Small Town Areas Research Articles

Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project.

Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge. We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies. Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups. We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.

Air Pollutants and Risk of Parkinson's Disease among Women in the Sister Study.

Air pollutants may contribute to the development of Parkinson's disease (PD), but empirical evidence is limited and inconsistent. This study aimed to prospectively investigate the associations of PD with ambient exposures to fine particulate matter with aerodynamic diameter () and nitrogen dioxide (). We analyzed data from 47,108 US women from the Sister Study, enrolled from 2003-2009 (35-80 years of age) and followed through 2018. Exposures of interest included address-level ambient and in 2009 and their cumulative averages from 2009 to PD diagnosis with varying lag-years. The primary outcome was PD diagnosis between 2009 and 2018 (). We used multivariable Cox proportional hazards and time-varying Cox models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). exposure in 2009 was associated with PD risk in a dose-response manner. The HR and 95% CI were 1.22 (95% CI: 1.03, 1.46) for one interquartile [4.8 parts per billion (ppb)] increment in , adjusting for age, race and ethnicity, education, smoking status, alcohol drinking, caffeine intake, body mass index, physical activity, census region, residential area type, area deprivation index (ADI), and self-reported health status. The association was confirmed in secondary analyses with time-varying averaged cumulative exposures. For example, the multivariable adjusted HR for PD per increment in was 1.25 (95% CI: 1.05, 1.50) in the 2-year lag analysis using cumulative average exposure. Post hoc subgroup analyses overall confirmed the association. However, statistical interaction analyses found that the positive association of with PD risk was limited to women in urban, rural, and small town areas and women with percentile ADI but not among women from suburban areas or areas with percentile ADI. In contrast, exposure was not associated with PD risk with the possible exception for women from the Midwest region of the US (, 95% CI: 1.20, 5.14) but not in other census regions. In this nationwide cohort of US women, higher level exposure to ambient is associated with a greater risk of PD. This finding needs to be independently confirmed and the underlying mechanisms warrant further investigation. https://doi.org/10.1289/EHP13009.

Biochar Amendment in Vermi-Wetland for Enhancing Nitrification during Excess Sludge Recycling

Vermi-wetland is a sustainable technology for recycling excess sludge in small-town areas. Although biochar (BC) amendment into the vermi-wetland could considerably boost the effectiveness of treating sludge, its impact on the nitrogen transformation in vermi-wetland remains unclear. Hence, this study aimed to explore the mechanism and performance of BC amendment into the vermi-wetland for enhancing nitrogen transformation during excess sludge recycling. The semi-aquatic plant Acorus calamus and the earthworm Eisenia fetida were planted in the designed vertical vermi-reactor, with corncob BC added to the upper and lower layers of one vermi-reactor, in comparison with the vermi-reactor without BC. The vermi-reactor with BC significantly lowered (p < 0.05) ammonia nitrogen (NH4+-N) and nitrite nitrogen (NO2−-N) in the effluent by 1.63 and 4.85-fold, respectively, and increased considerably nitrate nitrogen (NO3−-N) in the effluent by 1.5-fold. The numbers of ammonia-oxidizing bacteria (AOB) and archaea (AOA) in the vermi-reactor with BC were greatly enriched by 6 and 1.42-fold, compared with their counterparts (p < 0.05). Moreover, nirS and nirK gene copies in the vermi-reactor with BC were considerably improved (p < 0.05) by 2.03 and 1.82-fold, respectively. BC significantly enhanced the growth of earthworms by 6.92-fold and promoted plant growth by 1.28-fold. In addition, the AOB members like Nitrosomonas and Nitrosospira and the AOA members like Crenarchaeota and Thaumarchaeota cohabited in BC. Overall, these results suggest that a vermi-reactor amended with BC could enhance the nitrification processes of excess sludge, thereby improving the treatment performance of vermi-wetland.

Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency.

Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada. A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time. Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19-1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61-0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17-1.17; P = 0.13). Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.

Trends in Diagnostic Imaging by Nonphysician Practitioners and Associations With Urbanicity and Scope-of-Practice Authority

ObjectiveWe aimed to assess the changing share of diagnostic imaging billed by NPPs and how such changes differ by urbanicity within the context of scope-of-practice (SOP) regulations and legislation. MethodsThis retrospective cohort study used patient claims for diagnostic imaging studies spanning 2016-2020 from Optum Clinformatics Datamart datasets. Multivariable modeling determined the odds of patients receiving NPP-interpreted vs physician-interpreted imaging. Imaging rates and trends in proportions of NPP-billed claims were assessed by urbanicity and relative to other factors including SOP, imaging modality, and place of service. ResultsOf all identified imaging claims, 3,348,881 (3.0%) were attributed to NPPs, with the highest rates of NPP interpretations per 10,000 images occurring in rural and small-town areas. From 2016 to 2020, the rate of NPP-billed imaging increased from 257 to 331 claims per 10,000 beneficiaries (P = 0.004), observed across both metropolitan (240 to 315, P = 0.001) and micropolitan (367 to 436, P = 0.020) settings. Although rates in rural and small-town areas rose, the increase was not significant (330 to 392, P = 0.363). Rises in NPP imaging in metropolitan settings occurred in states with moderately restrictive (307 to 358, P = 0.008) and least restrictive (289 to 419, P = 0.004) SOP legislation. DiscussionRates of diagnostic imaging interpretation by NPPs are rising. Growth in recent years appears driven by metropolitan areas in states with less restrictive SOP regulations. Future work is necessary to assess the quality of and downstream costs related to increasing NPP-interpreted imaging.

Exploring Outcomes Related to Residential Determinants in Acute Mesenteric Ischemia Patients

IntroductionTo access the relationship between residential status and outcomes in surgical acute mesenteric ischemia (AMI) patients. MethodsRetrospective chart review of 153 AMI patients admitted to our institution between 2007 and 2021. Residential median income and Rural-Urban Commuting Area (RUCA) code were used as residential proxies. ResultsBeing of the female sex (odds ratio [OR] = 3.116 [1.276-7.609] P = 0.013) and having a vascular intervention performed (OR = 2.927 [1.087-7.883] P = 0.034) were both associated with a threefold increase in the risk of mortality. Increased age (OR = 1.037 [1.002-1.073] P = 0.039), elevated blood urea nitrogen (OR = 1.032 [1.012-1.051] P = 0.001), and living in higher residential income area (OR = 1.049 [1.009-1.091] P = 0.017) had a small, but statistically significant, increased risk of mortality. Patients in higher median income areas were less likely to undergo colonic resection (OR = 0.953 [0.911-0.997] P = 0.038) and tended to have a lower likelihood of receiving an ostomy (OR = 0.963 [0.927-1] P = 0.051). Being from urban or rural areas was not associated with mortality (OR = 1.565 [0.647-3.790] P = 0.321, although rural patients were more likely to undergo colon resection (OR = 2.183 [0.938-5.079] P = 0.070). Furthermore, rural patients were much more likely to be readmitted than urban dwellers (OR = 4.700 [1.022-21.618] P = 0.047). ConclusionsAMI patients living in rural or small-town areas were more likely to be readmitted and tended to undergo colonic resection. Patients residing in higher income areas had a slightly higher risk of mortality but tended to be less likely to require ostomy or colonic resection. These findings suggest a potential need for postoperative care initiatives focused on AMI patients living in rural and lower income areas.

MP77-03 THE EFFECT OF NEIGHBORHOOD ARCHETYPE ON PROSTATE CANCER-SPECIFIC MORTALITY FOR WISCONSIN MEN

You have accessJournal of UrologyCME1 Apr 2023MP77-03 THE EFFECT OF NEIGHBORHOOD ARCHETYPE ON PROSTATE CANCER-SPECIFIC MORTALITY FOR WISCONSIN MEN Ashanda R. Esdaille, Arighno Das, Glenn Allen, Daniel Shapiro, Kyle Richards, E. Jason Abel, David Jarrard, and Tudor Borza Ashanda R. EsdailleAshanda R. Esdaille More articles by this author , Arighno DasArighno Das More articles by this author , Glenn AllenGlenn Allen More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Kyle RichardsKyle Richards More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David JarrardDavid Jarrard More articles by this author , and Tudor BorzaTudor Borza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Socioeconomic factors are associated with prostate cancer (PCa) disparities. This study aimed to identify the association between rurality and neighborhood deprivation on prostate cancer-specific mortality (PCSM) for men diagnosed and treated in Wisconsin. METHODS: Wisconsin Cancer Reporting System (WCRS) data were used to identify all men diagnosed with PCa between 1995-2010. These data were merged with rural-urban commuting area (RUCA) codes to identify patients living in rural, small town, and urban areas. Deprivation was measured by the Area of Deprivation Index (ADI) at the census block group level using the Neighborhood Atlas®, a validated composite measure which allows for rankings of neighborhoods by socioeconomic disadvantage based on income, education, employment, and housing quality. ADIs were categorized into quartiles. Differences in baseline demographic and clinicopathologic characteristics were determined using chi-square tests. Cox proportional hazards models were used to estimate the effect of neighborhood archetype and deprivation on PCSM, adjusted for age, clinical grade, stage, diagnosis year +/- treatment. RESULTS: 62,474 men with PCa were identified with a median follow up of 5.7 years (primary) and 9.6 years (sensitivity analyses). 41,885 men (67%) resided in urban areas, 7,102 (11%) in small towns and 13,487 (22%) in rural areas. Men living in rural areas were diagnosed at older ages and more commonly had nodal and metastatic disease (p<0.001). Among all three neighborhood archetypes, definitive treatment increased in later time periods with overall higher rates of surgery versus radiation. In small towns, radiation was more prevalent. In comparison to men living in urban areas, there was no increased risk of PCSM for men in rural or small town areas (p=0.09-0.56). Further, there was no difference in PCSM risk for advantaged men living in urban, rural or small town areas (p=0.39-0.93). Disadvantaged rural men had increased risk of PCSM compared to disadvantaged urban men (Q3: aHR=1.2 (95% CI 1.0-1.35, p=0.042). This trend was not observed in men residing in the most deprived neighborhoods (Q4: p=0.21-0.53). CONCLUSIONS: Men living in rural areas had more aggressive disease on presentation in comparison to men residing in small towns and urban areas, possibly reflecting differences in screening patterns. Overall, there was no difference in PCa-specific deaths by neighborhood archetype; however, differences in deprivation status within the archetypes underscore the association between lack of neighborhood-level resources and oncologic outcome. Source of Funding: Esdaille: AUA/UCF Research Scholar Award Grant# 017-822959 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1102 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashanda R. Esdaille More articles by this author Arighno Das More articles by this author Glenn Allen More articles by this author Daniel Shapiro More articles by this author Kyle Richards More articles by this author E. Jason Abel More articles by this author David Jarrard More articles by this author Tudor Borza More articles by this author Expand All Advertisement PDF downloadLoading ...

PROYEKSI KEBUTUHAN AIR DOMESTIK DAN PARIWISATA UNTUK PENGEMBANGAN WILAYAH DI LABUAN BAJO

Clean water is essential for the welfare of life and regional development. As one of the super-priority tourism destinations, Labuan Bajo continues to experience growth and infrastructure development to support tourism development. Regional development in Labuan Bajo, classified as a semi-arid area for tourism needs, can potentially cause a clean water crisis. Tourism often uses clean water, triggering social conflicts with local communities. This study aims to analyze and project domestic clean water needs and tourism water needs in Labuan Bajo. The method used in this research is a quantitative method with data collection instruments by literature studies, field observations, and distributing questionnaires to 261 respondents in the urban area of Labuan Bajo. The results showed that the domestic water demand in Labuan Bajo was 90,23 liters/day/person or greater than the reference standard for the Directorate General of Human Settlement and Water Resources regarding the average domestic water demand in small town areas. The need for clean water for tourism in 2028 is projected to exceed domestic water needs, namely the need for tourism water of 33.928.095 liters/day. Meanwhile, the domestic demand for clean water is only 23.545.368 liters/per day. The high demand for clean water is caused by the urbanization of the population and an increase in the number of tourists. However, the geographical conditions of Labuan Bajo in the form of an archipelago and classified as a semi-arid area can cause a decrease in the carrying capacity, requiring further research related to efforts to manage clean water.

An empirical investigation of the dynamic linkages of land access and food security: Evidence from Ethiopia using system GMM approach

In this work, we empirically investigate how land acquisition and food security interact dynamically in Ethiopia's rural and small-town areas. Apparently, connections between the two issues getting more attention, yet dynamic links between them remain unexplored. This paper utilizes a moment-based generalized systems approach (SYS-GMM), and tests in panel data models. The results of system GMM estimates using data for 3288 households from 2011–12 to 2018–19 confirm that the lagged dependent variables were negative (-1.359) with statistically significant, which justifies the specification of the dynamic panel model and the adoption of the two-step system-GMM for estimating DPD analysis, which further validates the dynamic adjustment process and the lagged effect. It also confirmed that adult equivalence (a proxy for family size, and tropical livestock unit all exhibit elastic relationships i.e., −3.101 and 1.23 respectively at a 1% level of significance, while the other statistically significant predictors were found to have an inelastic relationship with food security (<1). Here, the response of food security to changes in a household's total livestock assets, adult equivalence, and yearly food consumption per adult equivalence is quick, as a proportionate change in these variables would result in a higher proportionate change in the level of a household's food security. The study further revealed that families with female heads (FHHs) experience more food insecurity than households with male heads. FHHs, however, are 11% less likely than male-headed families to be food secure. The results are further confirmed using different diagnostic tests which include serial correlation and Sargan/Hansen tests. The results are further confirmed using different diagnostic tests which include serial correlation and Sargan/Hansen tests. The robustness of the GMM results was confirmed by the pooled OLS, difference GMM, and the fixed effect model results. To this end, interventions and policies should be adopted to decrease the food insecurity of households in the long run in Ethiopia.

Spatial Pattern Evolution and Influencing Factors on Agricultural Non-Point Source Pollution in Small Town Areas under the Background of Rapid Industrialization.

To promote sustainable agricultural development in small town areas during rapid industrialization, it is important to study the evolution of agricultural non-point source pollution (ANSP) and its influencing factors in small town areas in the context of rapid industrialization. The non-point source inventory method was used to study the characteristics of ANSP evolution in 14 small town areas in Gongyi City from 2002 to 2019. Using the spatial Durbin model and geographical detectors, the factors influencing ANSP in small town areas were analyzed in terms of spatial spillover effects and the spatial stratified heterogeneity. The results showed a zigzagging downward trend of ANSP equivalent emissions over time. Spatially, the equivalent emissions of ANSP showed a distribution pattern of being high in the west and low in the east. There was a significant positive global spatial autocorrelation feature and there was an inverted "U-shaped" Environmental Kuznets Curve relationship between industrialization and ANSP. Affluence, population size, and cropping structure positively contributed to the reduction of ANSP. Population size, land size, and industrialization were highly influential factors affecting the spatial variation of ANSP and the interaction of these factors was bivariate or nonlinearly enhanced. This study provides a feasible reference for policymakers and managers to develop reasonable management measures to mitigate ANSP in small town areas during rapid industrialization.

Association of rurality with utilization of palliative care and hospice among Medicare beneficiaries who died from pancreatic cancer: A cohort study.

Pancreatic cancer has a 5-year survival of just 10%. Services such as palliative care and hospice are thus crucial in this population, yet their geographic accessibility and utilization remains unknown. We studied the association between rurality of patient residence and the use of palliative care and hospice. Cohort study of continuously enrolled fee-for-service Medicare beneficiaries aged ≥65 diagnosed with incident pancreatic cancer between 04/01/2016-08/31/2018 and who died by 12/31/2018. In this decedent cohort of 31,460 patients, 77% lived in metropolitan areas, 11% in micropolitan areas, 7% in small towns, and 5% in rural areas. Patient demographics were largely similar across rurality; however, the proportion of White, non-Hispanic patients and social deprivation was highest in rural areas and lowest in metropolitan areas. Overall, 33% of patients used any palliative care and 77% received hospice services. After risk adjustment, there were no statistically significant differences in the use of palliative care for patients residing in metropolitan versus micropolitan, small town, or rural areas. Patients in small town (OR = 0.77, 95% CI: 0.69-0.86) and rural areas (OR = 0.75, 95% CI: 0.66-0.85) had lower adjusted odds of receiving hospice care compared to patients in metropolitan areas. The use of palliative care services captured in Medicare was low, representing either underutilization or failure to accurately measure the extent of services used. While the overall level of hospice enrollment was high, patients in rural communities had relatively lower use of hospice services compared to those in metropolitan areas.

What are the top priorities of patients and clinicians for the organization of primary cardiovascular care in Quebec? A modified e-Delphi study.

Cardiovascular diseases are the leading cause of death and disability worldwide. Little is known about the organizational priorities of patients and clinicians involved in primary cardiovascular care. This study aimed to identify their shared top priorities and explore on which aspects their perspectives differed. A three-round modified online Delphi study was carried out with patients and clinicians in seven academic primary care settings from metropolitan, suburban and small-town areas in Quebec, Canada. Patient partners experienced in the mobilization of their experiential knowledge also participated in the study. Following an "open" round, the items elicited were assessed by a combined rating and ranking approach. Items achieving an initial consensus level ≥70% were reassessed and then rank-ordered based on their final scores. Levels of consensus achieved among patients and clinicians were compared using Fisher's Exact tests. Thirty panelists completed the study (9 clinic patients, 7 patient partners and 14 clinicians). Out of 41 organizational aspects generated, six top priorities were shared by patients and clinicians. These related to listening and tailoring care to each patient, provision of personalized information, rapid response in the event of a problem, keeping professional training up-to-date, and relational and informational continuity of care. Statistically significant differences were found between patients' and clinicians' perspectives regarding the importance of offering healthy lifestyle and prevention activities at the clinic (lower for patients), timely access to the treating physician (higher for patients), and effective collaboration with specialist physicians (higher for patients). Although their views differ on some organizational aspects, patients and clinicians share a small set of top priorities for primary cardiovascular care that may be transferable to other chronic diseases. These top priorities should remain a central focus of clinical settings, alongside other primary care reform goals.

Ethnic equity, Mapudungun, and CLIL

Abstract Since 2006, the Argentinian system of education has included intercultural bilingual education, a type of education across kindergarten, primary, and secondary education that guarantees the indigenous peoples’ right to receive quality and equitable education which preserves and strengthens their cultural practices, language, cosmovision, and ethnic identity in a multicultural society. In the province of Chubut, southern Argentina, the Ministry of Education launched a professional development program targeted at primary school teachers working in small town and rural areas with students ethnically associated to the Mapuche peoples and their language, Mapudungun. The aim of this paper is to examine how a group of four teachers understood and implemented CLIL in relation to ethnic equity and socially just education in a semi-rural area of Chubut. Framed as a case study, data were collected in 2021 and 2022 through group discussions, journal diaries, and arts-based methods. Data came from four primary school teachers as well as the program facilitator. By means of quality content analysis, the findings show teachers’ understanding of CLIL as an inclusive and equitable approach that can help promote ethnic identity and ethnolinguistic vitality.

Sociodemographic Factors of Depression During the COVID-19 Pandemic in Malaysia: the COVID-19 Mental Health International Study.

To determine the prevalence of depression and the sociodemographic factors associated with depression in Malaysia during the COVID-19 pandemic METHODS. This study is part of the COVID-19 Mental Health International Study to collect data on the impact of the pandemic on mental health through an online survey. People who were aged ≥18 years, able to read Malay or English, had access to the internet, and consented to participate were asked to complete a pro forma questionnaire to collect their sociodemographic data. The presence of distress and depression was assessed using the English or Malay version of the Center for Epidemiologic Studies Depression Scale. Of 963 participants, 451 (46.8%) had depression and 512 (53.2%) had no depression who were either normal (n = 169, 17.5%) or had distress (n = 343, 35.6%). Participants had higher odds of having depression when living with two people (adjusted odds ratio [AOR] = 3.896, p = 0.001), three people (AOR = 2.622, p < 0.001) or four people (AOR = 3.135, p < 0.001). Participants with three children had higher odds of having depression (AOR = 2.084, p = 0.008), whereas having only one child was a protective factor for depression (AOR = 0.481, p = 0.01). Participants had higher odds of having depression when self-employed (AOR = 3.825, p = 0.003), retired (AOR = 4.526, p = 0.001), being housekeeper (AOR = 7.478, p = 0.004), not working by choice (AOR = 5.511, p < 0.001), or unemployed (AOR = 3.883, p = 0.009). Participants had higher odds of depression when living in a small town (AOR = 3.193, p < 0.001) or rural area (AOR = 3.467, p < 0.001). Participants with no chronic medical illness had lower odds of having depression (AOR = 0.589, p = 0.008). In Malaysia during the COVID-19 pandemic, people who are living with two, three, or four people, having three children, living in a small town or rural areas, and having unstable income have higher odds of having depression. Urgent intervention for those at risk of depression is recommended.

Sufficiency as an Effective Strategy for More Sustainability and Fewer Vacancies in Rural Building Stock

Per capita residential space consumption has been rising continuously for many years. This significantly counteracts the effectiveness of costly energy efficiency measures and programs. This is countered by sufficiency of use concepts, which can contribute to reactivating and increasing the intensity of use of existing properties and avoiding new construction. They represent an important instrument for reducing land consumption and achieving climate neutrality in the building sector. The paper presents results of a research project that investigates the potential of sufficiency concepts for rural and small-town areas. This includes, among other things, survey results on the acceptance of sufficiency measures in the field of housing in a small town in Saxony.

Adoption of newly FDA-approved targeted immunomodulatory therapies by dermatologists: a cross-sectional analysis of Medicare Part D claims from 2013 to 2018.

Although targeted immunomodulatory medications are increasingly utilized for inflammatory skin conditions like plaque psoriasis, little is known of the trends in the adoption of newly Federal Drug Administration (FDA)-approved immunomodulators by dermatologists. We performed a retrospective, cross-sectional analysis of Medicare Part D Prescriber datasets to identify dermatologists filing Medicare prescription claims for immunomodulatory drugs FDA-approved for plaque psoriasis between 2013 and 2018. Differences in dermatologist characteristics were determined between dermatologists prescribing a psoriasis treatment within two years of its FDA approval, "early adopters" and non-prescriber dermatologists over the same time period. Biologics approved for psoriasis from 2013 to 2018 included certolizumab pegol, secukinumab, brodalumab, ixekizumab, guselkumab, and apremilast. Early adopter dermatologists (n = 783) accounted for 5% of all Medicare Part D prescribing dermatologists. Early adopters were more likely to be male, in practice longer, and had a greater number of average annual beneficiaries than dermatologists who did not. Only six (< 1%) early adopters practiced in a small town or rural areas. We believe these data show that the adoption of novel biologic treatments for psoriasis by dermatologists to Medicare beneficiaries may be associated with clinician experience and practice volume. Additionally, we identified low absolute numbers of dermatologists prescribing biologics overall in non-metropolitan areas, which may represent delayed access to novel psoriasis treatments for many Medicare beneficiaries.

Maritime Lexicon as Language Identity of Coastal Community in Tuban Regency, Indonesia

The coastal community of Tuban Regency has a distinctive language identity. This language identity becomes a distinguishing element with the surrounding speech community. It appears in the marine lexicon they use. This study aims to examine the linguistic identity by describing (1) the linguistic situation of the community, (2) the marine lexicon, which is their language identity, and (3) the relationship between the lexicon and its socio-cultural conditions in terms of Redfield's theory. The researcher collected data by observation and interviews in an ethnolinguistic framework to achieve this. The results of the study show (1) the linguistic situation of the coastal community of Tuban Regency has Mataraman Javanese as their mother tongue but is interfered with Arek Javanese and Madurese languages. (2) The naming of fish, ship parts, fishing equipment and fishing activities becomes a marine lexicon as a marker of the language identity of the speech community. (3) The marine lexicon is also a link to the socio-cultural conditions of coastal communities following Redfield's theory, namely coastal communities in small town areas that are developing. However, these coastal communities do not develop in harmony with the surrounding social communities.

32359 Adoption of newly FDA-approved targeted immunomodulatory therapies for Plaque Psoriasis by Dermatologists: An analysis of Medicare Part D claims from 2013-2018.

Background: Biologics are increasingly used for inflammatory skin conditions like plaque psoriasis. Little is known of prescriber trends in adoption of newly Food and Drug Administration (FDA)-approved immunomodulators by dermatologists. Methods: We performed a retrospective, cross-sectional analysis of the 2013-2018 Medicare Part D Public Use File to identify dermatologist claims for biologics approved for psoriasis. Annual drug claims and costs were determined per prescriber. Differences in dermatologist characteristics were determined between those prescribing plaque psoriasis treatments within 2 years of FDA approval, hereby referred to as “novel drugs” and nonprescribers with ≥10 Medicare Part D claims per year. Welch’s independent t-tests and chi-squared tests were used to compare continuous and categorical metrics, respectively. Significance was considered P $2 billion during the study period. Dermatologists who prescribed ≥1 novel drug (n = 778) were significantly more likely to be male (69% vs. 51%), in practice longer (24 vs. 18 median years), and had greater average annual beneficiaries (442 vs. 224) than those who did not (all P < .0001). Only 6 (<1%) prescribers of novel drugs practiced in small town or rural areas. Conclusions: The adoption of novel treatments for psoriasis by dermatologists who provide care to the Medicare population may be influenced by time in practice and practice volume. There is a paucity of dermatologist prescribers of novel biologics in nonmetropolitan areas to Medicare beneficiaries.

Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries

Rural patients with colon cancer experience worse outcomes than urban patients, but the extent to which disparities are explained by social determinants is not known. To evaluate the association of rurality with surgical treatment and outcomes of colon cancer and to investigate the intersection of rurality with race and ethnicity and socioeconomic status. This cohort study included fee-for-service Medicare beneficiaries 65 years or older diagnosed with incident, nonmetastatic colon cancer between April 1, 2016, and September 30, 2018, with follow-up until December 31, 2018. Data were analyzed from August 3, 2020, to April 30, 2021. Rurality of patient's residence, categorized as metropolitan, micropolitan, or small town or rural, using Rural-Urban Commuting Area codes. Receipt of surgery, emergent surgery, or minimally invasive surgery (MIS); 90-day surgical complications; and 90-day mortality. Among 57 710 Medicare beneficiaries with incident, nonmetastatic colon cancer, 46.6% were men, 53.4% were women, and the mean (SD) age was 76.6 (7.2) years. In terms of race and ethnicity, 3.7% were Hispanic, 6.4% were non-Hispanic Black (hereinafter Black), 86.1% were non-Hispanic White (hereinafter White), and 3.8% were American Indian or Alaska Native, Asian or Pacific Islander, or unknown race or ethnicity. Patients residing in nonmetropolitan areas were more likely to undergo surgical resection than those residing in metropolitan areas (69.2% vs 63.9%; P < .001). Black race was independently associated with lower hazard of surgical resection (hazard ratio, 0.92 [95% CI, 0.88-0.95]). Race and ethnicity and measures of socioeconomic status did not modify the association of rurality with surgery. Beneficiaries from small town and rural areas had higher odds of undergoing emergent surgery (adjusted odds ratio [OR], 1.32 [95% CI, 1.20-1.44]) but lower odds of undergoing MIS (adjusted OR, 0.75 [95% CI, 0.70-0.80]), with similar findings for patients residing in micropolitan areas. Members of racial and ethnic minority groups who resided in small town and rural settings experienced higher odds of postoperative surgical complications (P = .001 for interaction) and mortality (P = .001 for interaction). Notably, White patients who resided in small town and rural areas experienced lower odds of postoperative mortality than their White metropolitan counterparts (adjusted OR, 0.81 [95% CI, 0.71-0.92]), but Black patients who resided in small town and rural areas had significantly higher odds of postoperative mortality (adjusted OR, 1.86 [95% CI, 1.16-2.97]) than their Black metropolitan counterparts. These findings suggest that Medicare beneficiaries from small town and rural areas were more likely to undergo surgery for nonmetastatic colon cancer than metropolitan beneficiaries but also more likely to undergo emergent surgery and less likely to have MIS. The experiences of rural patients varied by race; rurality was associated with higher postoperative mortality for Black patients but not for other racial and ethnic groups.

Disparities in Access to Radiation Therapy by Race and Ethnicity in the United States With Focus on American Indian/Alaska Native People

Striking disparities in access to radiation therapy (RT) exist, especially among racial and ethnic-minority patients. We analyzed census block group data to evaluate differences in travel distance to RT as a function of race and ethnicity, socioeconomic status, and rurality. The Directory of Radiotherapy Centers provided the addresses of facilities containing linear accelerators for RT. We classified block groups as majority (≥ 50%) American Indian/Alaska Native (AI/AN), black, white, Asian, no single racial majority, or Hispanic regardless of race. We used the Area Deprivation Index to classify deprivation and Rural-Urban Commuting Area codes to classify rurality. Generalized linear mixed models tested associations between these factors and distance to nearest RT facility. Median distance to nearest RT facility was 72 miles in AI/AN-majority block groups, but 4 to 7 miles in block groups with non-AI/AN majorities. Multivariable models estimated that travel distances in AI/AN-majority block groups were 39 to 41 miles longer than in areas with non-AI/AN majorities. Travel distance was 1.3 miles longer in the more deprived areas versus less deprived areas and 16 to 32 miles longer in micropolitan, small town, and rural areas versus metropolitan areas. Cancer patients in block groups with AI/AN-majority populations, nonmetropolitan location, and low socioeconomic status experience substantial travel disparities in access to RT. Future research with more granular community- and individual-level data should explore the many other known barriers to access to cancer care and their relationship to the barriers posed by distance to RT care.