previous research on long term exposure to ambient air pollution and health placed...

Real-world glycaemic outcomes in children and young people on advanced hybrid closed-loop therapy: A population-based study in Western Australia.

To evaluate real-world glycaemic outcomes in children with type 1 diabetes (T1D) commencing advanced hybrid closed loop therapy (AHCL) and to explore these outcomes based on the cohort's clinical and socioeconomic characteristics. A single-centre, population-based retrospective study in children commencing AHCL (Smart Guard, Control IQ, CamAPS) with minimum 70% data from two-weeks CGM pre-AHCL was conducted between December 2021 and June 2023 in Western Australia. CGM metrics (time in range (TIR) 3.9-10 mmol/L, time below range (TBR) < 3.9 mmol/L, glucose management indicator (GMI)) were analysed at baseline, monthly and 6 months. HbA1c at baseline and 6 months were also collected. The proportion meeting glycaemic targets of TIR > 70%, TBR < 4% and GMI < 7.0% were determined. Change in TIR from baseline to 6 months was examined by the following characteristics: %TIR, age group and Index of Relative Socioeconomic Disadvantage (IRSD) of residential postcode. CGM data of 309 children, mean (SD) age 12.4 (3.2) years were analysed. Glycaemia improved from baseline to 6 months with (mean) TIR +8% (95% CI 7, 9; P ≤ 0.001), GMI -0.3% (95% CI -0.3, -0.2; P < 0.001) and (median) TBR -0.3% (95% CI -0.4, -0.1; P < 0.001). Proportion meeting glycaemic targets increased from 13.3% at baseline to 30.6% at 6 months. Improvement in TIR did not differ based on age group or IRSD Quintile. Greater increase in TIR was seen in those with lowest TIR at baseline (+20.9%, -0.2%; P < 0.001 for baseline TIR < 40%, >70%). There was a 0.27% reduction in HbA1c in 6 months (n = 116) (P < 0.001). AHCL improves glycaemia, irrespective of age and socioeconomic characteristics, with greatest changes seen in those with lowest baseline TIR.

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

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

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

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

Follow-up Trends in Patients Undergoing Modified Wendler Glottoplasty.

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

Effects of fine particulate matter from wildfire and non-wildfire sources on emergency-department visits in people who were housed and unhoused in San Diego County (CA, USA) during 2012–20: a time-stratified case–crossover study

Being unhoused can increase vulnerability to adverse health effects due to air pollution. We aimed to quantify changes in emergency-department visits during and after exposure to wildfire-specific and non-wildfire particulate matter 2·5 μm or less in diameter (PM2·5) in San Diego County (CA, USA) in people who were both unhoused and housed. For this time-stratified case-crossover study, we used data on exposure to wildfire-specific PM2·5 in California and individual-level data for people admitted to the emergency departments of two hospitals (UC San Diego Health emergency departments at La Jolla and Hillcrest, San Diego) in San Diego County between July 1, 2012, and Dec 31, 2020. People with a postcode outside of San Diego County were excluded. Demographic information was age group, race or ethnicity, and transport to the emergency department. Wildfire-specific PM2·5 concentration at the postcode level was previously estimated using an ensemble model that combined multiple machine-learning algorithms and explanatory variables obtained via data on 24-h mean PM2·5 concentrations from the US Environmental Protection Agency Air Quality System. Conditional logistic regression models were applied, adjusting for specific humidity, wind velocity, and maximum temperature extracted from the US Gridded Surface Meteorological Dataset. Housing status was established by registration staff or triage nurses on arrival at the emergency department. For people who were unhoused, exposure was defined based on the weighted mean PM2·5 concentration at the city level proportional to the number of people who were unhoused in each specific city across urban centres in San Diego County. For people who were housed, we used residence postcode to measure exposure. We assessed the association between PM2·5 from wildfire and non-wildfire sources and emergency-department visits in people who were housed and unhoused. There were 587 562 emergency-department visits at the two hospitals, 76 407 (13·0%) of which were by people who were unhoused. People who were housed had a higher exposure to overall PM2·5 (24-h mean over the study period of 9·904 mg/m3, SD 3·445) and non-wildfire PM2·5 (9·663, 2·977) than people who were unhoused (9·863, 3·221; 9·557, 2·599). However, people who were unhoused had a higher exposure to wildfire-specific PM2·5 (0·305, 1·797) than people who were housed (0·240, 1·690). Overall PM2·5 exposure was associated with increased odds of emergency-department visits for both people who were housed (odds ratio 1·003, 95% CI 1·001-1·004 per 1 μg/m3 PM2·5 for 0-3 days after exposure) and people who were unhoused (1·004, 1·000-1·008 for 0-3 days after exposure). We found that non-wildfire PM2·5 was associated with emergency-department visits among people who were housed (1·003, 1·002-1·005 for 0-3 days after exposure) and wildfire-specific PM2·5 was associated with emergency-department visits in people who were unhoused (1·006, 1·001-1·011 for 0-3 days after exposure). People who were unhoused in San Diego County were more likely to visit emergency departments after exposure to increased wildfire-specific PM2·5. As the intensity and frequency of wildfires increase, understanding risk factors for vulnerable populations, such as people who are unhoused, is crucial to develop effective adaptation strategies. US National Institutes of Health, National Institute on Aging.

The effect of air pollution on hospitalizations with Parkinson’s disease among medicare beneficiaries nationwide

We examined the effect of annual exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), on the rate of first hospitalization with a PD-related diagnosis (hospitalization with PD) among Medicare Fee-for-Service beneficiaries (2001-2016). Machine learning-derived annual air pollution concentrations were linked to residential ZIP codes. For each exposure, we fitted four models: 1) traditional outcome stratification, 2) marginal structural, 3) doubly robust, and 4) generalized propensity score matching Poisson regression models, adjusted for sociodemographic and meteorological confounders and long-term trends. Among 49,121,026 beneficiaries, incidence rate ratios of 1.08 (95% CI: 1.07, 1.10), 1.07 (95% CI: 1.05, 1.08), and 1.03 (95% CI: 1.02, 1.05) for an interquartile range increase in PM2.5 (3.72 µg/m3), NO2 (13.84 ppb), and O3 (10.09 ppb), respectively, were estimated from doubly robust models. Results were similar across modeling approaches. In this nationwide study, higher air pollution exposure increased the rate of hospitalizations with PD.

Access and models of obstructive sleep apnea care: a cross-national comparison of Canadian and Australian patient survey data.

To describe similarities and differences in OSA care pathways and their impact on patients in Australia and Canada, including among urban versus rural participants. In this secondary data analysis of patient surveys exploring OSA care in Australia and Canada, we recruited adults with a prior diagnosis of OSA from market research companies, social media, and patient-facing medical associations. Residential postal codes were used to classify participants as urban or rural. Survey domains included wait times and travel distances for care, providers, and treatments. Data from 589 Canadians (21% rural; 42% female, mean [SD] age = 57 [13] years) and 412 Australians (38% rural; 45% female, mean [SD] age = 58 [14] years) with OSA were included. Participants in both countries most commonly sought initial care for suspected OSA from a primary care practitioner. Canadian participants waited longer to seek care than Australian participants (37% vs 51% within 12 months of symptom onset). Wait times for diagnostic testing were longer in Canada (59% vs 76% within 3 months of initial assessment), especially in urban settings (58% vs 78%). In both countries, >80% of participants were offered positive airway pressure (PAP) therapy. Overall, a greater variety of treatments were offered and used by Australian participants. Greater access to diagnostic testing and a greater variety of treatments were found in Australia compared to Canada. Further research is needed to determine if reduced diagnostic wait times and presentation of increased therapy options found in Australia translate into better patient outcomes.