United States Census Data Research Articles

The epidemiology of recreation-related cervical and thoracic fractures

CONTEXTRecreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking. PURPOSETo characterize cervical and thoracic fractures associated with recreational activities. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEThe National Electronic Injury Surveillance System (NEISS) database OUTCOME MEASURE AND COMPARISONSRecreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics. METHODSThe NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity. RESULTSBetween 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38–3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18–64 (95% CI 1.85–2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68–2.22). Recreation-related cervical fracture rates in individuals 18–64 was 1.186 (95% CI 1.14–1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09–1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18–64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%). CONCLUSIONSThis investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football. LEVEL OF EVIDENCELevel III.

Assessing social disparities in inpatient vs. outpatient arthroplasty: a in-state database analysis.

Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty. Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture. Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications. Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention.

Sociodemographic Disparity of Asthma Calls in Wichita, Oklahoma City, and Tulsa

Asthma is a chronic respiratory disease that effects millions of people worldwide and disproportionately effect different sociodemographic groups, leading to injustices. These disproportionate effects are well documented in large cities. This study documents the distribution of asthma calls across different sociodemographic groups in the smaller cities of Wichita, Kansas, Tulsa, Oklahoma, and Oklahoma City, Oklahoma. Utilizing data from the 2010 United States Census and emergency medical service data, this study reveals that asthma calls are more prevalent in areas with higher concentrations of minority and low-income populations. This study underscores the significance of geographic and socioeconomic disparities in asthma occurrences and the need for targeted public health interventions to address these challenges.

(320) Erectile Dysfunction and Men’s Health Websites: How diverse is our Racial, Ethnic, and Sexual Orientation Representation?

Abstract Introduction Images featured in patient educational materials can enhance comprehension of medical conditions, particularly those associated with sensitive issues like erectile dysfunction (ED). Past research indicates that minority men are often underrepresented in online urological content and thus may not relate to the material. Objective The present study aims to evaluate the representation of racial, ethnic, and sexual orientation diversity in ED and men’s health content on reputable urology program websites. Methods Websites of the top urology departments from U.S. News &amp; World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically. Race was also interpreted using a numeric scale, Fitzpatrick skin rating, and median ratings classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively. Spearman’s rank correlation was used to measure inter-rater reliability of Fitzpatrick ratings and MedCalc’s z-test used to compare diversity proportions to national rates from census data. Results The top 50 ranked urology program websites were reviewed. Seven programs did not have any patient-facing ED or men’s health web pages. Nearly half of programs with sites did not contain any human images (n=19/43, 44%). A total of 113 images were collected and reviewed. Race in the 102 (90.3%) interpretable images included 6 (5.9%) Asian, 16 (15.7%) black, 75 (73.5%) white, and 5 (4.9%) other men. Latino men were represented in 3/70 (4.3%) images. Utilizing Fitzpatrick ratings, 94 (83.2%) subjects were classified as white and 19 (16.8%) non-white. Most images [67 (59.3%)] demonstrated a man without a partner which precluded sexual orientation evaluation. Of those pictured with a partner, 25 (92.6%) were interpreted as heterosexual and 2 (7.4%) as same sex. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.66-0.69. Table 1 compares interpreted image data to population benchmarks from United States census data. Conclusions Limited imagery on academic urology ED websites continues to underrepresent some groups, namely Latinos. Although men in same sex relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online men’s health, and namely ED, content is needed. Disclosure No.

The Pernicious Predictability of State-Mandated Tests of Academic Achievement in the United States

The purpose of this study was to determine the predictiveness of community and family demographic variables related to the development of student academic background knowledge on the percentage of students who pass a state-mandated, commercially prepared, standardized Algebra 1 test in the state of New Jersey, USA. This explanatory, cross-sectional study utilized quantitative methods through hierarchical regression analysis. The results suggest that family demographic variables found in the United States Census data related to the development of student academic background knowledge predicted 75 percent of schools in which students achieved a passing score on a state standardized high school assessment of Algebra 1. We can conclude that construct-irrelevant variance, influenced in part by student background knowledge, can be used to predict standardized test results. The results call into question the use of standardized tests as tools for policy makers and educational leaders to accurately judge student learning or school quality.

883. The Current State of Access: Inequitable Access to Infectious Disease Physicians in the Time of the COVID-19 Pandemic and Declining Fellowship Match Rates

Abstract Background Equitable access to specialty care is a key component of population health. Guidelines recommend specialty care within a 60-minute (min) drive. In 2017, 80% of United States (US) counties had no Infectious Diseases (ID) physicians. In the setting of the COVID-19 pandemic and declining fellowship match rates, we characterized inequities in geographic access to ID physicians in the US. Methods We geocoded the location of ID physicians from 2020 Medicare Provider Utilization and Payment Data. For people in the contiguous US, we conducted a cross-sectional analysis of one-way drive times to the closest ID physician overall and by age, gender, racial, and ethnic subgroups using 2020 US Census data. We calculated the median drive times and the proportion of each subgroup within x minutes to the nearest ID physician. Results We identified 6000 ID physicians at 2582 locations (Fig 1). Fig 2 demonstrates one-way drive times. In the US, 7.9% of people live &amp;gt; 60 min from ID specialty care. When stratified by rural/urban, 46.7% of rural people and 1.6% of urban people live &amp;gt; 60 min from the closest ID physician (Fig 3). Rural people had a median drive time of 57.2 min (95% CI 56.6-57.9) while urban people had a median drive time of 10.9 min (10.8-11.0). For people who identify as American Indian and Alaska Native (AIAN), 70.3% in rural areas and 8.8% in urban areas live &amp;gt; 60 min from the closest ID physician. For rural AIAN populations, median drive time was 95.1 min (86.0-104.1). For rural populations, the median drive time was &amp;gt; 60 min for those who identify as Native Hawaiian and Other Pacific Islander (69.1; 64.5-75.8), multiple races (65.5; 63.7-67.6), or Hispanic (66.9; 65.0-68.7). Conclusion Access to ID specialty care is inequitable. The largest disparities exist between rural and urban populations. Significant disparities exist for the AIAN population. In ID, we need recruitment and retention of our current workforce and recruitment of people who will serve rural and AIAN communities. If telemedicine continues to be supported, it could help to reduce disparities. This is also dependent on equitable access to high-speed internet, which is concentrated in urban/suburban areas. Without initiatives to expand the ID workforce and to increase internet access in rural areas, disparities in access will not improve. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc.: Stocks/Bonds

Public Perceptions and Informational Needs Regarding Surgical Residents

Identify what topics are of most interest to patients regarding surgical residents. Survey of general public describing a hypothetical surgery and then assessing comfort level with resident involvement in surgery, reactions to disclosure statements regarding resident involvement, and desires for additional information. This data was used to produce an amended statement about surgical residents and their involvement in a hypothetical surgery to determine the impact of increased information on participant comfort. Online survey via Mechanical Turk. Our sample was broadly representative of the United States based on race and age, but with higher education level than United States census data. Using a combination of hierarchical clustering, weighted averages, and VAS scoring, questions that were most highly valued by participants were related to what the resident will be doing in the operation and the impact of resident involvement. Participants who had a past negative experience with residents assigned higher importance to all questions, even those that may be seen as not clinically relevant. Increasing the amount of proactively provided information did not have a significant effect on comfort (p = 0.219) when compared to our baseline statement, except with those who reported past negative experience with residents (p = 0.039). These results demonstrate that the majority of potential patients want to know specific details about the residents' skills, what they will be doing in their surgery, and the impact of their participation. Surgeons should be attuned to patients with past negative experiences, who may desire more information. Additional information alone may not be sufficient to comfort some patients, and future research should consider information delivery styles and interpersonal effects on patient comfort level.

Importance of social vulnerability on long-term outcomes after heart transplantation

The relationship between social determinants of health and outcomes after heart transplantation has not been examined. The social vulnerability index (SVI) uses United States census data to determine the social vulnerability of every census tract based on 15 factors. This retrospective study seeks to examine the impact of SVI on outcomes after heart transplantation. Adult heart recipients who received a graft between 2012 and 2021 were stratified into SVI percentiles of <75% and SVI of ≥75%. The primary endpoint was survival. The median SVI was 48% (interquartile range: 30%-67%) among 23 700 recipients. One-year survival was similar between groups (91.4 vs 90.7%, log-rank P = .169); however, 5-year survival was lower among individuals living in vulnerable communities (74.8% vs 80.0%, P < .001). This finding persisted despite risk adjustment for other factors associated with mortality (survival time ratio 0.819, 95% confidence interval: 0.755-0.890, P < .001). The incidences of 5-year hospital readmission (81.4% vs 75.4%, P < .001) and graft rejection (40.3% vs 35.7%, P = .004) were higher among individuals living in vulnerable communities. Individuals living in vulnerable communities may be at increased risk of mortality after heart transplantation. These findings suggest there is an opportunity to focus on these recipients undergoing heart transplantation to improve survival.

Disparities in fertility preservation in rural adolescent and young adult patients with hematologic malignancies.

e18764 Background: As survival of patients with hematologic malignancies improves, quality of life (QOL) measures have gained importance. Cancer therapies can have a deleterious impact on fertility in patients of childbearing age. Previous studies have highlighted disparities in access to oncology care in rural patients, with negative effects on health outcomes and QOL. This study aims to explore the impact of rurality on fertility preservation in adult young adult (AYA) population. Methods: The study examined patients with a new diagnosis of acute leukemia or lymphoma, ages 15-39, between 2017-2022 at the University of Vermont Medical Center. These included Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), Hodgkin’s lymphoma, and Non-Hodgkin’s lymphoma. We identified 145 patients and collected data on demographics, insurance, zip codes, cancer diagnoses and whether referral to fertility preservation was requested. Rurality was determined using United States census data, with Rural-Urban Commuting Area (RUCA) codes 1-3 considered urban, and codes 4-10 being considered rural. Results: Of the 145 patients, majority resided in rural (N = 81 or 56%) as compared to urban areas (N = 64 or 44%). Majority of patient did not receive a referral for discussion of fertility preservation (N = 77 or 53%). Of the patients that were referred, more urban patients received referrals (N = 38 or 56%), compared to rural cancer patients (N = 30 or 44%), and this difference was statistically significant (OR = 2.5, 95% CI 1.2-5.14, p = 0.0074). The type of insurance the patient had impacted referral rates. Patients with private insurances were more likely to receive a referral compared to those who had no insurance or had Medicare/Medicaid, (N = 41 or 60% vs. N = 27 or 40%) and this difference was also statistically significant (OR = 2.13, 95% CI 1.04-4.38, p = 0.0243). Conclusions: We find that rural AYA patients with hematologic malignancies were less likely to receive referral for fertility preservation, compared to their urban counterparts. Patients with private insurances had the highest rates of referrals, while patients with Medicare/Medicaid or no insurance were less likely to be referred. This study highlights disparities in access to fertility preservation in rural cancer patients, with significant potential impact on quality of life.

Evaluating Demographic Representation in Clinical Trials: Use of the Adaptive Coronavirus Disease 2019 Treatment Trial (ACTT) as a Test Case.

Clinical trials initiated during emerging infectious disease outbreaks must quickly enroll participants to identify treatments to reduce morbidity and mortality. This may be at odds with enrolling a representative study population, especially when the population affected is undefined. We evaluated the utility of the Centers for Disease Control and Prevention's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), the COVID-19 Case Surveillance System (CCSS), and 2020 United States (US) Census data to determine demographic representation in the 4 stages of the Adaptive COVID-19 Treatment Trial (ACTT). We compared the cumulative proportion of participants by sex, race, ethnicity, and age enrolled at US ACTT sites, with respective 95% confidence intervals, to the reference data in forest plots. US ACTT sites enrolled 3509 adults hospitalized with COVID-19. When compared with COVID-NET, ACTT enrolled a similar or higher proportion of Hispanic/Latino and White participants depending on the stage, and a similar proportion of African American participants in all stages. In contrast, ACTT enrolled a higher proportion of these groups when compared with US Census and CCSS. The proportion of participants aged ≥65 years was either similar or lower than COVID-NET and higher than CCSS and the US Census. The proportion of females enrolled in ACTT was lower than the proportion of females in the reference datasets. Although surveillance data of hospitalized cases may not be available early in an outbreak, they are a better comparator than US Census data and surveillance of all cases, which may not reflect the population affected and at higher risk of severe disease.

PD20-01 CLINICAL TRIAL REPORTING AND REPRESENTATION OF RACE AND ETHNICITY IN UROLOGY 2007-2020

You have accessJournal of UrologyCME1 Apr 2023PD20-01 CLINICAL TRIAL REPORTING AND REPRESENTATION OF RACE AND ETHNICITY IN UROLOGY 2007-2020 Christopher J. Magnani, Brandon E. Turner, Jecca R. Steinberg, Xinyuan Zhang, Ryan Brewster, Jason Qian, Alexander P. Cole, Conor Driscoll, Alexander Bell, Brannon T. Weeks, Tina Hernandez-Boussard, James D. Brooks, Kymora Scotland, Quoc-Dien Trinh, and Elodi J. Dielubanza Christopher J. MagnaniChristopher J. Magnani More articles by this author , Brandon E. TurnerBrandon E. Turner More articles by this author , Jecca R. SteinbergJecca R. Steinberg More articles by this author , Xinyuan ZhangXinyuan Zhang More articles by this author , Ryan BrewsterRyan Brewster More articles by this author , Jason QianJason Qian More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Conor DriscollConor Driscoll More articles by this author , Alexander BellAlexander Bell More articles by this author , Brannon T. WeeksBrannon T. Weeks More articles by this author , Tina Hernandez-BoussardTina Hernandez-Boussard More articles by this author , James D. BrooksJames D. Brooks More articles by this author , Kymora ScotlandKymora Scotland More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Elodi J. DielubanzaElodi J. Dielubanza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess reporting and representation of race and ethnicity in United States (US) based clinical trials focused on urology. METHODS: We performed a cross-sectional study of US based trials (2007-2020) with results reported to the ClinicalTrials.gov registry. We examined whether race and ethnicity data were reported, evaluated changes over time with Mann-Kendall trend test, and compared race and ethnicity representation (proportion of enrolled participants reported as White, Black, Hispanic, Asian, or Native American) within trial funding sponsor (Industry, US Government, Academic) and urologic subspecialty (Oncology, Andrology, Endourology, Female, General Urology, Pediatrics, Renal Transplant). RESULTS: Of 9,015 urologic trials, 39.7% (3,583) were US-based of which 837 (23.4%) reported results to the registry. 417 (49.8%) reported any race and ethnicity data, involving 37,465 participants. Reporting increased over time (Figure 1, p<0.001). Reporting was significantly associated with sponsor (p<0.001, US Government outperforming Industry and Academic) and subspecialty (p=0.02, highest with Oncology and lowest with Endourology and General Urology) (Table). Racial and ethnic minorities (15.0%) were underrepresented relative to US Census data (27.6%), most notable with Hispanic patients (3.6% vs 15.4%, respectively). Trial diversity was significantly associated with subspecialty (p<0.001) but not sponsor (p=0.18). Oncology (13.3%) and Female (12.7%) had the least trial diversity while Pediatrics (30.6%) and Renal Transplant (41.0%) were the most diverse. CONCLUSIONS: Inadequate reporting of race and ethnicity data in clinical trials impedes understanding of barriers to trial diversity. Reported data demonstrates urologic clinical trials are not representative of the US population. This lack of representation perpetuates health disparities, with serious repercussions for underrepresented groups and for the field as a whole. Urology as a field should strive to improve diversity in clinical trial enrollment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e583 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher J. Magnani More articles by this author Brandon E. Turner More articles by this author Jecca R. Steinberg More articles by this author Xinyuan Zhang More articles by this author Ryan Brewster More articles by this author Jason Qian More articles by this author Alexander P. Cole More articles by this author Conor Driscoll More articles by this author Alexander Bell More articles by this author Brannon T. Weeks More articles by this author Tina Hernandez-Boussard More articles by this author James D. Brooks More articles by this author Kymora Scotland More articles by this author Quoc-Dien Trinh More articles by this author Elodi J. Dielubanza More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract A054: Disparities in the availability of neuro-oncology clinical providers and infrastructure in the United States

Abstract BACKGROUND: Barriers to clinical trial access have significant implications for patient care. Motivated by previous work which identified geographical and socioeconomic disparities in neuro-oncology trials’ accessibility in the United States (US), we assessed the role of these factors on the availability of neuro-oncology providers and member institutions of trial collaboratives and community outreach programs. METHODS: US Census data on population and geography and the Neighborhood Atlas’ Area Deprivation Index (ADI) were obtained. Data on UCNS-certified neuro-oncology subspecialists, NRG Oncology Main Member institutions, and NCI Community Oncology Research Program (NCORP) sites were obtained and mapped to 5-digit zip code tabulation areas (ZCTAs) using Google Geocode. Linear and logistic regression and spatial analyses were conducted in R using the spdep and spatialreg libraries, to assess the role of geography, disadvantage, and population on infrastructure accessibility. RESULTS: We identified 316 neuro-oncologists, 130 NRG institutions, and 963 NCORP sites, in 0.6%, 0.4%, and 2.2% of all ZCTAs in the US (N = 33120), respectively. Neuro-oncologists and NRG institutions were more likely to exist in more populated (OR=1.86, p&amp;lt;0.001; OR=1.80, p&amp;lt;0.001) and less-disadvantaged (OR=0.98, p&amp;lt;0.001; OR=0.98, p&amp;lt;0.001) regions, reflecting urban-rural and socioeconomic disparities. Moreover, neuro-oncologists were more likely to exist in geographically adjacent regions (OR=320.594, p&amp;lt;0.001), while NRG institutions were geographically more broadly distributed (OR=1.49, p=0.859). Where existent, a greater number of neuro-oncologists served less-disadvantaged regions (β=-0.014, p=0.021), while the number of NRG institutions was more equitably distributed overall (Moran’s I data=0.002, p=0.394; Moran’s I residuals=0.002, p=0.489; population: β=0.004, p=0.778; ADI: β=-0.0001, p=0.919). On the other hand, NCORP sites were more likely to exist in areas of greater disadvantage (OR=1.01, p=0.001), reflecting the NCORP mission to reach more diverse communities. However, NCORP sites were more likely to exist and were more prevalent among more populated (OR=2.79, p&amp;lt;0.001; β=0.076, p=0.007) and geographically adjacent regions (OR=8.23, p&amp;lt;0.001; ρ=0.120, p&amp;lt;0.001), reflecting urban-rural disparities. CONCLUSION: The identified disparities in availability of neuro-oncologists and institutions capable of hosting clinical trials may explain the previously reported disparities in trial sites. Disparities in neuro-oncologist availability suggest the need for neuro-oncology specific measures involving telehealth and local oncologists. The more equitable geographic and socioeconomic distribution of NRG institutions, and the more equitable socioeconomic distribution of NCORP sites reaffirm the importance of the mission and ability of such initiatives to bridge geographic and socioeconomic barriers. Finally, the existence of disparities across all infrastructure levels raises the concern that these disparities reflect broader disparities in access to neuro-oncology care. Citation Format: Yeonju Kim, Terri S. Armstrong, Mark R. Gilbert, Orieta Celiku. Disparities in the availability of neuro-oncology clinical providers and infrastructure in the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A054.

S305 Changes in Colorectal Cancer Incidence Associated With Medicaid Expansion: An Analysis of the National Cancer Database

Introduction: The Affordable Care Act (ACA), enacted in 2010, increased insurance coverage for states that expanded Medicaid, but its impact across the United States on Colorectal Cancer (CRC) detection remains unclear. The National Cancer Database (NCDB) is a hospital-based cancer registry that captures approximately 75% of diagnosed cancers in the U.S. and Puerto Rico. This study used the NCDB to investigate the changes in the frequency of colon cancer incidence before and after Medicaid expansion. Methods: We compared all adult cases of CRC in the NCDB using ICD-codes from pre-Medicaid expansion in 2006-2009 to the period after full state participation in 2015-2018. Information on patient demographics (age, sex, race, insurance status, educational attainment, residential location, Charlson-Deyo Comorbidity Score (CDCS), staging at diagnosis) were queried. United States census data from 2010 and 2020 were used to standardize CRC incidence. Chi-square and t-test analysis were performed using SPSS v.28. Results: With the ACA, the proportion of those without insurance dropped from only 3.3% to 3.0% in the NCDB database. The total incidence of CRC was 569,659 patients for the two study periods. There were 86.4 cases per 100,000 diagnosed pre-Medicaid expansion and 92.5 cases per 100,000 post-Medicaid expansion. Patients diagnosed after expansion were younger 65.6±12.4 y vs 67.1±12.7 y. In the post-Medicaid expansion period, there was an increase in the incidence of CRC in males (52.7% vs 50.5%), Non-Hispanic Black (12.4% vs 11.5%) and Hispanic patients (6.9% vs 4.8%), patients with lower educational attainment (22.6% vs 21.6%), and patients with greater comorbidities via CDCS (5.0% vs 2.9%). Though there were statistically significant differences in income and residential location, these findings were not clinically significant. There was a slight shift in the incidence of CRC diagnosed at a later stage post-expansion. Results are summarized in Table. Conclusion: Medicaid expansion was associated with an increase in the incidence of CRC diagnosis despite a very modest drop in the proportion uninsured. The age of diagnosis decreased post-Medicaid expansion. There was also an increase in the proportion of males, minorities, patients with lower educational attainment, and those with a greater number of comorbid conditions. CRC was not found at an earlier stage of diagnosis despite an increase in the access to medical care. These findings highlight the impact of expanding health insurance coverage for all. Table 1. - Comparison of Patient Characteristics between Pre-Medicaid Expansion (2006-2009) and Post-Medicaid Expansion (2015-2018) Factors Pre-Expansion (2006-2009) n=266,109 Post-Expansion (2015-2018) n=303,550 p-value Age (SD) y - 67.13 (12.7) 65.55 (12.4) p< 0.001 Sex Male 134,445 (50.5) 159,973 (52.7) p< 0.001 Female 131,664 (49.5) 143,577 (47.3) Race NWH 211,311 (79.4) 226,924 (74.8) p< 0.001 NHB 30,526 (11.5) 37,611 (12.4) Hispanic 12,799 (4.8) 21,018 (6.9) Other 11,473 (4.3) 17,997 (5.9) Income Less than $40,227 49,766 (19.6) 49,676 (19.1) p< 0.001 $40,227 - $50,353 57,193 (22.5) 57,874 (22.3) $50,354 - $63,332 59,329 (23.5) 60,291 (23.2) $63,333 or more 87,568 (34.5) 92,041 (35.4) Percent Without High School Degree 17.6% or more 54,980 (21.6) 58,975 (22.6) p< 0.001 10.9% - 17.5% 67,951 (26.7) 69,392 (26.6) 6.3% - 10.8% 71,875 (28.3) 71,563 (27.5) Less than 6.3% 59,561 (23.4) 60,463 (23.2) Insurance Private 103,997 (39.1) 119,317 (39.3) p< 0.001 Medicaid 11,495 (4.3) 24,050 (8.0) Medicare 141,713 (53.3) 150,794 (49.7) Non-Insured 8,904 (3.3) 9,389 (3.0) Residence Location Metropolitan 218,379 (84.6) 251,012 (84.6) p< 0.001 Urban 34,764 (13.5) 40,309 (13.6) Rural 5,062 (2.0) 5,248 (1.8) Treatment Facility Community Cancer Program 25,022 (9.4) 26,467 (8.7) p< 0.001 Comprehensive Community Cancer Program 114,751 (43.1) 123,506 (40.7) Academic Program 69,335 (26.1) 91,285 (30.1) Integrated Network Cancer Program 57,001 (21.4) 62,292 (20.5) Charlson-Deyo Score 0 186,579 (70.1) 217,758 (71.7) p< 0.001 1 56,325 (21.2) 52,888 (17.4) 2 16,160 (6.1) 17,727 (5.8) >3 7,045 (2.6) 15,177 (5.0) Stage at Diagnosis 0 18,376 (6.9) 14,210 (4.7) p< 0.001 I 60,846 (22.9) 64,322 (22.2) II 66,828 (25.1) 72,303 (23.8) III 68,524 (25.8) 83,346 (27.5) IV 51,535 (19.4) 69,369 (21.9)

Evaluation of Regional Geospatial Clusters in Inguinal Hernia Repair.

IntroductionThere is significant variation in how inguinal hernia repairs are conducted across the United States (US). This study seeks to utilize national public data on inguinal hernia repair to determine regional differences in the use of ambulatory surgical centers (ASC) and in the choice of laparoscopic or open technique.MethodsMedicare provider billing and enrollee demographic data were merged with US census and economic data to create a county-level database for the years 2014-2019. Location, technique, and total count of all inguinal hernia repair billing were recorded for 1286 counties. Moran’s I cluster analysis for inguinal hernia repairs, percent laparoscopic technique, and percent ACS were conducted. Subsequent hotspot and coldspot clusters identified in geospatial analysis were compared using ANOVA across 50 socioeconomic variables with a significance threshold of 0.001. Results There were 292,870 inguinal hernia repairs, of which 39.8% were conducted laparoscopically and 21.3% of which were in an ACS. Inguinal hernia repair coldspots were in the Mid-Atlantic and Northern Midwest, while hotspots were in Nebraska, Kansas, and Maryland (3.85 and 36.53 repairs per 1000 beneficiaries, respectively). Compared to coldspots, hotspot areas of repair were less obese, had less tobacco use, older, and less insured; there were no differences in gender, white population, or county urbanization (p<0.001). Laparoscopic technique coldspots were in the Mid-Atlantic, Michigan, and Great Plains, while hotspots were in the Rocky Mountains and contiguous states from Florida to Wisconsin (6.14% and 75.39%, respectively). ACS coldspots were diffusely scattered between Oklahoma and New Hampshire, while hotspots were in California, Colorado, Maryland, Tennessee, and Indiana (0.51% and 48.71%, respectively).ConclusionsInguinal hernia repair, the surgical setting, and the choice of technique demonstrated interesting geospatial trends in our population of interest that have not been previously characterized.

Abstract No. 178 Race representation in clinical studies evaluating embolization for hepatocellular carcinoma treatment compared with the United States Census data

Abstract No. 178 Race representation in clinical studies evaluating embolization for hepatocellular carcinoma treatment compared with the United States Census data

Cultural Humility: A Critical Step in Achieving Health Equity.

Cultural Humility: A Critical Step in Achieving Health Equity.

Understanding unidentified human remains investigations through the United States census data

Each year, thousands of unidentified human remains (UHR) cases are reported in the U.S. Technological advances have greatly enhanced the forensic community's capacity and capability to solve UHR cases, but little is known about the extent to which these resources are used by medical examiners and coroners (MECs). Using public datasets, the study purpose is to describe the current state MEC system with respect to UHR cases, the resources used to investigate these cases, and the evidence retention polices in place. There was an overall decline in UHR cases reported between 2004 and 2018. Less than half of MECs in both study years reported having established written final disposition and evidence retention policies for UHR cases. National missing persons databases were underused. This study provides an important window into the present state of UHRs being handled by our Nation's MEC offices and the resources available to solve these difficult cases.

Economic Assimilation of Mexicans and Central Americans in the United States1

Abstract Using United States Census data between 1970 and 2017, we analyze the economic assimilation of subsequent arrival cohorts of Mexicans and Central Americans by comparing their earnings and employment probability to those of natives with similar age and education. We find that, on average, these immigrants started with an earnings gap of 40–45% and eliminated half of it within 20 years of arrival. Recent cohorts that arrived after 1995 performed better than earlier cohorts in that they had smaller initial earnings gaps and faster convergence. Additionally, the most recent cohorts entered the United States without an employment rate disadvantage, and they surpassed natives within 10 years. We also find that Mexicans and Central Americans working in the construction sector and those living in nonenclave and urban areas had faster earnings convergence than the others.

Socioeconomic Disparities in Severe Acute Respiratory Syndrome Coronavirus 2 Serological Testing and Positivity in New York City.

BackgroundWe characterized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody test prevalence and positive test prevalence across New York City (NYC) in order to investigate disparities in testing outcomes by race and socioeconomic status (SES).MethodsSerologic data were downloaded from the NYC Coronavirus data repository (August 2020–December 2020). Area-level characteristics for NYC neighborhoods were downloaded from United States census data and a socioeconomic vulnerability index was created. Spatial generalized linear mixed models were performed to examine the association between SES and antibody testing and positivity.ResultsThe proportion of Hispanic population (posterior median, 0.001 [95% credible interval, 0.0003–0.002]), healthcare workers (0.003 [0.0001–0.006]), essential workers (0.003 [0.001–0.005]), age ≥65 years (0.003 [0.00002–0.006]), and high SES (SES quartile 3 vs 1: 0.034 [0.003–0.062]) were positively associated with antibody tests per 100000 residents. The White proportion (–0.002 [–0.003 to –0.001]), SES index (quartile 3 vs 1, –0.068 [–0.115 to –0.017]; quartile 4 vs 1, –0.077 [–0.134 to –0.018]) and age ≥65 years (–0.005 [–0.009 to –0.002]) were inversely associated with positive test prevalence (%), whereas the Hispanic (0.004 [0.002–0.006]) and essential worker (0.008 [0.003–0.012]) proportions had positive coefficients.ConclusionsDisparities in serologic testing and seropositivity exist on SES and race/ethnicity across NYC, indicative of excess coronavirus disease burden in vulnerable and marginalized populations.

167 The PEAGE Study: Patient Experience After Geriatric Evaluation

Based on United States (US) Census data, by 2030 the geriatric population (adults aged 65 and older) is expected to be 20% of the population. Currently there are 46 million older adults in the US, and this is projected to reach 90 million by 2050. As the population of the US ages, the population of patients evaluated in the emergency department (ED) will increase as well. In 2018, the American College of Emergency Physicians (ACEP) began a formal accreditation process for Geriatric Emergency Departments (GED).