Census Bureau Research Articles

Revisiting Equity in Healthcare Spending: Variation in Reimbursement for Aortic Procedures from the Perspective of Medicare Payments.

Medicare insures over 65 million Americans and is a primary driver of private insurance reimbursement rates. However, public data shows Medicare reimbursement for comparatively complex procedures such as aortic aneurysm repair is disproportionate. Medicare reimbursement rates are multifactorial and highly localized, yet little is known about nationwide trends. Therefore, we sought to compare Medicare reimbursement for aortic surgery by geographic region and state poverty level. Fee charged, total payment received, and Medicare payment data for aortic procedures comes from publicly available datasets. Geographic regions were determined using Center for Disease Control designations, and state level poverty statistics were obtained from published Census Bureau data. Mean fee charged, total, and Medicare payments were compared by poverty and geographic subgroup. States with the highest poverty levels received significantly lower Medicare payments when compared to states with lower poverty levels. Medicare and total payments for aortic procedures varied significantly by geographic region with Midwest and Southern states receiving lower Medicare and total payments relative to the Northeast and West. Further geographic division revealed lower Medicare payments to North Central, East South-Central, and West South-Central states with correspondingly lower total payments. Total payments were highest in the Pacific West. Aortic procedures are disproportionately reimbursed from Medicare. Our results suggest that states with the highest poverty levels were paid strikingly less than other regions for complex aortic procedures. Payments also varied regionally, with Midwestern and Southern providers receiving lower reimbursement than their Northeastern and Western counterparts.

The interface of Latinos, language and space in restaurant naming in Philadelphia

Abstract Considering the growth of the Hispanic or Latino population reported by the 2020 Census Bureau in Philadelphia and an increase of Latino restaurants bearing names in Spanish in the city, this article explores the use of Spanish in eighty three restaurant names to determine the types of meanings that Spanish construes, the restaurateurs’ apparent motivation, and its relevance within Latino studies in a city and state that do not historically have a large number of Latinos. The qualitative analysis relies on a linguistic landscapes approach, specifically Scollon and Scollon’s (2003) and Ben-Rafael’s (2009) frameworks. The analysis reveals that the use of Spanish not only functions as a sign of identity and group membership, but also serves to create the restaurateurs’ social space and to distinguish their establishments. These dynamics increase the visibility of some of these Latino groups and of the Latino community as a whole, in a city where their presence and visibility has not yet received much attention.

Unmasking Racial, Ethnic, and Socioeconomic Disparities in United States Chordoma Clinical Trials: Systematic Review.

Chordoma is a rare bone cancer with limited treatment options. Clinical trials are crucial for developing effective therapies, but their success depends on including diverse patient populations. The objective of this study was to systematically evaluate the reporting of racial, ethnic, and socioeconomic diversity in United States clinical trials exploring treatment for chordoma. A literature search was conducted through PubMed/Medline, Cochrane, Epistemonikos, and ClinicalTrials.gov databases for published US chordoma trials up until 19 August 2024. The data collected included trial characteristics and racial and ethnic data, as well as socioeconomic indicators when available. Methodological Index for Non-Randomized Studies (MINORS) and Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) analyses were adopted to assess the methodological quality. The N-1 Chi-squared (χ2) test was implemented to compare the reported racial and ethnic data with the most recent US Census Bureau data. Five trials involving 111 patients (median age: 63 years; 34% female) were included. Four studies (80%) were single-arm non-randomized studies with one study (25%) having a high methodological quality and three (75%) having a moderate quality based on the MINORS analysis. Most patients (91%, n = 82) were White/Caucasian, representing a proportion which was significantly higher than the reported 75% in the US population (p = 0.0005). Black/African American patients (2%, n = 2) were significantly underrepresented compared to the 14% in the US population (p = 0.0015). Regarding ethnicity, Hispanic/Latino patients (7%, n = 6) were significantly underrepresented compared to the 20% in the US population (p = 0.0021). No measures of socioeconomic status were reported. This systematic review highlighted the need for improved racial and ethnic diversity in chordoma trials and the better reporting of socioeconomic data. The underrepresentation of minority groups may obscure potential disparities in disease incidence, treatment access, and clinical outcomes.

Protecting Vulnerable Respondents: A Critical Analysis of the Privacy-Preserving Methods of the 2010 and 2020 Decennial Census

This paper offers a comprehensive analysis of the statistical disclosure limitation (SDL) methodologies employed by the U.S. Census Bureau on the 2010 and 2020 Decennial Census releases under the perspective of the disclosure risk of the most vulnerable respondents. We first review the SDL methodology used up to the Decennial Census 2010, which was based on targeted swapping. Second, we examine recently reported reconstruction and reidentification results on the Decennial Census 2010 outputs, which form the foundation for the U.S. Census Bureau’s decision to switch to a differentially private (DP) method for the 2020 release. Third, we examine the actual privacy and data accuracy achieved by the DP method and compare with the privacy and accuracy offered by the formerly employed swapping mechanism. We conclude that the DP method is not an adequate solution to protect the typically sparse tables present in the Decennial Censuses because it does not offer meaningful privacy guarantees in general, it poorly protects the privacy of the most vulnerable respondents in particular, and it significantly degrades the quality of the released data. We also argue that the claimed disclosure risks of previous Census releases were overstated because of a flawed reidentification procedure. Therefore, the U.S. Census Bureau’s decision to change the SDL methodology to a DP-based one for the 2020 release was not only unwarranted, but it also reduced privacy and data quality compared to former releases.

Measuring jury diversity in the court of public opinion

Do jury pools reflect the community from which they are drawn, and how can one be certain? Inspired by the growing body of diversity science literature, this study explores some of the complex dimensions involved in measures of juror heterogeneity. Using survey data from a sample of nearly 38,000 summonsed jurors in Washington State, this research explores the discordance between jurors’ self-identified race/ethnicity and their perceptions of how others ascribe them, using Census Bureau classifications. Findings indicate that the incongruence between one’s personal identification and external categorization may account for the observed variability in juror representation across different stages of the juror selection process. Specifically, a significant portion of respondents who self-identified as non-White reported feeling that they were perceived as White by others. We speculate that instances of racial contestation may inadvertently contribute to the exclusion of non-White individuals on the basis of one’s phenotypical proximity to Whiteness. Potential implications for criminal justice reform efforts and future research directions are discussed.

Eligibility for and reach of the National Breast and Cervical Cancer Early Detection Program, 2018-2021.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to timely breast and cervical cancer screening and diagnostic services to women who have low incomes and are uninsured or underinsured. Documenting the number of women eligible and the proportion of eligible women who receive NBCCEDP-funded services is important for identifying opportunities to increase screening and diagnostic services among those who would not otherwise have access. Using the Census Bureau's Small Area Health Insurance Estimates data, we estimated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these estimates along with the number of women served by the NBCCEDP to calculate the percent of women served by race/ethnicity and state. We calculated the percent of eligible women who are up to date with screening using the 2019 National Health Interview Survey. The NBCCEDP served 15.0% of women ages 40-64 eligible for breast cancer services in 2018-2019 and 5.6% of women ages 21-64 eligible for cervical cancer services in 2018-2020. The NBCCEDP served 13.5% of women ages 40-64 eligible for breast cancer services in 2020-2021 and 5.9% of women ages 21-64 eligible for cervical cancer services in 2019-2021. The percent of women ages 40-64 who received breast cancer services declined by 1.5 percentage points between 2018-2019 and 2020-2021. The percent of women ages 21-64 who received cervical cancer services increased by 0.3 percentage points between 2018-2020 and 2019-2021. The percent of eligible women served varied among states. The state interquartile ranges of the percent of women served were 12.3-27.7% for breast cancer services in 2018-2019 and 3.9-14.7% for cervical cancer services in 2018-2020. Among women eligible for the NBCCEDP, 61.4% are not up to date with breast cancer screening and 40.6% are not up to date with cervical cancer screening. There is wide variation between states in the share of eligible women served for breast and cervical cancer screening services. We found that both the number and the percentage of eligible women who received NBCCEDP breast cancer services declined during a period that overlapped with the COVID-19 pandemic. A large proportion of eligible women did not receive breast or cervical cancer screening.

Comparing the incidence of hypospadias across the United States: A contemporary analysis.

Hypospadias is a common congenital malformation occurring in up to 80 in 10,00 live male births, with emerging evidence associating exogenous environmental exposures with increased disease incidence. Military personnel are at particularly higher risk for such exposures and indeed, the rate of hypospadias in infant males born to United States military servicewomen deployed during the Gulf War has been reported to be more than 5 times greater compared to undeployed female military personnel. To characterize contemporary trends in hypospadias incidence in the general population as well as high risk groups such as males born from US servicewomen using the National Birth Defects Prevention Network. We queried the National Birth Defects Prevention Network and the Office of Statewide Health Planning and Developing for rates of hypospadias in the general US population and each state as well as the Department of Defense. Hypospadias rates were compared between 2014 and 2018. Median household income by state was obtained from the 2018 United States Census Bureau Data to compare differences in hypospadias incidence by state and median household income from 2014 to 2018. The incidence of hypospadias in the United States was 71.6 per 10,000 male births between 2014 and 2018 (Table 1). In 2018, the states/entities with the highest incidence of hypospadias were the Department of Defense (113.19 per 10,000), Colorado (113.47 per 10,000), Tennessee (109.14 per 10,000), and Alabama (104.06 per 10,000). There was no significant association between hypospadias incidence and median state household income (p=0.71). Our findings suggest that hypospadias incidence was significantly higher within the Department of Defense registry and in the states of Colorado, Tennessee, and Alabama compared to the national average. This identifies a regionalized incidence for hypospadias which is likely multifactorial and warrants further investigation. The incidence of hypospadias in the United States was 71.6 per 10,000 male births in 2014-2018, with the highest rates reported in the Department of Defense, Colorado, Tennessee, and Alabama.

American Pharmacists Association Foundation Incentive Grants: A 30-year descriptive review.

The American Pharmacists Association Foundation Incentive Grant program provides funding for pharmacy learners to conduct community pharmacy-based research projects. Over the 30-year period since its inception, the number of grants awarded has grown through support from the Community Pharmacy Foundation. The objective of this project was to describe the breakdown of project topics and geographic reach of Incentive Grant-funded projects from 1994 to 2024 and summarize the number of patients or survey respondents reached. All available reports and supporting documents for the Incentive Grant program were reviewed using the American Pharmacists Association Foundation internal database. Projects were assigned a geographical region using US Census Bureau Divisions and categorized using focus areas from grant calls-for-proposals. Project impact was evaluated by summing the number of interventions reported in final reports. A total of 784 projects were conducted and 551 had final reports available. Thirteen project focus areas were identified, with a majority of projects related to cardiovascular disease management (21.1%), pharmacy workflow/processes (14%), and immunizations (13.3%). Projects were conducted most frequently in the U.S. regions of South Atlantic (27.4%), East North Central (24.2%), and West North Central (14.9%). Of 398 projects with intervention-level data reported (2004-2024), 100,547 interventions were made (86,616 patients impacted and 13,931 survey respondents reached). The findings of this study serve as a summary of community pharmacy-based research over time, indicating the American Pharmacists Association Foundation Incentive Grant program has likely had a positive influence on community pharmacy-based research as evidenced by number of funded projects, geographic scope, participant impact, and breadth of project focus.

Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study

BackgroundIndividual measures of socioeconomic status have been associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery. We hypothesized that increased neighborhood income inequality (as measured by the Gini index) may be associated with a slower recovery after stroke. MethodsThis was a retrospective cohort study of adult patients hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Individual patient data was abstracted from the EHR, and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and functional independence (modified Rankin scale ≤2) at discharge and first outpatient follow-up. These models controlled for patient demographics, stroke risk factors, stroke severity, and stroke treatment. A second binary regression was also performed using a subset of patients to assess possible predictors of being discharged as recommended (i.e. having a discharge destination that was consistent with the recommendation of the inpatient medical team). ResultsThree hundred and thirty-seven patients were included in this analysis. The median time to first outpatient follow-up was 35 days. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up (modified Rankin scale ≤2) such that patients from higher inequality neighborhoods had decreased odds of being independent. More specifically, each 1% increase in neighborhood Gini index was associated with 8% decreased odds of independence at follow-up (OR=0.923, 95% CI: 0.863-0.987). Being discharged as recommended was associated with increased odds of independence at follow-up (OR=3.359, 95% CI: 1.055-10.695). Greater income inequality (OR=0.909, 95% CI: 0.841-0.983) and Asian race (OR=0.093, 95% CI: 0.011-0.766) were associated with decreased odds of being discharged as recommended. ConclusionAmong a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with decreased odds of achieving functional independence up (modified Rankin scale ≤2) by the time of first outpatient follow-up (at a median of 35 days following discharge). This disparity may be driven by discharge destination and race.

A novel framework for increasing research transparency: Exploring the connection between diversity and innovation.

A split sample/dual method research protocol is demonstrated to increase transparency while reducing the probability of false discovery. We apply the protocol to examine whether diversity in ownership teams increases or decreases the likelihood of a firm reporting a novel innovation using data from the 2018 United States Census Bureau's Annual Business Survey. Transparency is increased in three ways: 1) all specification testing and identifying potentially productive models is done in an exploratory subsample that 2) preserves the validity of hypothesis test statistics from de novo estimation in the holdout confirmatory sample with 3) all findings publicly documented in an earlier registered report and in this journal publication. Bayesian estimation procedures that leverage information from the exploratory stage included in the confirmatory stage estimation replace traditional frequentist null hypothesis significance testing. In addition to increasing statistical power by using information from the full sample, Bayesian methods directly estimate a probability distribution for the magnitude of an effect, allowing much richer inference. Estimated magnitudes of diversity along academic discipline, race, ethnicity, and foreign-born status dimensions are positively associated with innovation. A maximally diverse ownership team on these dimensions would be roughly six times more likely to report new-to-market innovation than a homophilic team.

Association of rurality and decreased continuity of care prior to a diagnosis of prediabetes.

To assess trends in continuity of care (COC) by geographic context (i.e., rural vs urban) among a cohort of persons with prediabetes prior to and after diagnosis of prediabetes. We use cross-sectional data from Geisinger's electronic health record between 1997 and 2017. Our dependent variable is the Modified Modified Continuity Index (MMCI), a measure of dispersion among primary care providers seen. Our primary independent variable is a binary indicator variable for rurality constructed from the 2010 Census Bureau's Urban and Rural Classification. We control for age, sex, race/ethnicity, and baseline clinical characteristics. We use fractional logistic regression with bootstrapped standard errors. Urban residing patients had greater odds of increased COC in the 3-year period prior to a diagnosis of prediabetes (aOR = 1.10, 95% CI = 1.03, 1.18; P =.007). However, there were no significant differences in COC among rural and urban residing patients upon diagnosis of prediabetes in unadjusted and fully adjusted regression models. Other factors significantly associated with COC across the observed time periods (pre- and post-diagnosis of prediabetes) include age, male, and hypertension in the patients' problem list at baseline. Among persons diagnosed with prediabetes, rurality was associated with decreased COC in the 3-year period prior to being diagnosed. However, in the 3-year period after diagnosis of prediabetes, geographic disparities in COC were not observed. Rural residing patients need enhanced continuity of primary care to potentially improve opportunistic screening for prediabetes.

LIFE EXPECTANCY AND COVID-19 MORTALITY DISPARITIES AMONG NATIVE AMERICAN OLDER ADULTS IN WYOMING

Abstract Accumulated inequities contribute to health disparities. Striking evidence of this is found in Native older adults in Wyoming. The history of violence and racism against Native peoples in the US is a national shame. Documenting the health challenges experienced by Native older adults brings awareness and potential remedy to this racist history. American Indian and Alaska Native communities are a historically under-researched population and are at greater risk than non-Hispanic white older adults for many chronic conditions. The current study reports on results from the Wyoming Healthy Aging Data Reports (healthyagingdatareports.org). We compared community rates of life expectancy and COVID-19 mortality in Wyoming and in Fremont County (home to the largest proportion of older Native adults in WY). Data sources include US Census Bureau American Community Survey 2016-2020 (population characteristics), Robert Wood Johnson Foundation (community life expectancy), and the Wyoming Department of Health (COVID-19 infection and mortality rates). Small area estimation techniques were used to calculate rates, and ArcGIS software was used for mapping and geographic analyses. Results show an estimated 2,430 Native American older adults who are 55+ are living in Wyoming, and 56% of them reside in Fremont County. Life expectancy rates in Fremont County (73) are 5 years lower than the state average (78.1). There is also a 1.5x higher COVID mortality rate in Fremont County (513.7) as opposed to the state average (340.4). Communities that have experienced systematic discrimination and inadequate health care services have poor outcomes. Policy interventions to address such inequities are warranted.

REVISITING THE US TEACHING NURSING HOME: WHAT ARE STUDENTS’ PERCEPTIONS OF CARING FOR OLDER ADULTS?

Abstract The U.S. Census Bureau predicts that by 2050, over 20% of the U.S. population will fall into the category of older adults and will be the “core business” of the nursing profession. This growing demand is coupled with critical staff shortages, especially in nursing homes, a deficit that was exacerbated by the experiences of the COVID-19 pandemic. The American Association of Colleges of Nursing has identified care for older adults as a priority for undergraduate nursing programs and nursing education literature suggests there are critical barriers toward greater integration of the knowledge, skills, and dispositions needed to adequately care for older adults living in nursing homes. The purpose of this study was to understand undergraduate nursing students’ perceptions about their first clinical learning experience in a nursing home and working with older adults., Students (N= 105) from a large research university who were enrolled in the Nursing Fundamentals course were recruited to participate in the study. De-identified course artifacts (e.g., Age-Friendly Health Systems 4Ms Framework course assignments) generated by consented participants were compiled and analyzed using thematic analysis. Two themes emerged from the data and included students’ assumptions and lessons learned about caring for older adults living in nursing homes. In addition, students identified opportunities that could improve care for older adults, especially around “What Matters” and functional mobility. These findings will serve as the basis to guide best practices for integrating additional learning experiences in the undergraduate nursing curriculum using the Age-Friendly Health Systems 4Ms Framework.

BRIDGING THE DIGITAL DIVIDE: A USER-CENTERED DESIGN APPROACH TO ENHANCING SOCIAL CONNECTIVITY AMONG OLDER ADULTS

Abstract Social isolation is highly prevalent among older adults, leading to negative health outcomes and increased healthcare costs. With the U.S. Census Bureau projecting a near doubling of adults aged 65 and older by 2060, addressing this issue is crucial. Innovative, user-centered solutions are imperative because older adults often face health, cognitive, and mobility limitations that diminish opportunities for engagement. Technologies can help overcome these barriers. This study aimed to develop a potential intervention to enhance social connectivity among older adults through user-centered design, understanding their needs in using digital technologies. This qualitative study employed an ethnographic approach, engaging 50 older adults in Los Angeles. Semi-structured interviews and participant observations were conducted. Thematic analysis informed the iterative design of a prototype named TwinFlame. The study revealed three key insights: 1. Older adults prioritized user-friendly interfaces facilitating communication with loved ones. 2. Participants expressed a need for educational support in using digital devices, particularly for advanced features. 3. Cultural competence was critical in ensuring inclusivity and acceptance of the proposed solution. TwinFlame, a device resembling a candle with integrated digital communication features, was developed to address these needs. Its design incorporates simplified interfaces, built-in tutorials, and culturally sensitive elements. While not yet tested, TwinFlame’s potential for enhancing social connectivity lies in its user-centered approach, directly addressing the identified needs of older adults. This research contributes to understanding how tailored digital tools can potentially reduce the digital divide and social isolation among older adults, highlighting the importance of user-centered design in gerontechnology.

Refined Marriage Rates and Coresidential Relationships by Sexual Identity and Age: A Research Note

AbstractThis research note estimates refined marriage rates and coresidential relationships among individuals identifying as gay, lesbian, and straight in the United States seven years after the legalization of same-sex marriage. Data to estimate refined marriage rates or coresidential relationships by sexual identity are not available in a single national dataset so we leverage data from the U.S. Census Bureau's 2022 American Community Survey and Household Pulse Survey, to estimate refined marriage rates and the share in a coresidential union for straight, lesbian, and gay populations aged 18 to 64, based on the unmarried population and age. Findings highlight the importance of considering age alongside sexual identity when analyzing marital behavior and coresidential relationships. Both refined marriage rates and percentage living in coresidential relationships were lower among gay identifying males across all age groups, whereas rates among lesbian identifying females were comparable to those among straight identifying males and females. This study contributes to research on contemporary relationship dynamics as well as calling for new demographic data and investigations into the complexities of marriage and cohabitation among diverse populations.

The Association between the Social Vulnerability Index and Access to California High School Athletic Trainers.

Social determinants of health are known to affect overall access to youth sports, however, it is not fully understood how multiple social determinants of health may impact access to school-based athletic training services. To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers in California. Retrospective, cross-sectional study. Online survey. California Interscholastic Federation (CIF) high school respondents of the 2022-23 Participation Census. Association between Social Vulnerability Index scores and access to school-based athletic trainer services. This study uses data from CIF high school respondents of the 2022-23 Participation Census. School addresses were used to extract SVI scores from the U.S. Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels. There were 1,598 respondent schools (65% public, 24% private, and 11% charter). 49% of schools reported having an athletic trainer, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to athletic trainers and certified athletic trainers at both county (OR: 0.89 (95% CI: 0.80, 0.99); p = .04) and census tract levels (OR: 0.93 (95% CI: 0.89, 0.97); p = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having an certified athletic trainer at the census tract level (OR: 0.94 (95% CI: 0.89, 0.98); p = .006), but not the county level (p = .16). Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.

Comparison of Tests and Confidence Intervals for Univariate Normal Mean Based on Multiply Imputed Synthetic Data Obtained by Posterior Predictive Sampling

There is a huge literature on data analysis under privacy or confidentiality protection. Among many inferential statistical methods based on parametric models, data analysis based on perturbation of original sensitive data using plug-in and posterior predictive sampling are quite common. In this paper we consider a very basic inferential problem of tests and confidence intervals for a normal mean with unknown variance based on synthetic data obtained from multiple imputations under posterior predictive sampling method. Several methods are suggested and compared. A general expression of the local power of a class of tests is also derived which can be used in a design context to determine a combination of sample size and number of imputations to guarantee a desired level of local power. A measure of privacy protection is derived to demonstrate that privacy would be compromised if too many imputations are released. An application to draw inference about the household earnings, corresponding to a US Census Bureau data, is illustrated.

Demographics of Ophthalmology and Optometry Practices and Changes in Utilization Patterns of Procedures and Services Following Private Equity Acquisition.

To characterize private equity (PE) acquisition of ophthalmology and optometry practices and compare procedural utilization before and after acquisition. Ophthalmologists and optometrists in practices acquired from 2012 to 2016 were identified and characterized using an internet archive with an additional search in 2017 to characterize doctor turnover. United States Census Bureau and Internal Revenue Service Data were used to determine population health insurance and adjusted gross income (AGI). Healthcare Common Procedure Coding System codes were drawn from the Medicare database. Six platform companies acquired 36 practices between 2012 and 2016, including 518 optometrists and 136 ophthalmologists with a net doctor decrease of 3% and 7%, respectively (years 2016 to 2017). PE firm-owned practices were primarily located in metropolitan core areas with above-average AGI and insurance coverage. Diagnostic procedures, total encounters, cataract surgery, and yttrium aluminum garnet (YAG) capsulotomy volume increased per physician 1-year post-acquisition. In adjusted difference-in-difference comparisons, cataract surgery (13.3% relative increase, P<0.001) and YAG capsulotomy (35.6% relative increase, P<0.001) remained significant. PE practices demonstrated an increase in cataract surgery procedures (28,813/platform pre-acquisition to 33,930/platform post-acquisition, P=0.015). PE acquisitions of ophthalmology and optometry practices were centered in metropolitan core areas with above-average AGI and insurance coverage. PE acquisition led to less optometrists and ophthalmologists employed at the practice. Overall, they exhibited doctor turnover with a net doctor decrease. When compared to non-PE doctors, PE-acquired doctors demonstrated an increase in cataract surgery and YAG capsulotomy volume. Overall, cataract surgery volume increased among PE practices after acquisition.

Understanding MAT access in the context of unused MAT capacity in the United States: when increasing rural MAT capacity is not enough

BackgroundSection 1262 Consolidated Appropriations Act of 2023 eliminates the federal DATA waiver registration requirement to prescribe buprenorphine for opioid use disorder (OUD), along with patient limits, perhaps as a way to increase provider capacity to prescribe buprenorphine. Understanding the factors that influence provider capacity, patient access, and whether community need for MAT is met could inform how to capitalize on DATA waiver eliminations in the United States.MethodsThis observational study utilized required reporting from two cohorts of the Rural Communities Opioid Response Program (RCORP). Consortia (N = 80) provided data on OUD/SUD-related services, service area information, consortium membership, and grant progress, including barriers to and facilitators of achievements. These data were combined with National Survey of Drug Use and Health (NSDUH) and U.S. Census Bureau’s 2016−2020 American Community Survey (ACS) 5-Year Estimates Data to examine MAT capacity, access, and service area need.ResultsA 79% increase in potential buprenorphine prescribers from 2019 to 2022 resulted in 1,060 rural providers with the ability to prescribe buprenorphine. The number of individuals who received MAT increased by 42% over the same three years, with over 20,000 individuals receiving MAT by the end of the funding period. While both capacity and access did increase, an additional 11,454 individuals could have potentially received buprenorphine if all waivered providers prescribed to a conservative patient limit of thirty patients. 70% of consortia provided MAT to at least 11.5% of their estimated service area need (national rate of MAT provision among individuals 18 years and older with an OUD), indicating unused MAT capacity was not related to lack of service area need. Provider (e.g., concerns of clinical complexity), patient (e.g., mistrust of the healthcare system), pharmacy (e.g., cost concerns), and pharmacist (e.g., stigma) barriers impacted MAT provision and availability.ConclusionMAT treatment capacity is a necessary but not exclusive requirement for increasing access to MAT. Addressing the multi-faceted barriers to prescribing MAT, particularly buprenorphine, will be critical to ensure the Consolidated Appropriations Act of 2023 does in fact result in a larger workforce that actually prescribes buprenorphine and a pharmacy system that stocks these medications.

Workforce Analysis of Laryngologists in the United States Between 1993 and 2022.

This study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050. A national database of fellowship-trained laryngologists (FTLs) and nonfellowship-trained laryngologists (nFTLs) practicing primarily laryngology was formed by identifying laryngologists via internet search, with validation by regional laryngologists and senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, institutional affiliation, and practice zip code. US Census Bureau population data and projections were grouped by hospital referral region (HRR), as defined by the Dartmouth Healthcare Atlas. The National Resident Matching Program (NRMP) provided annual fellowship match data from 2012 to 2022. As of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. The median practice length for all laryngologists was 11 years. HRRs with the largest number of laryngologists were Manhattan, Boston, and Los Angeles, with 23, 16, and 14 respectively. One hundred and ninety-four of 306 (63%) HRRs did not have an active, primary laryngologist. The national median density of people per laryngologist including HRRs with at least one laryngologist was 645,160. Assuming a 35-year practice horizon prior to workforce exit and holding the 2018-2022 NRMP average of 18 fellows constant, the number of forecasted laryngologists by 2040 would be 568-an increase of 66%. To date, no comprehensive database of practicing US laryngologists nor laryngology workforce forecast exists. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low-density areas. NA Laryngoscope, 2024.