Urban-rural Residence Research Articles

Rural-urban disparities in postpartum contraceptive use among women in Nigeria: a Blinder-Oaxaca decomposition analysis

BackgroundUnintended pregnancies are a global public health concern that could be prevented with appropriate access to contraceptive methods. Evidence from research has indicated that avoidance of closely space birth/pregnancy within the first year of postpartum, mitigates the risk of adverse health outcomes such as preterm birth, low birth-weight, etc. Postpartum family planning helps women to minimize closely spaced and unplanned pregnancies within the first 12 months after delivery. Less contraceptive use is often present in more socially disadvantaged groups. Studies from Nigeria have shown a persistent disparity on contraceptive use between rural and urban residents. To identify the factors explaining these inequalities is important to implement targeted interventions. This study aimed to identify the factors contributing to the rural-urban disparity in postpartum contraceptive use among women in Nigeria.MethodsThis is a cross-sectional study using the Nigerian Demographic Health Survey. In total, 28,041 postpartum Nigerian women were included. Self-reported contraceptive use was the outcome, while the selected explanatory variables were grouped according to three theoretical perspectives: materialistic, behavioural/cultural, and psychosocial variables. Descriptive statistics and Blinder-Oaxaca decomposition were used to summarize and identify the factors contributing to the rural-urban disparity in postpartum contraceptive use.ResultsIn this study, 27% of women reported to have used contraceptives during the postpartum period. The rural-urban disparity in postpartum contraceptive use accounted for 18.2 percentage points. The findings further showed that the disparities in postpartum contraceptive use between rural-urban residence were mostly explained by materialistic variables (82%), followed by the behavioural/cultural variables and age (included as covariate) accounting for 15.6 and 3.0%, respectively. Household wealth (37%) and educational attainment (38%) had the most significant contribution to the differences in postpartum contraceptive use. Only 15% of the difference in postpartum contraceptive use remained unexplained.ConclusionThis study has shown important inequalities in postpartum contraceptive use between rural and urban residents in Nigeria. These differences were mainly explained by materialistic factors. These findings highlight crucial areas for the government to target in order to close the existing gap between rural and urban settings in contraceptive use in the country.

Analysis of the Impact of Digital Finance Development on Household Consumption of Urban and Rural Residents in China

In recent years, China's digital finance has developed rapidly, profoundly changing the way residents live and consume. Especially in the context of China's Urban-rural dual economic structure, the impact of digital finance development on urban and rural household consumption is significantly different. The dual structure of urban and rural areas and the development model of financial efficiency and fairness have led to the imbalance between urban and rural development in China's financial system. Many economically backward rural areas have lagged behind in financial development. Digital finance has expanded the coverage and service scope of Inclusive Finance, and changed people's lifestyle and consumption habits. Realize the docking of consumption willingness and consumption capacity. Narrow the gap between urban and rural consumption. The study shows that the development of digital finance has significantly increased the consumption level of urban and rural households, but overall the impact on the consumption of urban households has been greater. Specifically, the depth of use of digital finance has a greater impact on the household consumption of urban residents, and the breadth and degree of digital financial coverage have a greater impact on the consumption of rural households. Further research found that there are differences in the impact mechanism of digital financial development on household consumption of urban residents and rural residents: The development of digital finance mainly promotes the consumption of urban households by increasing residents' incomes and reducing the uncertain risks faced by households, and increases the consumption of rural households by facilitating payment and alleviating liquidity constraints.

Abstract 245: Increased Prevalence Of Children With Congenital Heart Disease In Colorado From 2012 - 2019

Introduction: Congenital heart defects (CHD) are the most common birth defects and are estimated to affect almost 1% of births per year in the US. Most CHD prevalence estimates are based on data from population-based birth defects surveillance systems and these estimates are inconsistent due to varied definitions. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population. Methods: We analyzed all payer claims data (APCD) from Colorado from 2012-2019. Children with CHD were identified by applying CHD ICD-9 and ICD-10 diagnoses codes from the Society of Thoracic Surgeons (STS) International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD) harmonized cardiac codes. We included children with CHD < 18 years of age who resided in Colorado, had a documented zip code, and had at least one ambulatory healthcare claim. We analyzed the test for linear trends in the proportion of CHD diagnoses from 2012-2019 with the Cochran-Armitage (Z) test. Differences among patient characteristics and CHD diagnosis were tested using the Pearson Chi-square test and Wilcoxon rank sum tests as appropriate. Results: Overall the current study analyzed 1,565,438 children with 36,567 CHD diagnoses (i.e. 23.4 per 1,000 live births), comprising 2.3% of the pediatric population. Between 2012 and 2019 the statewide rate of children diagnosed with CHD significantly increased from 21.9 to 32.3 per 1,000 children per year (Z: 5.38; p<0.001). There were statistically significant differences in the magnitude of the trend in CHD prevalence rate by region (Z: -31.82), urban-rural residence (Z:-24.02), degree of chronic complex conditions (Z: -38.78), disease severity (Z: -44.11), age (Z: -72.89), insurance type (Z: 46.51) and median household income (Z: 12.87; all p<0.001). Conclusion: The current study is the first population-level analysis of pediatric CHD in the US and these findings suggest that the statewide CHD prevalence rate has increased significantly since 2012. Children with CHD are a priority population for quality improvement in pediatrics given their growing prevalence and corresponding risk of adverse outcomes.

Association of Urban-Rural Residence and Concurrent HIV Infection and Opioid Use Disorder Among Medicare Beneficiaries-United States, 2020.

Published research provides minimal insights into variation by urban or rural residence of HIV infection risk and injection drug use. We used the 2020 Medicare claims data to assess the association of urban-rural residence and concurrent HIV infection and opioid use disorder (OUD), adjusted for demographic risk factors, among Medicare beneficiaries (MBs) with fee-for-service claims paid during 2020. Medicare beneficiaries with both HIV infection and OUD were more likely than those without to be aged ≤64 years, male, Black, residing in the U.S. Northeast, residing in an urban county, and to have one or more comorbid condition. Medicare beneficiaries who lived in urban counties had higher odds (adjusted odds ratio 4.04; 95% confidence interval 3.72, 4.39) of having HIV and OUD than those who lived in rural counties. Urban-rural residence was associated with concurrent HIV infection and OUD, independent of age, sex, race/ethnicity, and comorbidity among MBs with claims paid during 2020.

Urban-Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region.

IntroductionRural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic–surgical pathway and urban–rural residency in our region.MethodsWe retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017–2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural–urban residency classification from the Department of Land.ResultsA total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; p = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, p = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, p = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, p = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [F(3, 270), p < .05, R2 = 0.24]: rurality (p = 0.04), GP involvement (p = 0.04), and presence of lung cancer-related symptoms (p = 0.02).ConclusionsIn our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program.

Local government in Ghana: Exploring the factors that predict public attitudes towards local government elections in Ghana

ABSTRACT Local government decentralization, as a policy option, has been on the political and developmental agenda of Ghana since 1957. At the heart of Ghana’s local government and decentralization policies are Metropolitan, Municipal, and District Assemblies (MMDAs) and Chief Executives (MMDCEs), currently appointed by the President. Since MMDCEs are appointed by the president, there are arguments about whether their allegiance lies with the president or their local constituents. In recent years, citizens’ demand for local government elections is commonplace in Ghana. The present study explores the factors that influence public support for local government elections in Ghana, specifically the election of MMDCEs. Analyzing national representative data (n = 2400), obtained from the Afrobarometer Round 7 survey about Ghana, several important revelations were made. The analysis revealed that the majority of respondents (73%) support local government elections in Ghana. Additionally, political party affiliation, rural-urban residency, region, and problems facing Ghana are strong predictors. Overall, the present study provides partial support for path dependency theory and the sequential theory of decentralization.

Disparities in Telehealth Utilization in a Population of Publicly Insured Children During the COVID-19 Pandemic.

Telehealth became a crucial vehicle for health care delivery in the United States during the COVID-19 pandemic. However, little research exists on inequities in telehealth utilization among the pediatric population. This study examines disparities in telehealth utilization in a population of publicly insured children. This observational, retrospective study used administrative data from Alabama's stand-alone Children's Health Insurance Program, ALL Kids. Rates of any telehealth use for March to December 2020 were examined. In addition-to capture lack of health care utilization-rates of having no medical claims were examined and compared with March to December 2019 and 2018. Multinomial logit models were estimated to investigate how telehealth use and having no medical claims (reference category: having medical claims but no telehealth) were associated with race/ethnicity, rural-urban residence, and family income. Of the 106,478 enrollees over March to December 2020, 13.4% had any telehealth use and 24.7% had no medical claims. The latter was greater than no medical claims in 2019 (19.5%) and 2018 (20.7%). Black and Hispanic children had lower odds of any telehealth use (odds ratio [OR]: 0.81, P < 0.01; OR: 0.68, P < 0.01) and higher odds of no medical claims (OR: 1.11, P < 0.05; OR: 1.73, P < 0.05) than non-Hispanic White children. Rural residents had lower odds of telehealth use than urban residents. Those in the highest family income-based fee group had higher odds of telehealth use than the lowest family income-based fee group. As telehealth will likely continue to play an important role in health care delivery, additional efforts/investments are required to ensure telehealth does not further exacerbate inequities in pediatric health care access.

District-Level Analysis of Inequality in Malnutrition Among Children: Evidence from Maharashtra, India

Background and Objective: India currently faces the triple burden of malnutrition characterized by the coexistence of undernutrition and overnutrition along with micronutrient deficiencies. The unequal distribution of child health outcomes in the population may affect the goal of a ‘malnutrition free world’. The nutritional status and its inequalities among post under-five age have rarely been assessed in the country. This study examines the degree and extent of asset-based household wealth inequalities in malnutrition among preschool and school children in the Maharashtra state of India. Methods: The study utilizes the fourth round of the District Level Health Survey 2012-2013 to provide district-level estimates of the inequalities in five malnutrition indicators-stunting, wasting, underweight, overweight, and anemia among children. Concentration curves, normalized concentration index, geographical maps and correlation matrix are used to analyze the data by districts, rural-urban residence and gender. Results: Considerable proportion of children are malnourished in Maharashtra, even with its advanced economic status. Malnutrition levels among school going children are as high as those of children under six years of age. The findings indicate that malnutrition inequalities manifest primarily among the weaker sections of society. However, children from affluent households are more likely to suffer from overweight and obesity issues. The prevalence of malnutrition is higher in rural areas, but inequality is significantly higher in urban regions. The nutritionally backward areas are concentrated in the tribal districts of the Marathwada division and a few others from Vidarbha and Amravati. Many districts of Maharashtra have multiple burdens of malnutrition and have high inequalities on more than one indicator. A negative correlation is observed between the prevalence of malnutrition and human development indicators. Conclusion: There is a need to capture broader age groups in the nutrition monitoring frameworks. Recognizing the regional heterogeneity in the malnutrition prevalence and distribution calls for unique health intervention strategies to specific district targets.

Research on the design of serious illness insurance scheme in Shanghai based on micro-simulation

BackgroundUrban and rural residents’ basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai.MethodsWe developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai’s current policies.ResultsThe payment of SIMIS according to high expenses, the total medical expenses of seriously ill patients show an increasing trend, with an average annual growth rate of 3.56%. The URRBMI fund payment covers 56%–58% of total medical expenses, and the SIMIS fund covers 5%–7% of the total medical expenses. Both cover 62%–63% of total medical expenses. Self-payment under SIMIS covers 22%–23% of the total medical expenses, total self-payment covers 14%–15% of the total medical expenses, and the medical expenses borne by individuals cover 36%–38% of the total medical expenses.The fund expenditure is 213 million yuan and average annual cost borne by individual patients ranges from 40 000 to 60 000 yuan.ConclusionsThe policy of designing SIMIS according to national guidelines does not meet the development needs of Shanghai. Shanghai should take the current policy of paying compensation according to the treatment of serious illness as the policy basis, consider the security needs of patients with large medical expenses outside the scope of protection, and adjust policies appropriately to prevent poverty caused by illness.

Making Europe health literate: including older adults in sparsely populated Arctic areas

BackgroundOlder people have been identified as having lower health literacy (HL) than the general population average. Living in sparsely populated Arctic regions involves unique health challenges that may influence HL. The research aim was to explore the level of HL, its problematic dimensions, and its association with the selection of contextual factors among older adults living in sparsely populated areas in Northern Iceland.MethodThis was a cross-sectional study based on a stratified random sample from the national register of one urban town and two rural areas. The study included 175 participants (57.9% participation rate) who were community-dwelling (40% rural) and aged 65–92 years (M 74.2 ± SD 6.3), 43% of whom were women. Data were collected in 2017-2018 via face-to-face interviews, which included the standardised European Health Literacy Survey Questionnaire-short version (HLS-EU-Q16) with a score range from 0 to 16 (low-high HL).ResultsThe level of HL ranged from 6–16 (M 13.25, SD ± 2.41) with 65% having sufficient HL (score 13–16), 31.3% problematic HL (score 9–12) and 3.7% inadequate HL (score 0–8). Most problematic dimension of HL was within the domains of disease prevention and health promotion related to information in the media. Univariate linear regression revealed that better HL was associated with more education (p=0.001), more resiliency (p=0.001), driving a car (p=0.006), good access to health care- (p=0.005) and medical service (p=0.027), younger age (p=0.005), adequate income (p=0.044) and less depression (p=0.006). Multivariable analysis showed that more education (p=0.014) and driving a car (p=0.017) were independent predictors of better HL.ConclusionDifficulties in HL concern information in the media. HL was strongly associated with education and driving a car however, not with urban-rural residency. Mobility and access should be considered for improving HL of older people.

Delays and declines in seasonal influenza vaccinations due to Hurricane Harvey narrow annual gaps in vaccination by race, income and rurality.

Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality. Retrospective cohort analysis. Texas counties affected by Hurricane Harvey. Active users of the Veterans' Health Administration in 2017. We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural-urban residence of patients. The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034-1.095) in the hurricane. year. Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non-low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.

The Fujian eye cross sectional study: objectives, design, and general characteristics

PurposeTo describe the objective and design of the Fujian Eye Study and to introduce the general characteristics and vision condition of this study.MethodsThe Fujian Eye Study (FJES) is a population-based cross-sectional survey on the public eye health status of residents over 50 years old in the entire Fujian Province of Southern China, which contains both urban and rural areas and coastal and inland regions. 10,044 participants were enrolled using a two-stage cluster sampling design and underwent a questionnaire and a series of standard examinations both physical and ocular. The main subgroups of data collection included age, sex, region, refractive error, education background, income, eating habits, smartphone usage in the dark, complaints of eye discomfort, history of chronic diseases, consumption of tobacco, alcohol, or tea.Results8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects) and rural populations (3533 subjects) and coastal residents (6434 subjects) and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39 (SD 8.87) years (median 64 years; range 50–98 years). 227 (3.33%) had vision impairment (VI), 195 (2.87%) had low vision and 14 (0.21%) were blind. The mean presenting near visual acuity (PNVA) was 0.28 (0.17), the mean presenting distance visual acuity (PDVA) was 0.61 (0.30), and the mean best corrected visual acuity (BCVA) was 0.82 (0.28).ConclusionsThe FJES collected detailed questionnaire information and overall ocular and physical examinations, which provide the opportunity to identify risk factors and images of VI and eye diseases and to evaluate their associations with chronic diseases and basic personal information.

Geographic practice preferences of graduating medical students pursuing careers in dermatology

Geographic practice preferences of graduating medical students pursuing careers in dermatology

Rural depopulation and the rural-urban gap in cognitive functioning among older adults.

As the population ages, the number of people with cognitive impairment will rapidly increase. Although previous research has explored the rural-urban gap in physical health, few studies have analyzed cognitive health. The purpose of this study was to examine rural-urban differences in cognitive health, with a focus on the moderating effect of population decline. The study used individual-level nationally representative data from the 2000-2016 waves of the Health and Retirement Study (N = 152,444) merged to county-level contextual characteristics. Hierarchical linear models were used to predict the cognitive functioning of US adults aged 50 and over by rural-urban residence, county depopulation, and their interactions while controlling for individual-level and county-level demographic and contextual factors. Older adults living in rural counties had lower cognitive functioning than urban adults. The interaction between living in a rural and depopulated county was statistically significant (P < .001). The rural penalty in cognitive functioning was 40% larger for those who lived in counties that lost population between 1980 and 2010 compared to those who lived in stable or growing rural counties. These results were independent of race-ethnicity, gender, age, education, income, region, employment status, marital status, physical health, and depression as well as the county's racial-ethnic composition, age structure, economic and educational disadvantage, and health care shortages. The results have important implications for those seeking to reduce health disparities both between rural and urban older adults and among different groups of rural people. Interventions targeting those living in rural depopulating areas are particularly warranted.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.

Water, sanitation and the risk of chronic diseases in old age: Results from the Ghana WHO SAGE 2

Background: The associations of water and sanitation with population health have been well-documented. However, the specific effects of water and sanitation on chronic diseases in old age are least explored. This study examines the associations between water, sanitation and chronic diseases among older people in Ghana and whether these associations are moderated by sex and spatial variation. Methods: Data from the WHO-SAGE Wave 2 involving adults aged ≥ 50 years were analyzed. Chronis diseases were assessed based on the self-reported diagnosis by a healthcare professional. The exposures included water sources, type of toilet, and sharing of toilet facilities. Generalized logistic regression models estimated the effects of water and sanitation indicators on chronic diseases. Results: Overall, 18.8% of the sample reported at least one chronic disease. Compared to men and those in rural areas, women and urban residents respectively were more likely to report chronic disease (p &lt; 0.001). After full adjustments, logistic regressions showed that the use of unimproved sanitation (OR = 1.732, CI: 1.377–5.418) and sharing of sanitation facilities (OR = 1.624, CI: 1.095–1.320) were associated with higher odds of chronic diseases. However, the use of water did not reach significance (p = 0.125). We found a significant interaction effect for type of toilet × sex (OR = 3.498, CI: 1.744–16.442), source of water × residence (OR = 5.935, CI: 1.320–26.685), and type of toilet × spatial variation (OR = 1.998, CI: 1.462–8.642). Conclusions: The use of unimproved sanitation facilities and the sharing of toilet facilities are associated with the occurrence of chronic diseases among older people. Policy and public health interventions targeted at improving the health and well-being of older people should conspicuously include better access and improved sanitation services.

Prevalence of depression in China during the early stage of the COVID-19 pandemic: a cross-sectional study in an online survey sample

ObjectivesWe aimed to determine (1) the prevalence of depression during the COVID-19 pandemic among Chinese adults and (2) how depression prevalence varied by province and sociodemographic characteristics.DesignCross-sectional study.SettingNational online survey...

Influence of rurality on lymph node assessment among women diagnosed with ductal carcinoma in situ and treated with mastectomy, SEER 2000-2015.

Despite recommendations from national organizations supporting the use of lymph node assessment (LNA) among patients with ductal carcinoma in situ (DCIS) at time of mastectomy, variation in practice patterns across the United States has been observed. However, few studies have evaluated LNA differences and rurality. Data from the SEER Patterns of Care studies were used to identify women who underwent mastectomy for newly diagnosed DCIS during 2000, 2005, 2010, and 2015. Weighted multivariate logistic regression was used to evaluate the association between rural-urban residence and the use of LNA. A subgroup analysis was performed comparing the use of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB). Of the 504 patients included in the analysis, approximately 81% underwent LNA at time of mastectomy with lower rates of use observed among rural patients (66%) versus urban patients (82%). In multivariate analysis, LNA increased over time (p < 0.0001), and rural patients were less likely to receive LNA compared to urban patients [adjusted odds ratio (aOR) = 0.19; 95% confidence interval (CI) 0.06-0.66]. However, the likelihood of undergoing ALND relative to SLNB was lower among rural compared to urban patients (aOR = 0.16; 95% CI 0.03-0.73). Over time, the use of LNA with mastectomy has increased among DCIS patients. However, significant rural-urban differences in the use and type of LNA persist. The findings of this study highlight the importance of continued research aimed at examining the impact of rurality on the receipt of high-quality cancer care.

A Bayesian approach to combining multiple information sources: Estimating and forecasting childhood obesity in Thailand.

We estimate and forecast childhood obesity by age, sex, region, and urban-rural residence in Thailand, using a Bayesian approach to combining multiple source of information. Our main sources of information are survey data and administrative data, but we also make use of informative prior distributions based on international estimates of obesity trends and on expectations about smoothness. Although the final model is complex, the difficulty of building and understanding the model is reduced by the fact that it is composed of many smaller submodels. For instance, the submodel describing trends in prevalences is specified separately from the submodels describing errors in the data sources. None of our Thai data sources has more than 7 time points. However, by combining multiple data sources, we are able to fit relatively complicated time series models. Our results suggest that obesity prevalence has recently starting rising quickly among Thai teenagers throughout the country, but has been stable among children under 5 years old.

Labour market and wage inequalities between permanent rural migrants and urban-born residents in China

ABSTRACT This study provides some of the first empirical evidence on the role of the labour market in determining individual-level wages and the consequent wage inequalities. Unlike traditional earnings equations that focus on human capital factors, this study follows recent wage theory, the Nash bargaining model, and finds that not only human capital but also the labour market are important factors in determining individual-level wages. Further, this study examines wage inequalities between urban-born workers and permanent rural migrant workers, who constitute a sizable part of all rural migrants in urban China but have been ignored in previous academic studies. Different from temporary rural migrants examined in previous studies, permanent rural migrants share the same citizenship rights and social welfare as urban-born workers. However, we still find that these permanent migrants (classified as talent, land, and ‘supported’ migrants) face disadvantages in acquiring high wages. Using a developed version of the two-fold Blinder–Oaxaca decomposition based on our theoretical model, we find that the wage inequalities between permanent rural migrants and urban residents are caused by both the workers’ education and labour market tightness, as well as the father’s employment status, housing prices, and other factors.