Sociodemographic Variation Research Articles

Incidence and trends of hepatic cancer among children and adolescents in the United States from 2000 to 2017: Evidence from the Surveillance, Epidemiology, and End Results registry data.

Primary liver tumors are rare pediatric malignancies. Knowledge of the epidemiology of pediatric liver tumors is limited. This study aims to present the national incidence trends of pediatric liver tumors over 18years, according to sociodemographic and histological subtype variation. The Surveillance, Epidemiology, and End Results registry was queried from 2000 to 2017 for 1,099 patients between ages 0 and 19 with liver tumors. Age-standardized incidence rates by age, sex, and race/ethnicity were examined among histological subtypes. Annual percentage change (APC) was calculated via joinpoint regression for various sociodemographic and histotype subgroups. An increase of age-adjusted incidence rate of pediatric hepatic cancers was observed between 2000 and 2017 (APC, 1.7% [95% confidence interval or CI: 0.6%-2.8%], p-value = 0.006), which may likely attribute to the increasing incidence of hepatoblastoma and mesenchymal tumors (APC, 2.5% [95% CI: 1.1%-3.8%], p-value = 0.001). The incidence trend of hepatocellular carcinoma remained stable in the study period. The non-Hispanic Asian/Pacific Islander children and adolescents had a higher risk of hepatic tumors (incidence rate ratio or IRR, 1.42 [95% CI: 1.16-1.72], p-value = 0.0007) when compared with the non-Hispanic white subgroup, while a non-Hispanic black child was associated with a lower incidence rate (IRR, 0.64 [95% CI: 0.50-0.80], p-value < 0.0001). Significantly lower hepatic tumor incidence occurred in females than males, with an incidence rate ratio of 0.69 (95% CI: 0.61-0.78; p-value < 0.0001). Hepatic tumor incidence was also significantly lower in those aged 1-4years (IRR, 0.47 [95% CI: 0.40-0.54]; p-value < 0.001) and 5-19years (IRR, 0.09 [95% CI: 0.08-0.10]; p-value < 0.001) when compared with the youngest age group aged less than 1year. These significant differences were also detected for the subgroup of hepatoblastoma and mesenchymal liver tumors but less among hepatocellular carcinomas (all p-values less than 0.0001). Continued increasing incidence of pediatric hepatoblastoma and mesenchymal liver tumors was discovered and warranted further investigation. Additional findings include a lower incidence of hepatic cancer among non-Hispanic black individuals and higher incidence of hepatic cancer in non-Hispanic Asian/Pacific Islander, male, and aged 1-4-year children and adolescents.

Sociodemographic Variations in the Availability of Urban Green Spaces in an Older Swedish Population.

Urban green spaces (UGS) can have a positive impact on health and thereby potentially ease the strain on the health care system. However, the availability and benefits seem to vary between different sociodemographic groups. The aim of this study was to investigate associations between sociodemographic factors and availability to UGS among people aged 65 years or older. Data on sociodemographic variables and residential coordinates were obtained for three cross-sectional cohorts in two cities (Malmö and Kristianstad) and three years (2010, 2015, and 2019). Three measures of urban green spaces; total (UGS), public (PGS) and quiet (QGS), within 300 m were used to determine availability. The results indicated higher availability to both total and publicly available urban green spaces for groups with lower socioeconomic status (SES) is positive from a health perspective. However, availability to high qualitative publicly available urban green spaces, from a noise perspective, was lower, indicating the opposite.

397 Assessment of Sociodemographic Disparities in Emergency Department Pain Management

397 Assessment of Sociodemographic Disparities in Emergency Department Pain Management

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population.

The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.

Influence of food safety concerns on safe food purchasing at rural and urban consumers in Bangladesh

Food contamination and food adulteration are widely known public health issues in Bangladesh. This research explores consumers' perceptions of food hazards and safe food purchasing strategies. The study uses data from a survey of 450 primary household food purchasers in an urban supermarket and two traditional bazaars in urban and regional areas. This study explored the differences between consumers in urban and regional areas. The urban supermarket consumers showed more significant concerns about food hazards and safe food purchasing strategies than consumers at the urban and regional bazaars. Urban consumers indicated a higher food safety perception, whereas regional consumers were concerned about food safety deterioration. This study finds that urban supermarket consumers considered biological food hazards more during food purchasing than the regional bazaar. Most of the consumers in this study were concerned about chemical food hazards such as formalin and pesticide residues, and these consumers considered food purchasing factors such as tastes and expiry dates more while purchasing food. On the other hand, consumers concerned about biological hazards emphasised food purchasing place and product origin. Urban and regional bazaar consumers considered prices more than urban supermarket consumers. The study also explores sociodemographic variations, such as women having more concern about chemical food hazards than men and people with less formal education levels showing less concern about food hazards. Therefore, dissemination of safe food knowledge, adequate infrastructure, monitoring, and policymaking are some immediate necessary steps to improve food safety situations and safe food accessibility in Bangladesh.

Developing Geographic Areas for Cancer Reporting Using Automated Zone Design.

The reporting and analysis of population-based cancer statistics in the United States has traditionally been done for counties. However, counties are not ideal for analysis of cancer rates, due to wide variation in population size, with larger counties having considerable sociodemographic variation within their borders and sparsely populated counties having less reliable estimates of cancer rates that are often suppressed due to confidentiality concerns. There is a need and an opportunity to utilize zone design procedures in the context of cancer surveillance to generate coherent, statistically stable geographic units that are more optimal for cancer reporting and analysis than counties. To achieve this goal, we sought to create areas within each US state that are: 1) similar in population size and large enough to minimize rate suppression; 2) sociodemographically homogeneous; 3) compact; and 4) custom crafted to represent areas that are meaningful to cancer registries and stakeholders. The resulting geographic units reveal the heterogeneity of rates that are hidden when reported at the county-level while substantially reducing the need to suppress data. We believe this effort will facilitate more meaningful comparative analysis of cancer rates for small geographic areas and will advance the understanding of cancer burden in the United States.

Sociodemographic variation in prescriptions dispensed in early pregnancy in Northern Ireland 2010-2016.

AimTo establish the prevalence of prescriptions dispensed in early pregnancy by maternal age and area deprivation, for women who gave birth in Northern Ireland (NI) 2011–2016.Study designPopulation-based linked cohort study.MethodsThe NI Maternity System (NIMATS) database was used to identify all births to resident mothers in NI between 2011 and 2016. Prescriptions dispensed between the last menstrual period (LMP) and the first antenatal care visit (mean 10.7 weeks) (2010–2016) were extracted from the Enhanced Prescribing Database (EPD) which records all prescriptions dispensed by pharmacists in NI. EPD data were linked to NIMATS using the mother’s Health and Care Number. Maternal deprivation based on the NI Multiple Deprivation Measure 2017 was linked using the mother’s postcode.ResultsThe cohort included 139,687 pregnancies resulting in live or stillbirths to 106,206 women. A medication was dispensed in 63.5% of pregnancies, and in 48.7% of pregnancies excluding supplements (vitamins, iron, and folic acid). Folic acid was the most commonly dispensed medication (33.1%). Excluding supplements, the mean number of medications was 1.1, with 4.2% having ≥5 medications. The most common non-supplement medications were antibiotics (13.1%), antiemetics (8.7%), analgesics (6.9%), hormonal medications (6.9%) and antidepressants (6.1%). Younger women (<20 years) had more antibiotics while older women (40+ years) had more antidepressants, cardiovascular, antihypertensives, anticoagulant medications and thyroxine. The proportion of women living in the most deprived areas with prescriptions for antidepressants, sedatives, tranquilisers, analgesics, and anti-epileptic medications was double the proportion of women with these medications in the least deprived areas.ConclusionHalf of all pregnant women in NI were dispensed a non-supplement medication between LMP and the first antenatal care visit. Younger and older mothers and those living in the most deprived areas were more likely to have medications dispensed. More antidepressants were dispensed in areas of social deprivation.

Geographic, Occupational, and Sociodemographic Variations in Uptake of COVID-19 Booster Doses Among Fully Vaccinated US Adults, December 1, 2021, to January 10, 2022

COVID-19 booster vaccine can strengthen waning immunity and widen the range of immunity against new variants. To describe geographic, occupational, and sociodemographic variations in uptake of COVID-19 booster doses among fully vaccinated US adults. This cross-sectional survey study used data from the Household Pulse Survey conducted from December 1, 2021, to January 10, 2022. Household Pulse Survey is an online, probability-based survey conducted by the US Census Bureau and is designed to yield estimates nationally, by state, and across selected metropolitan areas. Receipt of a booster dose was defined as taking 2 or more doses of COVID-19 vaccines with the first one being the Johnson and Johnson (Janssen) vaccine, or taking 3 or more doses of any of the other COVID-19 vaccines. Weighted prevalence estimates (percentages) were computed overall and among subgroups. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to explore correlates of receiving a booster dose among those fully vaccinated. A total of 135 821 adults completed the survey. Overall, 51.0% were female and 41.5% were aged 18 to 44 years (mean [SD] age, 48.07 [17.18] years). Of fully vaccinated adults, the percentage who reported being boosted was 48.5% (state-specific range, from 39.1% in Mississippi to 66.5% in Vermont). Nationally, the proportion of boosted adults was highest among non-Hispanic Asian individuals (54.1%); those aged 65 years or older (71.4%); those with a doctoral, professional, or master's degree (68.1%); those who were married with no children in the household (61.2%); those with annual household income of $200 000 or higher (69.3%); those enrolled in Medicare (70.9%); and those working in hospitals (60.5%) or in deathcare facilities (eg, funeral homes; 60.5%). Conversely, only one-third of those who ever received a diagnosis of COVID-19, were enrolled in Medicaid, working in pharmacies, with less than a high school education, and aged 18 to 24 years old were boosted. Multivariable analysis of pooled national data revealed that compared with those who did not work outside their home, the likelihood of being boosted was higher among adults working in hospitals (APR, 1.23; 95% CI, 1.17-1.30), ambulatory health care centers (APR, 1.16; 95% CI, 1.09-1.24), and social service settings (APR, 1.08; 95% CI, 1.01-1.15), whereas lower likelihood was seen among those working in food or beverage stores (APR, 0.85; 95% CI, 0.74-0.96) and the agriculture, forestry, fishing, or hunting industries (APR, 0.83; 95% CI, 0.72-0.97). These findings suggest continuing disparities in receipt of booster vaccine doses among US adults. Targeted efforts at populations with low uptake may be needed to improve booster vaccine coverage in the US.

Health-Related Quality of Life and Its Socio-Demographic and Behavioural Correlates during the COVID-19 Pandemic in Estonia.

The aim of the study was to analyse health-related quality of life (HRQoL) among the Estonian general population and its socio-demographic and behavioural correlates during the COVID-19 pandemic. Longitudinal data on 1781 individuals from an Estonian rapid-assessment survey on COVID-19 were used. HRQoL was assessed with the EQ-5D-3L in June 2020 (baseline) and in May 2021 (follow-up). The HRQoL index score and its socio-demographic and behavioural variations were analysed using paired t-tests and Tobit regression modelling. Statistically significant declines in mean EQ-5D index scores were observed for all socio-demographic and behavioural variables considered. Most of these changes were due to increased reporting of problems in the pain/discomfort and anxiety/depression health domains. Older age, being unemployed or economically non-active and having financial difficulties were significantly associated with lower HRQoL in both baseline and follow-up measurements. In the follow-up data, women had significantly lower HRQoL compared to men, whereas higher education proved to be the only protective factor regarding HRQoL. Unhealthy dietary habits and low physical activity had a negative impact on the HRQoL score in the follow-up data. These results indicate that the COVID-19 pandemic has had a substantial impact on HRQoL in the Estonian population.

Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic.

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

Disparities in Receipt of Smoking Cessation Assistance Within the US

This cross-sectional study analyzes sociodemographic variations in receiving smoking cessation assistance from health professionals by individuals who reported smoking, or quitting, within the past year.

Socio-demographics, Social Support and Adherence: A Cross-sectional Descriptive Perspective of users of Antiretroviral Therapy in a Nigerian Secondary Health Facility

Studies in varied resource settings report consistent trends in benefits among Clients adherent to Antiretroviral Therapy (ART). Social support in this instance may potentiate treatment outcomes. This study aims to determine the socio- demographics, social support and adherence to ART among clients accessing care at a General Hospital in Nigeria. This is a descriptive cross-sectional study of a sample of 340 clients determined using Cochran formula and selected via systematic sampling. Data collection is by interview via semi-structured questionnaire. Analysis is by statistical package for social sciences version 22.0. Tests of associations are with chi-square test with alpha set at &lt; 0.05. The study reveals bimodal age groups. Males are 122 (35.9%),43 (12.7%) are long distant commercial vehicle drivers, 25 (7.4%) are hospitality workers, while113 (32.2%) reports receipt of social support and298 (87.7%) adherence to HAART. An association exists between social support and adherence (p=0.000).In summary, the survey finds socio-demographic variations, with association between social support and adherence. There is need for behavioral change interventions that target variations in socio- demographics in enhancing adherence via good social support.

Preventive Behaviour of Adults and Its Predictors in Response to COVID-19 Pandemic in Rural Bangladesh: Findings from a Community Survey

Background: Bangladesh with its large population is highly vulnerable to the devastating blows of coronavirus disease 2019 (COVID-19) and rural people are more at risks due to demographic characteristics and unequal health facilities. Currently, focuses are more on testing and clinical management of COVID-19 but initiatives or innovations on behavioural changes are almost unseen to prevent the spread of the disease which is more urgent until getting specific treatment or vaccine. Objective: The study was aimed to determine significant predictors in the preventive health practices during COVID-19 pandemic. Methods: The study was conducted among 810 rural adults of Bangladesh in 2020. Multistage sampling method was done and data were collected through face-to-face interview using a pretested questionnaire. Significant factors of COVID-19 prevention behaviour were determined through hierarchical regression and path relationships were explained through causal model. Results: Almost half of the rural adults showed poor COVID-19 prevention behaviour during the pandemic crisis. Poor knowledge and attitude regarding COVID-19 prevention were also common scenarios in rural areas. Majority of the rural adults were not well motivated and lack of seriousness made them more vulnerable for COVID-19. Socio-demographic and regional variation showed significance predicting health practices of rural adults regarding COVID-19 prevention. Information, attitude, motivation and intention were also found significant in hierarchical regression to predict the outcome. The causal model of preventive health behaviour was justified through all the significant direct and indirect path relationships (p&lt;0.001). Conclusion: Socio-economic disparity should be reduced for behavioural changes of rural adults to ensure healthy practices during the pandemic. This study has great implications regarding designing health programs by emphasizing significant predictors to improve community behaviour to prevent the spread of coronavirus. Bangladesh Med Res Counc Bull 2021; 47(1): 9-16

Dietary intake and its associated factors among in-school adolescents in Ghana.

Early-life nutrition related experiences may fuel the emergence of obesity and type 2 diabetes in adolescence. The adoption of unhealthy dietary practices early in life is an indicator of adverse cardiometabolic health in adulthood. In-school adolescents' dietary practices in Ghana have not been explored extensively despite increasing levels of obesity in adolescents. This study sought to examine dietary practices, socio-demographic disparities and the factors influencing dietary choices among in-school adolescents in Ghana. A school-based, cross-sectional study was conducted in the Central region of Ghana in 2017. Using multistage sampling procedures, a total of 1,311 in-school adolescents were selected for the study. A modified version of the generic Global School Health Survey questionnaire on dietary practices was adapted and used for data collection. Percentage and frequency counts were used to report on the dietary practices, while Chi-square was used to determine socio-demographic variations in the dietary practices. Binary logistic regression was used to compute the influence of socio-demographic characteristics of respondents on the prevalence of healthy dietary behavior among in-school adolescents. The study revealed the prevalence of healthy dietary practices (49.9%, n = 654) among in-school adolescents in the region. The study also found increased frequency in consumption of soft drinks (93%, n = 1220) and toffees/sweets (90%, n = 1183) among in-school adolescents. However, low intake of breakfast (57%, n = 749) was observed among the adolescents. Significant disparities were observed in relation to gender, age, parental communication, academic performance and geographical location in the dietary practices of in-school adolescents. Furthermore, gender (OR = 1.36, P = 0.007), academic performance (OR = 2.19, P = 0.001) and geographical location (OR = 1.79, P = 0.001) were found to be significantly associated with dietary practices among in-school adolescents in the region. There was low consumption of fruits and vegetables among adolescents. Fruits and vegetables consumption was associated with gender, academic performance and geographical location, and these may be a reflection that knowledge on healthy food choices and availability are important factors influencing dietary choices among in-school adolescents. School health policy interventions aimed at improving nutritional status among adolescents and enhanced fruit and vegetable consumption in the country should take into account the potential benefit of increasing availability of fruits and vegetables in schools, while reducing access to sweets and soft drinks in the schools and communities.

Socio-Demographic Variations on Age-Sex Mortality in Namibia: An Analysis of the 2016 Civil Registration and Vital Statistics Data

Mortality studies are important for the effectiveness of subsystem of health services in a country. Before the Coronavirus pandemic outbreak, there has been a gradual decline in the global mortality indicators, which can be linked to the improving economic development and social wellbeing of the global population, especially, in developing regions such as East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. This decline in mortality and the high fertility in developing countries are the contributing factors to the increase on global population. Apart from the aggregated frequencies of deaths and crude death rates reported in population census reports, little to no attention has been paid to detailed inference mortality analysis with respect to the age-sex variation perspective in Namibia. Thus, this paper used the negative binomial regression modelling technique to perform an inference mortality analysis across all ages and both sexes in the country as well as across regions and marital status using the 2016 Civil Registration Vital systems data from the Ministry of Home Affairs and Immigration. Results showed that there was a significant relationship between mortality and theindividuals' age, sex, marital status and region. In addition, Oshana, Kavango East, Khomas, Hardap and Omaheke regions had high mortality rates, while infants and elderly individuals had a high probability of dying. Furthermore, the study revealed that individuals who were single and aged 15-59 and 5-14 years had less expected death count. Hence, it is recommended that interventions (such as affordable and proper health care and well-being services) targeted at the (most) vulnerable age groups, marital group and regions be made a priority, in order to meet Sustainable Development Goal 3.

Unmet need for treatment-seeking from public health facilities in India: An analysis of sociodemographic, regional and disease-wise variations.

Treatment-seeking behaviour is closely associated with the health status of individuals and countries. About 800 million people have no access to health services in the developing world. Though the situation has been improving, the inequalities across geographical regions, socioeconomic status, and disease types continued to persist. The available literature suggests research gaps in examining the unmet need for treatment-seeking from public health facilities across sociodemographic characteristics, regions, and specific diseases. Data for this study comes from the three rounds of National Sample Survey (NSS) (2004, 2014, 2018). We applied descriptive, bivariate, and multivariable analysis to investigate the unmet need for treatment-seeking for public health facilities across sociodemographic characteristics, regions, and specific diseases between 2004 and 2018. The unmet need for treatment-seeking from public health facilities remained high at 60% in 2004 to 62% in 2018. However, the proportion of respondents who did not seek treatment has reduced 12% to 3% from 2004 to 2018. In states like Andhra Pradesh, Madhya Pradesh, Maharashtra, Punjab, Telangana, Uttar Pradesh, and West Bengal, the unmet need for treatment-seeking from public health facilities was more than 60% in 2018. For 2018, the quality of services at public health facilities was the main reason for showing a higher unmet need for treatment-seeking in the richer MPCE quintiles. On the other hand, the ailment not considered serious as the main reason for the unmet need for treatment-seeking from any sources has got nearly doubled from 36% in 2004 to 71% in 2018. This study concludes that improving the availability of various kinds of services at public health facilities should be a priority under India's universal health coverage program. Education plays a vital role in treatment-seeking. Thus, there is an urgent need for increasing awareness among people for treatment-seeking. Ensuring a minimum quality of health care services and reducing long waiting timing would reduce the apathy to receive services from the public health facilities.

Incidence patterns of childhood non-Wilms renal tumors: Comparing data of the Nationwide Registry of Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST), Greece, and the Surveillance, Epidemiology, and End Results Program (SEER), USA

BackgroundWe used, for the first time, data registered in the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST)-Greece to estimate incidence/time trends of the rare childhood (0–14 years) non-Wilms tumors (non-WT), and compared the results of malignant non-WT to those from the Surveillance, Epidemiology, and End Results Program (SEER)-USA. MethodsFifty-five cases (n = 33 malignant-only) were extracted from NARECHEM-ST (2001–2020) and 332 malignant cases from SEER (1990–2017). To allow between-country comparisons, age-standardized incidence rates (AIR) of malignant-only non-WT were calculated, and temporal trends were evaluated using Poisson and joinpoint regressions. ResultsIn NARECHEM-ST, malignant and non-malignant non-WT accounted for 22.6% of all renal tumors. Among malignant tumors, the AIR was 1.0/106 children in Greece, similar to that calculated for SEER, USA (AIR=0.9/106). The proportion of infant malignant and non-malignant non-WT was 27% (20% before 6 months) in NARECHEM-ST. Most common non-WT in Greece were congenital mesoblastic nephromas (CMN) diagnosed mainly in infancy (CIR=7.2/106). The proportion of infant malignant non-WT was 20% in SEER (AIRinfancy=2.5/106), mainly attributed to rhabdoid tumors (CIR=1.6/106). The male-to-female (M:F) ratio of malignant non-WT was 0.9 in NARECHEM-ST vs. 1.2 in SEER, whereas boys outnumbered girls with clear cell sarcoma in NARECHEM-ST (M:F=4.0). Lastly, significantly increasing trends in incidence rates were noted in NARECHEM-ST [+ 6.8%, 95% confidence intervals (CI): 0.5, 13.3] and in SEER (+7.3%, 95%CI: 5.6, 9.0). ConclusionsObserved incidence, time trends and sociodemographic variations of non-WT may reflect differential registration practices and healthcare delivery patterns including differences regarding surveillance, coding and treatment practices.

251 Sociodemographic and clinical variation in rates of hospitalization for diabetic ketoacidosis

OBJECTIVES/GOALS: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. Though largely preventable, DKA is one of the most common acute complications of diabetes. In the US, rates of DKA hospitalization and associated costs have been increasing over the past two decades. METHODS/STUDY POPULATION: In this study, we used the Kentucky Statewide Inpatient Database (2010-2019) and the Nationwide Readmission Database (2010-2018) to explore variation in rates of DKA hospitalization across key sociodemographic subgroups (age, sex, race/ethnicity, rural/urban, insurance coverage, and county-level poverty index) and identify clinical predictors of DKA hospitalization. The primary outcome was hospitalization with a first diagnosis of DKA identified using ICD-9 and -10 codes. Crude rates were calculated using state- and county-level population estimates obtained from the US Census Bureau and are presented as the total number of events per 10,000 people. Regression models will be used to examine the associations between DKA hospitalization and clinical predictors. RESULTS/ANTICIPATED RESULTS: In Kentucky, from 2010-2019, rates of DKA hospitalization increased by 45% (from 65.5 to 94.8 per 100,000). The largest variation was observed by age, race/ethnicity, and insurance. In those aged 15-44, rates of DKA hospitalization were three times higher than rates in the youngest (&lt;15) and oldest (&gt;75) groups (&gt;130 vs &lt;45 per 100,000). Non-Hispanic Blacks experienced rates of DKA hospitalization that were 2x higher than rates observed in non-Hispanic Whites (183.9 vs 92.6 per 100,000). Those covered by Medicaid had the highest rates of DKA hospitalization (171.3 vs 32.4 per 100,000 in commercially insured). Small, but consistent, disparities were observed in rural vs urban counties and higher poverty rates. Predictors of DKA hospitalization are being examined in the Nationwide Readmission Database. DISCUSSION/SIGNIFICANCE: Our findings underscore significant variation in DKA risk across key sociodemographic subgroups and will examine and confirm previously identified clinical predictors of DKA. Because DKA is largely preventable, identifying individuals at higher risk and targeting interventions and services to these individuals may help reduce DKA rates.

Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020.

The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.

Prevalence of Depression and Anxiety among Doctors Working in Emergency Units in Al-Madinah, Saudi Arabia, 2021

Background: Depression and anxiety are familiar for most people these days . Almost no one in this world is free from these “Anxiety” and “Depression”. Demanding profession has been associated with poor psychological health due to multiple factors such as overworking hours and night shifts.&#x0D; Objective: To estimate the prevalence of Depression and anxiety among doctors working in emergency units in Almadinah, 2021 and to correlate the level of Depression and anxiety according sociodemographic variations and work-related variation. &#x0D; Methods: A descriptive cross-sectional study was conducted in Al-Madinah city. All doctors who working in emergency department in governmental and private hospitals in Al-Madinah City during the study period was included. All doctors start working in emergency department less than two weeks and doctors who specialized other than Emergency Medicine were excluded.&#x0D; Results: the score of depression level was normal in 46.5% of our participants, abnormal in 26.2% and borderline abnormal in 27.2%. The score of anxiety level was normal in 23.3% of our participants and borderline abnormal in 26.7% and was abnormal in 50.0%. There is significant correlation between anxiety and marital status, number of children, average monthly income, hospital type, position and specialty (P&lt;0.05). There is significant correlation between anxiety and nationality, number of children, average monthly income, hospital type, position and specialty (P&lt;0.05).&#x0D; Conclusion: We have shown that ER physicians are at high risk of experiencing anxiety and depressive symptoms. There is significant correlation between anxiety and depression and number of children, average monthly income, hospital type, position and specialty.