Urban Counties Research Articles

Barriers and Recommendations for Right-of-Way Acquisition Process

Right-of-way (ROW) acquisition consumes a large portion of a transportation project’s budget, and it continues to grow more expensive, complicated, and time-consuming for project execution. This paper identifies ROW acquisition challenges and barriers as a result of the 2006 eminent domain law change in the state of Minnesota. Additionally, the study identifies the root causes for the identified barriers and recommends actions to overcome them. Property owners are intended to be protected under the eminent domain legislation against the government seizing their property for an unfair price. Many practitioners, however, think the legal change has complicated the ROW acquisition process and led to a substantial cost surge. The study investigates the barriers associated with the ROW acquisition process, and conducted a statewide questionnaire, expert interviews, and analysis of individual projects. An extensive literature review and input from the Minnesota Department of Transportation technical advisory panel were used to identify initial barriers associated with the ROW acquisition process. The survey was distributed to all ROW acquisition professionals in Minnesota to collect data on the severity and impact of ROW acquisition barriers and practices. Additionally, the statewide survey was designed to collect data regarding unidentified ROW acquisition barriers and practices. The survey results were also used to conduct unstructured interviews with ROW professionals in urban counties in Minnesota because they face more condemnation cases when compared with ROW acquisition cases in rural areas. Additionally, the authors carefully selected individual projects to identify the barriers that affect the ROW acquisition process. This paper presents the root causes of ROW acquisition barriers and recommendations to address the negative impacts of those barriers on ROW acquisition. A total of 11 barriers and their root causes are identified based on the statewide questionnaire, expert interviews, and analysis of case studies. This study contributes to the body of knowledge by identifying ROW acquisition barriers and recommendations from which other state highway agencies can benefit.

Association between passively collected walking and bicycling data and purposefully collected active commuting survey data-United States, 2019.

Commercially-available location-based services (LBS) data derived primarily from mobile devices may provide an alternative to surveys for monitoring physically-active transportation. Using Spearman correlation, we compared county-level metrics of walking and bicycling from StreetLight with metrics of physically-active commuting among U.S. workers from the American Community Survey. Our strongest pair of metrics ranked counties (n=298) similarly for walking (rho=0.53 [95% CI: 0.44-0.61]) and bicycling (rho=0.61 [0.53-0.67]). Correlations were higher for denser and more urban counties. LBS data may offer public health and transportation professionals timely information on walking and bicycling behavior at finer geographic scales than some existing surveys.

A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis.

Long driving times from hospice providers to patients lead to poor quality of care, which may exacerbate in rural and highly isolated areas of Appalachia. This study aimed to investigate geographic patterns of pediatric hospice care across Appalachia. Using person-level Medicaid claims of 1,788 pediatric hospice enrollees who resided in the Appalachian Region between 2011 and 2013. A database of boundaries of Appalachian counties, postal addresses of hospices, and population-weighted county centroids of residences of hospice enrollees driving times from the nearest hospices were calculated. A choropleth map was created to visualize rural/urban differences in receiving hospice care. The average driving time from hospice to child residence was 28minutes (SD = 26). The longest driving time was in Eastern Kentucky-126minutes (SD = 32), and the shortest was in South Carolina-11min (SD = 9.1). The most significant differences in driving times between rural and urban counties were found in Virginia 28 (SD = 7.5) and 5minutes (SD = 0), respectively, Tennessee-43 (SD = 28) and 8minutes (SD = 7), respectively; and West Virginia-49 (SD = 30) and 12minutes (SD = 4), respectively. Many pediatric hospice patients reside in isolated counties with long driving times from the nearest hospices. State-level policies should be developed to reduce driving times from hospice providers.

Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma.

Background: The 2015 American Thyroid Association (ATA) guidelines shifted recommendations toward less aggressive management of papillary thyroid cancer (PTC). Subsequently, several studies demonstrated a trend in performing thyroid lobectomy (TL) over total thyroidectomy (TT). However, regional variation has persisted without a clear indication of what factors may be influencing practice variation. We aimed to evaluate the surgical management of PTC in patients in rural and urban settings to assess trends of TL compared with TT following the implementation of the 2015 ATA guidelines. Methods: A retrospective cohort analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2019 of patients with localized PTC <4 cm who underwent TT or TL. Patients were classified as living in urban or rural counties based on the 2013 Rural-Urban Continuum Codes. Procedures performed from 2004 to 2015 were categorized as preguidelines, while those performed from 2016 to 2019 were categorized as postguidelines. Chi-square, Student's t-test, logistic regression, and Cochran-Mantel-Haenszel test were used. Results: A total of 89,294 cases were included in the study. Eighty thousand one hundred and fifty (89.8%) were from urban settings and 9144 (9.2%) were from rural settings. Patients from rural settings were older (52 vs. 50 years, p < 0.001) and had smaller nodules (p < 0.001). On adjusted analysis, patients in rural areas were less likely to undergo TT (adjusted odds ratio 0.81, confidence interval [CI] 0.76-0.87). Before the 2015 guidelines, patients in urban settings had a 24% higher odds of undergoing TT compared with those in rural settings (odds ratio 1.24, CI 1.16-1.32, p < 0.001). There was no difference in the proportions of TT and TL based on setting following guideline implementation (p = 0.185). Conclusions: The 2015 ATA guidelines led to a change in overall practice in surgical management of PTC toward increasing TL. While urban and rural practice variation existed before 2015, both settings had an increase in TL following the guideline change, emphasizing the importance of clinical practice guidelines to ensure best practice in both rural and urban settings.

D98. Access to Certified Burn Centers in The United States: The Geospatial and Transport Cost of Transfer

PURPOSE: Although ABA-verified burn centers are critical in minimizing burn-associated morbidity and mortality, disparities in burn care access remain – particularly for rural and pediatric patients. The present study quantifies inequitable burn care access as a function of physical proximity and assesses its impact on burn-associated transport costs. METHODS: County-level distances (n=3,106) to the nearest ABA-verified adult (n=59) or pediatric (n=43) burn center were determined and mapped. Average per mile transport cost for each population (urban vs. rural) was estimated from CMS ambulance fee schedules. Total transport cost was determined based on county-level distance calculations, and cost burden was compared between cohorts. RESULTS: Pediatric patients reside 30.57 miles (p < 0.001) further than adults from the nearest center, accounting for a 10.5% - 15.9% transport cost increase. Transport costs increased dramatically between urban and rural counties, with rural patients facing a cost increase of 32.7% and 80.88% for ground and air transportation, respectively. CONCLUSION: Physical proximity to burn care may appear to differ only modestly across age and region. However, the seemingly marginal increase in distance significantly impacts the cost of patient transport. The present study highlights both physical and economic barriers to access faced by rural and pediatric burn patients. Increasing ABA burn center certification in targeted areas across the US may decrease the disparities in access to burn care faced by these groups.

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing.

Studying patients' social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people's social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people's social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19-related policies aimed to improve. The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Post-COVID-19 responses showed improvement across almost all social needs-related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis.

Financial Challenges of Family Child Care Providers During the COVID-19 Pandemic: A Phenomenological Study.

The impact of COVID-19, both in quality and quantity, on the field of early childhood education, ECE is immeasurable. However, as research shows, its impact on family child care (FCC), has been worse than other sectors of ECE. FCC providers worldwide have always perceived their work as a service to families and children, yet FCC homes have not received much attention and recognition from researchers and policymakers compared to center-based ECE programs. This phenomenological inquiry with 20 FCC providers in a large urban county in California highlights the financial challenges that FCC providers faced during the early part of the pandemic before they received financial support from the state in the spring of 2021. The cost of running the program was quite high because of reduced enrollment and the regular purchase of sanitary materials. To keep their programs afloat, some participants had to lay off their staff, others kept them without salary, others had to exhaust their savings, and most incurred credit card debt. Most of them also experienced psychosocial stress. Their financial hardships during the pandemic would have been far worse without the emergency funding received from the state. However, as experts warn, the field of ECE needs a permanent solution and the situation could be even worse after the emergency funds run out in 2024. The nation has witnessed the dedicated service of FCC providers during the pandemic, especially to families of essential workers. Much work is needed at empirical and policy levels to support and celebrate the service of FCC providers.

What Is the Geographic Distribution and Density of Orthopaedic Advanced Practice Professionals in Rural Counties? A Large-database Study.

Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care. This role has been highlighted by projections of nationwide shortages in orthopaedic surgeons, with rural areas expected to be most affected. Given that approximately half of rural counties have no practicing orthopaedic surgeons and that advanced practice professionals have been shown to be more likely to practice in rural areas compared to physicians in other medical disciplines, orthopaedic advanced practice professionals may be poised to address orthopaedic care shortages in rural areas, but the degree to which this is true has not been well characterized. (1) What percentage of rural counties have no orthopaedic caregivers, including surgeons and advanced practice professionals? (2) Is the density of advanced practice professionals greater than that of orthopaedic surgeons in rural counties? (3) Do orthopaedic advanced practice professionals only practice in counties that also have practicing orthopaedic surgeons? (4) Are NPs in states with full practice authority more likely to practice in rural counties compared with NPs in restricted practice authority states? We identified orthopaedic surgeons and advanced practice professionals using the 2019 Medicare Provider Utilization and Payment Data, as this large dataset has been shown to be the most complete source of claims data nationwide. Each professional's ZIP Code was matched to counties per the US Postal Service ZIP Code Crosswalk Files. The total number and density of physician and advanced practice professionals per 100,000 residents were calculated per county nationwide. Counties were categorized as urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) or rural (micropolitan and noncore) using the National Center for Health Statistics Urban-Rural Classification Scheme. Comparisons between rural and urban county caregivers were conducted with the chi-square test and odds ratios. Population densities were compared with the Wilcoxon rank sum test. A bivariate density map was made to visualize the nationwide distribution of orthopaedic caregivers and determine the percentage of rural counties with no orthopaedic caregivers as well as whether orthopaedic advanced practice professionals practiced in counties not containing any surgeons. Additionally, to compare states with NP's full versus restricted practice authority, each NP was grouped based on their state to determine whether NPs in states with full practice authority were more likely to practice in rural counties. We identified a group of 31,091 orthopaedic caregivers, which was comprised of 23,728 physicians, 964 NPs, and 6399 PAs (7363 advanced practice professionals). A total of 88% (20,879 of 23,728) of physicians and 87% (6427 of 7363) of advanced practice professionals were in urban counties, which is comparable to nationwide population distributions. A total of 39% (1237 of 3139) of counties had no orthopaedic professionals (defined as orthopaedic surgeons or advanced practice professionals) in 2019. Among these counties, 82% (1015 of 1237) were rural and 18% (222 of 1237) were urban. The density of advanced practice professionals providing orthopaedic services compared with the density of orthopaedic surgeons was higher in rural counties (18 ± 70 versus 8 ± 40 per 100,000 residents; p = 0.001). Additionally, 3% (57 of 1974) of rural and 1% (13 of 1165) of urban counties had at least one orthopaedic advanced practice professional, but no orthopaedic surgeons concurrently practicing in the county. There was no difference between the percentage of rural counties with an NP in states with full versus restricted practice authority for NPs (19% [157 of 823] versus 26% [36 of 141], OR 1.45 [95% CI 0.99 to 2.2]; p = 0.08). As advanced practice professionals tended to only practice in counties which contain orthopaedic surgeons, our analysis suggests that plans to increase the number of advanced practice professionals alone in rural counties may not be sufficient to fully address the demand for orthopaedic care in rural areas that currently do not have orthopaedic surgeons in practice. Rather, interventions are needed to encourage more orthopaedic surgeons to practice in rural counties in collaborative partnerships with advanced practice professionals. In turn, rural orthopaedic advanced practice professionals may serve to further extend the accessibility of these surgeons, but it remains to be determined what the total number and ratio of advanced practice professionals and surgeons is needed to serve rural counties adequately. To increase rural orthopaedic outreach, state legislatures may consider providing financial incentives to hospitals who adopt traveling clinic models, incorporating advanced practice professionals in these models as physician-extenders to further increase the coverage of orthopaedic care. Furthermore, the creation of more widespread financial incentives and programs aimed at expanding the experience of trainees in serving rural populations are longer-term investments to foster interest and retention of orthopaedic caregivers in rural settings.

Impact of the COVID-19 pandemic on pediatric Medicaid dental claims in Arizona.

To examine the role COVID-19 had on access to dental services among children in Arizona by comparing paid pediatric dental claims made before and during the pandemic. In a retrospective descriptive study, we examined Medicaid paid claims for dental services among pediatric patients from March through December 2019 and during the outbreak in 2020. Using dental claims data obtained from the Centers for Health Information and Research at Arizona State University (ASU), we analyzed Medicaid (Arizona Health Care Cost Containment System [AHCCCS]) reimbursed dental services. During the COVID-19 pandemic, paid preventive dental claims for children aged birth to 21 years decreased in 2020 compared to the same time period in 2019. Pediatric patients in Arizona utilized fewer dental services and had less access to credentialed Medicaid dental providers during the pandemic. Further, rural counties had statistically significant fewer preventive, minor restorative, major restorative, and endodontic claims compared to urban counties. Arizona rural counties also had fewer providers who were paid $10,000 or more per year during 2020 than in 2019. COVID-19 has had a detrimental impact on pediatric dental service utilization. While dental services were provided during the COVID-19 pandemic, preventive and restorative dental claims dropped for rural Arizona children aged birth to 21 years. This reveals potential negative impacts on oral health. Further research should examine the direct and indirect impact the COVID-19 pandemic has had on dental service utilization and oral health for the general pediatric population.

United States county jail treatment and care of pregnant incarcerated persons with opioid use disorder

BackgroundStandards of care for pregnant persons with opioid use disorder (OUD) have been published across multiple institutions specializing in obstetrics and addiction medicine. Yet, this population faces serious barriers in accessing medications for OUD (MOUD) while incarcerated. Therefore, we examined the availability of MOUD in jails. MethodsA Cross-sectional survey of jail administrators (n=371 across 42 states; 2018–2019) was conducted. Key indicators for this analysis include pregnancy testing at intake, number of county jails offering methadone or buprenorphine to pregnant incarcerated persons for detoxification on admission, continuation of pre-incarceration treatment, or linkage to post-incarceration treatment. Analyses were performed using SAS. FindingsPregnant incarcerated persons had greater access to MOUD than non-pregnant persons (χ2=142.10, p<0.0001). Larger jurisdiction size and urban jails were significantly more likely to offer MOUD (χ2=30.12, p<0.0001; χ2=26.46, p<0.0001). Methadone was the most common MOUD offered for continued care for all incarcerated persons. Of the 144 jails within a county with at least one public methadone clinic, 33% did not offer methadone treatment to pregnant persons, and over 80% did not provide linkage after release from jail. ConclusionMOUD access was greater for pregnant incarcerated persons compared to non-pregnant persons. Compared to urban jails, rural jails were significantly less likely to offer MOUD, even as the number of opioid deaths in rural counties continues to surpass those in urban counties. The lack of post-incarceration linkage in counties with at least one public methadone clinic could be indicative of broader issues surrounding connections to MOUD resources.

Abstract 4217: Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Abstract Individual environmental contaminants have been associated with breast cancer (BCa); however, simultaneous evaluations of multiple exposures are limited. The USEPA has constructed an environmental quality index (EQI) that includes different exposures across air, water, land, sociodemographic, and built environments. As links between BCa and the EQI have so far been confined to total BCa incidence, herein we investigated if these multiple exposures in broad EQI domains were associated with BCa incidence stratified by stage of disease. Incidence rates of total, in situ, localized, regional, and distant breast cancer were assessed by linking the EQI dataset to county-level age-standardized incidence rates obtained from the North Carolina Central Cancer Registry (2010-2014), which reports all cancer cases diagnosed in NC residents. Generalized linear models (SAS 9.3) were constructed to determine the associations between breast cancer incidence rates by summary stage and the EQI in total and by domain, compared across rural versus urban counties. Models were adjusted for percent African American (AA), percent smokers, and mammography screening rates in each county. Mann-Whitney rank tests and D'Agostino-Pearson normality tests were used to determine statistical significance. Results showed that the EQI is variable across NC, akin to variability across the U.S. (interquartile range 25th-75th% for total EQI in NC: -0.187 to 0.734 vs in the U.S.: –0.606 to 0.706). In counties with poor total EQI scores, and thus poor overall environmental quality, total BCa incidence increased by 10.82 cases per 100,000 persons (95%CI: 2.04, 19.60, p=0.016). This association was most pronounced for localized BCa (β=5.59, 95%CI: 0.59, 10.58, p=0.029). Higher incidence of early-stage disease (carcinoma in situ β=5.25, 95%CI: 2.34, 8.16, p=0.001 and localized BCa β=6.98, 95%CI: 2.24, 11.73, p=0.004) and total breast cancer (β=11.44, 95%CI: 3.01, 19.87, p=0.008) also occurred in counties with poor land quality, especially urban counties. The county AA percentage was associated with increased incidence of regional (0.12 cases per % increase, 95% CI 0.01, 0.22, p=0.022) and distant BCa (0.06 per % increase, 95% CI 0.02, 0.10, p=0.003). Associations persisted and were strengthened in urban counties for regional BCa, and in rural counties for distant BCa. In sum, we found that BCa is associated with environmental quality differentially by disease stage, environmental domain, and urbanicity. Although what drives poor EQI varies by region, our analyses are generalizable to other states and counties across the U.S. and suggest that cumulative environmental exposures should be assessed in the context of cancer stage. Funding: Duke Cancer Institute pilot (GRD, KPH) in P30 Cancer Ctr grant; NIEHS T32-ESO21432-05; NCI-3P20CA202925-04S2 Diversity Supplement (LGS). Citation Format: Larisa M. Gearhart-Serna, Kate Hoffman, Hillary Hsu, Gayathri R. Devi. Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4217.

MP75-09 RURAL AND URBAN GENITOURINARY CANCER INCIDENCE AND MORTALITY IN THE PENNSYLVANIA CANCER REGISTRY FROM 1990-2019

You have accessJournal of UrologyCME1 Apr 2023MP75-09 RURAL AND URBAN GENITOURINARY CANCER INCIDENCE AND MORTALITY IN THE PENNSYLVANIA CANCER REGISTRY FROM 1990-2019 Jonathan Pham, Ahmad Alzubaidi, Tullika Garg, and Jay Raman Jonathan PhamJonathan Pham More articles by this author , Ahmad AlzubaidiAhmad Alzubaidi More articles by this author , Tullika GargTullika Garg More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer mortality is steadily rising in rural communities in the United States compared to urban counterparts. The underlying causes of these disparities are complex and multifactorial. Our objective was to describe trends in rural and urban incidence and mortality of genitourinary (GU) cancers in the Pennsylvania Cancer Registry. METHODS: We conducted a retrospective review of age-adjusted incidence and mortality rates of GU (prostate (PC), bladder (BC), and kidney (KC)) cancers by county from 1990-2019. Counties were designated as urban or rural using the Center for Rural Pennsylvania’s population-density based definition defined as 284 people per square mile using 2019 county census data. In Pennsylvania, 48 rural counties and 19 urban counties were identified. Joinpoint regression was used to model average annual percent changes (AAPC) in age-adjusted incidence and mortality rates in urban and rural counties. RESULTS: From 1990-2019, overall age-adjusted GU cancer incidence significantly decreased in rural (AAPC -7.5%, p=0.04) and in urban counties (-6.6%, p=0.02). For PC, age-adjusted incidence decreased in rural counties by -10.5% (p=0.02) and in urban counties by -9.1% (p=0.01). Age-adjusted incidence of BC was unchanged for both urban and rural counties. KC incidence increased in both rural counties (AAPC=+11.2, p=0.002) and in urban counties (AAPC=+9.3%, p=0.01).Overall GU cancer age-adjusted mortality decreased in rural counties (AAPC=-11.6, p=0.047) and in urban counties (AAPC -12.2, p=0.01). PC mortality for rural and urban counties decreased at similar rates (AAPC -15.5, p=0.03 and -15.4, p=0.02, respectively). Age-adjusted mortality for BC was unchanged for rural and urban counties over the study period. KC mortality in urban counties decreased (AAPC -6.9% p=0.03), while mortality in rural counties remained stable. CONCLUSIONS: From 1990-2019, overall GU cancer incidence and mortality have decreased in both rural and urban Pennsylvania counties. Across all counties, PC incidence and mortality have decreased, and BC incidence and mortality have remained stable. KC incidence increased across all counties; however, mortality remained stable in rural counties. These data may inform targeted interventions to improve outcomes for specific GU cancers in rural areas. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1082 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Pham More articles by this author Ahmad Alzubaidi More articles by this author Tullika Garg More articles by this author Jay Raman More articles by this author Expand All Advertisement PDF downloadLoading ...

Understanding the Effects of COVID-19 on Child Maltreatment Reporting Among Rural Versus Urban Communities in the United States

The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted child protective services (CPS) reporting systems in the United States. It may have also led to widened gaps between rural and urban communities in child maltreatment (CM) report rates due to decreased interaction between children and mandated reporters especially in urban jurisdictions. Using data from the National Child Abuse and Neglect Data System, this study tests the hypothesis that during the onset of the COVID-19 pandemic, the decrease in CM reports made to CPS in urban counties was more pronounced than in rural counties. Reports of CM received by CPS offices between January 6, 2020 and June 28, 2020 were aggregated to per-county-per-week-per-10,000 children maltreatment report rates. We used changepoint analyses to analyze the inter- and intra-region incidence rate ratios among rural and urban counties. Moreover, we used multilevel random effects models to generate regression coefficients for the associations between rates of children with a maltreatment report, COVID-19 occurrence, rural-urban designation, and maltreatment risk factors. During the study period, rates of children with a maltreatment report among urban counties decreased more dramatically when compared with rural counties. Our findings persisted even with the inclusion of control variables associated with maltreatment risk factors. Social distancing restrictions may have had the unintended consequence of decreasing the visibility of at-risk children in urban counties more so than in rural counties. Considering geography is critical to continue to protect children during the COVID-19 pandemic and as we prepare for future disasters.

A Descriptive Study on Opioid Misuse Prevalence and Office-Based Buprenorphine Access in Ohio Prior to the Removal of the Drug Addiction Treatment Act of 2000 Waiver.

Background Medications for the treatment of opioid use disorder (MOUD) are effective evidence-based strategies to reduce opioid overdose deaths. Strategies to optimize MOUD availability and uptake are needed. Objective We aim to describe the spatial relationship between the estimated prevalence of opioid misuse and office-based buprenorphine access in the state of Ohio prior to the removal of the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver requirement. Methods We conducted a descriptive ecological study of county-level (N=88) opioid misuse prevalence and office-based buprenorphine prescribing access in Ohio in 2018. Counties were categorized into urban (with and without a major metropolitan area) and rural. The county-level prevalence estimates of opioid misuse per 100,000 were derived from integrated abundance modeling. Utilizing data from the Ohio Department of Mental Health and Addiction Services, as well as the state's Physician Drug Monitoring Program (PDMP), buprenorphine access per 100,000 was estimated by the number of patients in each county that could be served by office-based buprenorphine (prescribing capacity) and the number of patients served by office-based buprenorphine (prescribing frequency) for opioid use disorder. The ratios of opioid misuse prevalence to both prescribing capacity and frequency were calculated by county and mapped. Results Less than half of the 1,828 waivered providers in the state of Ohio in 2018 were prescribing buprenorphine, and 25% of counties had no buprenorphine access. The median estimated opioid misuse prevalence and buprenorphine prescribing capacity per 100,000 were highest in urban counties, particularly those with a major metropolitan area. Although the median estimated opioid misuse prevalence was lower in rural counties, all counties in the highest quartile of estimated misuse prevalence were rural. In addition, the median buprenorphine prescribing frequency was highest in rural counties. While the ratio of opioid misuse prevalence to buprenorphine prescribing capacity was lowest in urban counties, the ratio of opioid misuse prevalence to buprenorphine prescribing frequency was lowest in rural counties. Opioid misuse prevalence and buprenorphine prescribing frequency demonstrated similar spatial patterns, with highest levels in the southern and eastern portions of the state, while office-based buprenorphine prescribing capacity did not. Conclusion Urban counties had higher buprenorphine capacity relative to their burden of opioid misuse; however, access was limited by buprenorphine prescribing frequency. In contrast, in rural counties, a minimal gap was evident between prescribing capacity and frequency, suggesting that buprenorphine prescribing capacity was the major factor limiting access. While the recent deregulation of buprenorphine prescribing should help improve buprenorphine access, future research should investigate whether deregulation similarly impacts buprenorphine prescribing capacity and buprenorphine prescribing frequency.

Influence of conspiracy theories and distrust of community health volunteers on adherence to COVID-19 guidelines and vaccine uptake in Kenya.

Public trust is key for compliance to government protocols in times of health mitigating COVID-19 measures and its vaccination initiative, and thus understanding factors related to community health volunteers (CHVs) trusting the government and conspiracy theories is vital during the COVID-19 pandemic. The success of universal health coverage in Kenya will benefit from the trust between the CHVs and the government through increased access and demand for health services. This cross-sectional study collected data between 25 May to 27 June 2021 and it involved CHVs sampled from four counties in Kenya. The sampling unit involved the database of all registered CHVs in the four counties, who had participated in the COVID-19 vaccine hesitancy study in Kenya. Mombasa and Nairobi (represented cosmopolitan urban counties). Kajiado represented a pastoralist rural county, while Trans-Nzoia represented an agrarian rural county. Probit regression model was the main analytical method which was performed using R script language version 4.1.2. COVID-19 conspiracy theories weakened generalised trust in government (adjOR = 0.487, 99% CI: 0.336-0.703). Banking on COVID-19 related trust in vaccination initiatives (adjOR = 3.569, 99% CI: 1.657-8.160), use of police enforcement (adjOR = 1.723, 99% CI: 1.264-2.354) and perceived risk of COVID-19 (adjOR = 2.890,95% CI: 1.188-7.052) strengthened generalised trust in government. Targeted vaccination education and communication health promotion campaigns should fully involve CHVs. Strategies to counter COVID-19 conspiracy theories will promote adherence to COVID-19 mitigation measures and increase vaccine uptake.

Research on the Slope Gradient Effect and Driving Factors of Construction Land in Urban Agglomerations in the Upper Yellow River: A Case Study of the Lanzhou–Xining Urban Agglomerations

Analyses of the scale and structural characteristics of construction land serve as the basis for optimizing the spatial pattern of territorial planning. Existing studies have focused mainly on the horizontal expansion of urban construction land. Therefore, based on the Google Earth Engine (GEE) platform, in this paper, we use high-precision land-use cover data, DEM data and socioeconomic data to construct the standard dominant comparative advantage index (NRCA) using the geological mapping analysis method and we systematically analyze the horizontal scale, slope spectrum characteristics, gradient effects and driving factors of construction land in the Lanzhou–Xining urban agglomeration (LXUA) from 1990 to 2020 at four scales: the urban agglomeration, provincial area, typical city and county (district) scales. The results of the study show that urban construction land, rural settlement land and other construction land in the LXUA show “linear”, inverted-“U” and “J” growth patterns, respectively. Three types of construction land show different spatial transfer characteristics. The scale and extent of climbing of urban construction land in the LXUA is gradually decreasing over time, and the number of climbing rural settlement lands in 2000–2010 was as high as 34 counties (districts), while the number of counties (districts) with strong climbing degrees of other construction land rose to 12 from 2010 to 2020. The relative hotspots of the slope-climbing phenomenon of the three types of construction land have gradually expanded spatially, with Lanzhou city and Xining city as the center, and the overall spatial characteristics are “more in the east and less in the west”. The population and GDP are the main factors influencing the slope-climbing phenomenon of urban construction land, while rural settlements are influenced mainly by natural conditions, and accessibility is the key factor affecting other construction land.

The Effect of Community Type on Access to Orthopedic Services for Medicaid-Insured Patients

Purpose Medicaid-insured patients have less access to specialty care compared to those who are privately insured. Limited and delayed access to orthopaedic services can affect patient outcomes, especially for patients living in rural areas. The purpose of this study was to evaluate the effect of community setting in access to orthopaedic care for Medicaid-insured patients. Methods The study population included board-certified orthopaedic specialists obtained from the American Academy of Orthopaedic Surgeons (AAOS) within five Florida counties, representing urban and rural communities. Investigators used the Secret Shopper methodology to schedule an appointment for a rotator cuff repair. Medicaid acceptance rate, wait time, and average distance to clinics accepting Medicaid were calculated and compared between urban and rural counties. Results Of the 108 clinics identified, 76.9% performed arthroscopic rotator cuff repair. The appointment rate across all counties was 100% (n=83) for privately insured patients and 9.6% (n=8) for Medicaid patients. There was no significant difference in access when comparing access to care with Medicaid in urban and rural counties (p=0.984). Medicaid patients had significantly shorter wait times in rural counties compared to urban counties (p=0.021). Rural counties encountered a significantly greater average travel distance to clinics accepting Medicaid compared to urban counties (p=0.042). Conclusion Medicaid-insured patients have limited access to orthopaedic care, regardless of community setting. Medicaid-insured patients in rural counties were more likely to have shorter wait times to the appointment and travel longer distances to clinics.

Study on Coupling and Coordination of E-Commerce &amp; Logistics and Urbanization Under County Agriculture and Rural Digitalization ——Take Sichuan &amp; Shaanxi Revolutionary Base Area (Sichuan) as an Example

As an important part of the Rural Revitalization Strategy, e-commerce &amp; logistics under the digitalization of county agriculture and rural areas is conducive to consolidating and expanding the achievements of poverty alleviation and continuously narrowing the development gap between urban and rural areas, and is conducive to the revitalization and development of old revolutionary areas and the realization of new urbanization. Based on the coupled development theory and coordination theory, establish reasonable evaluation indicators, and use the coupled development model to explore the coupling relationship between county urbanization, logistics economy and rural e-commerce in the Sichuan &amp; Shaanxi revolutionary base area (Sichuan) as a sample, and analyze and study the relationship between the three and their development laws. In the implementation plan of Sichuan Province for implementing the revitalization and development plan of the old revolutionary base areas in Sichuan &amp; Shaanxi, it is proposed to build a number of logistics parks, logistics centers, distribution centers and third-party logistics information platforms based on regional central cities for trade logistics, accelerate the construction of trade centers and professional markets, create trade towns, and incorporate the rural market circulation system into the urbanization plan; For e-commerce, we should strengthen the construction of logistics distribution and other support systems, and actively develop county e-commerce.

Gentrification and Air Quality in a Large Urban County in the United States

Introduction: Increases in industrialization and manufacturing have led to worsening pollution in some components of air quality. In addition, gentrification is occurring in large cities throughout the world. As these socioeconomic and demographic changes occur, there have been no studies examining the association of gentrification with air quality. To investigate this association, we studied the trends of gentrification, changes in racial distribution and changes in air quality in each zip code of a large urban county over a 40-year period. Methods: We conducted a retrospective longitudinal study over 40 years in Wayne County, Michigan using socioeconomic and demographic data from the National Historical Geographic Information System (NHGIS) and air quality data from the United States Environmental Protection Agency (EPA). To assess gentrification, longitudinal analyses were performed to examine median household income, percentage with a college education, median housing value, median gross rent and employment level. The racial distribution was evaluated in each zip code during the time period. Gentrification was studied in relation to air quality using nonparametric 2-sample Wilcon-Mann-Whitney tests and Binomial Generalized Linear Regression models. Results: Although air quality improved overall over the 40-year period, there was a lesser rate of improvement in gentrified areas. Furthermore, gentrification was strongly associated with racial distribution. The most substantial gentrification occurred from 2010 to 2020, in which a specific cluster of adjacent zip codes in downtown Detroit experienced intense gentrification and a drop in the percentage of African-American residents. Conclusions: Gentrified areas seem to have a less pronounced improvement in air quality over time. This reduction in air quality improvement is likely associated with demolitions and the construction of new buildings, such as sporting arenas and accompanying traffic density. Gentrification is also strongly associated with an increase in non-minority residents in an area. Although previous definitions of gentrification in the literature have not included racial distribution, we suggest that future definitions should include this metric given the strong association. Minority residents who are displaced as a result of gentrification do not experience the improvements in housing quality, accessibility to healthy foods and other associations of gentrification.

Environmental characteristics and disparities in adult asthma in north central Texas urban counties

ObjectivesDisparities in asthma prevalence present a persistent challenge to public health. The complex nature of the issue requires studies through a wide range of lenses. To date, little research has examined associations between asthma and multiple social and environmental factors simultaneously. This study aims to fill the gap with a focus on the impacts of multiple environmental characteristics and social determinants of health on asthma. Study designThis study uses secondary analysis with data from a variety of sources to analyze the effects of environmental and social factors on adult asthma occurrence in North Central Texas. MethodHospital records and demographic and environmental data for four urban counties in North Central Texas (Collin, Dallas, Denton, and Tarrant) come from the Dallas/Fort Worth Hospital Council Foundation, the US census, the North Central Texas Council of Governments, and the Railroad Commission of Texas. The data were integrated using ArcGIS. A hotspot analysis was performed to inspect the spatial patterns of hospital visits for asthma exacerbations in 2014. The impacts of multiple environmental characteristics and social determinants of health were modeled using negative binomial regression. ResultsThe results revealed spatial clusters of adult asthma prevalence and disparities by race, class, and education. The occurrence of asthma exacerbations was positively associated with exposure to traffic-related air pollution, energy-related drilling activities, and older housing stock and negatively linked to green space. ConclusionsAssociations between built environmental characteristics and asthma prevalence have implications for urban planners, healthcare professionals, and policy makers. Empirical evidence for the role of social determinants of health supports continuing efforts in policies and practices to improve education and reduce socio-economic inequities.