Urban Rural Research Articles

Abstract 4146306: Rural Urban Disparities in Inpatient Outcomes of Chronic Limb-Threatening Ischemia in the United States

Background: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by chronic ischemic rest pain, non-healing wounds, or gangrene in one or both legs. With prevalence rates of 1-2% in the United States (increasing with age, with over 20% of adults over 70 diagnosed with CLTI) and 1-year mortality rates approaching 20-25%, CLTI is a critical public health issue due to its significant impact on patient morbidity, mortality, and healthcare resources. Aims: To understand if disparities exist between rural and urban inpatient outcomes for patients with CTLI. Methods: A retrospective analysis of the National Inpatient Sample database from 2016 to 2021 was conducted to identify patients admitted with CLTI according to ICD-10 codes. Patients were stratified by rural and urban status, followed by propensity-matched analysis to compare inpatient outcomes between these groups. Results: A total of 2,667,279 patients with CLTI, with 445255 (16.7%) categorized as rural status and the remaining 83.3% categorized as urban status, were included in this study. Patients belonging to rural status had an increased odds of in-hospital mortality (aOR)=1.35; 95% CI 1.26-1.45; p<0.001), in-patient sudden cardiac arrest (aOR=1.27; 95% CI=1.13-1.43; p<0.001), cerebrovascular accidents (aOR=1.31; 95% CI=1.19-1.45; p<0.001), venous thromboembolism (aOR=1.18; 95% CI=1.09-1.27; p<0.001), surgical site infection (aOR=1.25; 95% CI=1.16-1.35; p<0.001), requirement for vasopressors (aOR=2.02; 95% CI=1.76-2.32; p<0.001), invasive (aOR=1.18; 95% CI=1.10-1.26; p<0.001) and non-invasive (aOR=1.37; 95% CI=1.25-1.50; p<0.001) mechanical ventilation, hemodialysis (aOR=1.11; 95% CI=1.06-1.15; p<0.001), major amputation (aOR=1.38; 95% CI=1.32-1.43; p<0.001), surgical revascularization (aOR=1.53; 95% CI=1.46-1.60; p<0.001), endovascular revascularization (aOR=1.53; 95% CI=1.46-1.60; p<0.001), and blood transfusion (aOR=0.92; 95% CI=0.88-0.97; p=0.001). No difference was observed in the odds of acute myocardial infarction (aOR=1.06; 95% CI=0.99-1.14; p=0.082) and risk of acute kidney injury (aOR=0.99; 95% CI=0.96-1.02; p=0.485). Conclusions: Disparities in CLTI outcomes are evident, with patients from rural areas experiencing worse outcomes than their urban counterparts. Future research should focus on understanding the underlying causes of these disparities and developing targeted interventions to bridge the gap between rural and urban health care outcomes.

Abstract 4116714: Macrophage Colony Stimulating Factor as a Causal Metabolic Mediator of Cardiovascular Disease: An Observational and Mendelian Randomization Analysis

Background: Macrophage biology plays a key role in the pathogenesis of atherosclerosis and circulating macrophage colony-stimulating factor (M-CSF) is a marker of macrophage activity. However, there is conflicting evidence regarding its role as a mediator of cardiovascular disease. Methods: We evaluated the association between plasma M-CSF concentration with myocardial infarction, stroke, heart failure and mortality in a large substudy involving 9992 participants drawn from 14 countries and followed for a median period of 9.8 years (Interquartile Range 8.9 years - 11.4 years) utilizing a nested case-cohort design in the Prospective Urban Rural Epidemiology (PURE) study. We then conducted a two-sample Mendelian randomization (MR) analysis to evaluate the upstream determinants (using genome wide association data from the PURE biobank and publicly available consortia) and downstream effects on clinical events.. Results: The strongest causal upstream determinant of M-CSF concentration was body mass index (BMI), which showed a positive association with plasma M-CSF concentration (Beta: 0.17 SD increase; 95% CI: 0.08 - 0.27). In a survival analysis, M-CSF was independently associated with increased incident myocardial infarction (HR: 1.25 per 1 SD M-CSF increase; 95% CI: 1.13-1.38), stroke (HR: 1.17; 95% CI:1.04-1.32), and heart failure (HR: 1.34; 95% CI: 1.15-1.56) and other cardiovascular disease risk factors. Circulating M-CSF concentration also showed a strong association with long-term risk of overall mortality (HR: 1.44; 95% CI: 1.39-1.60). Mendelian randomization analyses confirmed that increased M-CSF was associated with increased risk of MI, heart failure, and ischemic stroke (specifically large artery atherosclerotic and cardioembolic stroke). Conclusions: M-CSF is a strong causal driver of cardiovascular disease morbidity whose concentration is causally influenced by body mass index. Our analysis suggests a role for macrophage activity in mediating the relationship between body mass index and cardiovascular disease outcomes.

Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.

Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. To assess whether rural residence is associated with receipt of recommended post-discharge COPD care. We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies. Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)). Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.

Digital Inclusive Finance, Rural Loan Availability, and Urban–Rural Income Gap: Evidence from China

Reducing the urban–rural income gap stands as a pivotal factor in attaining sustainable economic development. Policymakers and researchers have focused on whether digital inclusive finance can narrow the urban–rural income gap. Utilizing provincial-level panel data from 31 regions in China, this paper empirically tests the impact of digital inclusive finance on the urban–rural income gap across different areas of China, specifically analyzing the mediation effect of rural loan availability. The findings indicate that (1) the expansion of digital inclusive finance can enhance the inclusiveness of financial services in rural areas and narrow the urban–rural income gap; (2) the effect of digital inclusive finance on the urban–rural income gap exhibits regional heterogeneity; (3) the rural loan availability has a mediation effect on the urban–rural income gap, but its growth will weaken the narrowing effect of digital inclusive finance on urban–rural income gap; and (4) the reduction in the urban–rural income gap attributable to digital inclusive finance exhibits a nonlinear relationship with the level of urbanization. This paper recommends guiding the digital transformation of rural financial institutions and enhancing farmers’ financial literacy to increase the availability of loans in rural areas. Furthermore, implementing region-specific policies and regulations could effectively narrow the urban–rural income gap.

Natural Hazards and Climate Change Impacts on Food Security and Rural–Urban Livelihoods in Mozambique—A Bibliometric Analysis and Framework

Mozambique is confronted with numerous risks related to food security and natural disasters. The study conducted a literature review on natural hazards and food security. This can help to identify gaps and further areas of research. A bibliometric analysis was conducted using standardized text search terms, and the VOSviewer tool was used to analyze over 7000 scientific articles and cluster over 60,000 keyword co-occurrences. The results show that research on natural hazards for food security needs to be integrated. The priority topic of disasters focuses on specific hazards such as climate change, floods, and hurricanes, which are also linked to demographic and other social variables. More studies on food security, such as droughts, sustainable development, and other human and social conditions, are being conducted. Resilience as an emerging research paradigm needs to be addressed in comparison. One result is an analytical framework on impacts on food security in the context of disaster risk, based on the empirical findings of the literature review. It shows how everyday risks such as disease or food security can be conceptually better linked to natural hazards and resilience. It shows that further research is needed on the interlinkages of multiple risks, of which Mozambique is an outstanding example. The methodology presented is also applied to provide a framework for linking multiple risks to food security and natural hazards. The innovative dimension of the research is that this inquiry constitutes one of the pioneering attempts to conduct a bibliometric analysis of the linkages between natural hazards, food security, and resilience in Mozambique. Another noteworthy contribution is introducing a novel analytical framework that integrates food security and disaster risks.

City Boundaries—Utilizing Fuzzy Set Theory for the Identification and Localization of the Urban–Rural Transition Zone

This article examines the potential of fuzzy set theory for analysing gradual changes in land use patterns within peri-urban areas. The primary objective of the study was to propose a methodology based on fuzzy set theory for the precise delineation of city boundaries and the identification and spatial localisation of the urban–rural transition zone. The analysis focused on elucidating the defining parameters of this area and the scope of land use changes within the urban–rural transition zone. The analysis employed data from four discrete time points. The data were collected in 2005, 2010, 2017, and 2022. The characteristics of the urban–rural transition zone were evaluated through an examination of historical data and the current land use patterns in regions experiencing direct urbanization pressure. The study demonstrated that, although spatial barriers remain, the city’s development has continued at a consistent pace. Between 2005 and 2010, the area of land classified as urban exhibited a 10% increase, with a further 7% increase observed in the subsequent period, spanning 2010 to 2017. In the most recent period under examination, the urban land area increased by 9%, a figure that is consistent with the rates observed in previous years. These results indicate the stability of urbanization processes in the analysed city, while also revealing significant changes in the limits of urban development and in the intensity of land use. The research project concentrated on the city of Olsztyn and the neighbouring suburban areas, which are subject to direct influence from the city’s expansion. The area under study encompasses 202.4 km2 within an eight-km radius of the city centre. The authors of the study emphasized the necessity for systematic monitoring of changes in the transition zone between urban and rural areas. This is to ensure effective control of spatial development and ongoing adjustment of planning tools to effectively prevent uncontrolled expansion. The methodology used enabled the precise delimitation of urban development and the transition zone. This allowed for an in-depth analysis of changes in land use intensity.

Nutritional Status and Quality of Life: Urban–Rural Disparities and the Impact of Obesity

The shift in dietary habits has reshaped the population’s health profile, leading to a rise in overweight individuals and a subsequent decline in health-related quality of life (HRQoL). This study evaluated the correlations between demographic, social, and health-related factors and HRQoL in rural and urban areas of Bahia, Brazil. The cross-sectional study included 124 participants aged 18–60 who underwent interviews, anthropometric measurements, and laboratory tests. The WHOQol-BREF instrument assessed the HRQoL. The results showed that rural participants had lower educational levels, income, and access to sanitation. Despite these challenges, rural residents reported better HRQoL in psychological, social relations, and health satisfaction domains, although differences diminished after age adjustment. Urban participants, who had higher rates of obesity and related metabolic risks experienced a negative correlation between BMI and HRQoL, especially in the social relationships domain. The study highlights that environmental and social factors, such as weight-related stigma and social connections, significantly influence HRQoL in urban areas, emphasizing the need for public health interventions that address both nutritional status and urban-specific challenges.

The Impact of Covid19 on the Urban–Rural Happiness

The Impact of Covid19 on the Urban–Rural Happiness

Interactive effects of outdoor fine particulate matter and metabolic, behavioural, and psychosocial risk factors on cardiovascular disease: analysis of the PURE-China cohort study

Abstract Background Long-term PM2.5 exposure has been associated with an elevated risk of cardiovascular disease (CVD) and its associated risk factors.[1–4] There is a paucity of studies investigating the interactive effects of PM2.5 exposure and a comprehensive list of risk factors including metabolic, behavioural, and psychosocial risk factors on CVD risk.[5] Purpose This study aims to examine the interactive effects of PM2.5 exposure and metabolic, behavioural, and psychosocial risk factors on incident CVD. Methods The Prospective Urban Rural Epidemiology (PURE)-China cohort study is a population-based cohort study recruiting participants aged 35–70 years from 115 communities in 12 provinces of China between 2005 and 2009, and followed up until August 31, 2021.[6] Participants’ metabolic, behavioural, and psychosocial risk factor information was recorded. PM2.5 concentrations were extracted from a 1x1 km2 global model.[7,8] For this analysis, we included participants aged 35–70 years at baseline without a history of CVD, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (CVD deaths, myocardial infarction, stroke, and heart failure). Additive interaction was measured by relative excess risk due to interaction (RERI), the proportion of disease attributable to interaction (AP), and the synergy index (SI).[9,10] To comply with the additive interaction method, we classified concentrations of PM2.5 into low and high levels by the median of 3-year average PM2.5 concentration (45.7 μg/m3, IQR: 33.7-74). Cox proportional hazard models were used to assess the associations of metabolic, behavioural, and psychosocial risk factors on incident CVD by PM2.5 concentrations. Results The PURE-China study recruited 47 931 participants, of which 39 329 are eligible for this analysis. During the median follow-up period of 11.9 years (IQR: 9.6-12.6), 1462 and 2155 major CVD events had occurred in the low and high PM2.5 group respectively. There was a synergistic interaction between PM2.5 and the systolic blood pressure (SBP) for CVD: RERI: 0.363, 95% CI: 0.196-0.531; AP: 0.098, 95% CI: 0.081-0.115; SI: 1.155, 95% CI: 1.132-1.177; high LDL cholesterol: RERI: 0.219, 0.003-0.436; AP: 0.135, 0.008-0.263; SI: 1.549, 0.947-2.533. A significant synergistic interaction was also identified between PM2.5 and household air pollution (RERI: 0.457, 0.292-0.622; AP: 0.277, 0.184-0.37; SI: 3.362, 1.409-8.019). Interactions between PM2.5 and low grip strength on CVD were significantly synergistic, but antagonistic between PM2.5 and low physical activity (RERI: -0.248, -0.485--0.012; AP: -0.174, -0.349-0.001; SI: 0.633, 0.412-0.971). Conclusion Addictive interaction was between PM2.5 and SBP, high LDL cholesterol, household air pollution, low grip strength and low physical activity on incident CVD, indicating the benefit of coordinated control strategies for metabolic, physical, and environmental risk factors for the prevention of CVD.

Rural–Urban Divide of COVID-19 Fatalities in India—Investigating the Role of Lifestyle Disorder Diseases

AbstractUsing data on weekly COVID-19 infections and fatalities at the district level for 19 states and 4 union territories of India, we investigate the determinants of COVID-19 deaths focusing exclusively on the second wave of infections. We include several macroeconomic and structural indicators for districts namely, per capita district domestic product, the degree of urbanization, population density, percentage of aged population, share of agriculture, poverty, among several others. Our findings suggest that fatalities have a clear rural–urban divide. Rural agricultural districts with more poor people have experienced less cases and fatalities. Fatalities are more clustered in prosperous and dense industrial districts. Regions having higher COVID-19 fatalities also have a higher proportion of ageing population with urban life-style disorder related diseases such as obesity, diabetes, and hypertension. Prevalence of respiratory illnesses further aggravates the effects of some of these life-style disorder diseases on COVID-19 fatalities.

The Impact of Urbanization on Rural Population Structure in China

Urbanization has been speeding up in China since reform and opening up policies were promoted, which promotes the progression of rural economy, but furthermore provides a certain degree of negative impact on the rural population structure. On the basis of summarizing the concept of urbanization, this study provides a thorough analysis of China's recent rural population structure and urbanization trend, and finally concludes that the quickening pace of urbanization in China makes the rural population structure face some problems and challenges. This study also offers some thoughts and recommendations in this area. At the same time, when analyzing the trend and population structure, by comparing and summarizing the secondary data and relevant literature, this paper concludes that China's urbanization has caused problems such as talent shortage in rural areas, rural aging and gender structure imbalance of the left-behind population. To solve these problems, China should establish a sound and perfect social security system and encourage the integration of rural and urban development. China ought to also establish a sound pension system and optimize the population structure; in rural areas, the promotion of respect for women has been strengthened and relevant laws have been introduced to gradually eliminate gender discrimination. It is beneficial to promote the national economy, cultural development.

Key themes of community-oriented primary care projects from a longitudinal, rural interprofessional health professions curriculum (1997–2023)

BackgroundThe Community Oriented Primary Care Project Model (COPC) has been well studied globally as well as in the United States as a way to provide both community-centered primary care and to engage in community based research. Rural trainees through the University of Illinois College of Medicine’s Rural Medical Education Program (RMED) and Rural Pharmacy Education Program (RPHARM) students through the University of Illinois Chicago College of Pharmacy have participated in a COPC project as a capstone to a four month longitudinal, immersive community-based experience in a rural primary care setting. The purpose of this study was to assess the type of projects implemented through a rural health professions curriculum over a 30 year project period. .MethodsA research team reviewed projects on 30 elements; including topic and demographics. Patterns in COPC topics and rurality of the location in which the COPC project were also examined by using 2021 U.S. Census Bureau population data and Rural Urban Commuting Area (RUCA) Code.ResultsCOPC projects were categorized into 31 main topic areas with mental health being the most prevalent topic area covered by projects (n = 67, 15.7%) followed by 43 (10.1%) projects that focused on nutrition/exercise, and 41 (9.6%) focused on substance use (presented as a separate category from mental health in this analysis).ConclusionsFor three decades, COPC themes reflect priority health issues in rural communities while providing a scholarly activity for health profession student trainees Past projects have also been implemented in highly rural areas where research is not often conducted. The COPC research process can be easily replicated in other trainee models such as to fulfill ACGME requirements of scholarly activity and can provide a template for trainees of this model to implement community-engaged research in the future.

Identification and Spatiotemporal Evolution Analysis of the Urban–Rural Fringe in Polycentric Cities Based on K-Means Clustering and Multi-Source Data: A Case Study of Chengdu City

Urban fringe areas, serving as transitional zones between urban and rural landscapes, are characterized by their transitional nature, high dynamics, and spatial heterogeneity. Identifying the extent of an urban–rural fringe (URF) and analyzing its evolutionary characteristics are crucial for urban planning and development. However, limited research exists regarding the identification of a URF and the analysis of its spatiotemporal evolution in polycentric cities. Using Chengdu as a case study, this research employed the K-means clustering method to identify the spatial extent and evolution patterns of the URF in Chengdu from 2010 to 2020 based on the spatiotemporal characteristics of multi-source data. The results indicate that (1) the K-means clustering method can reasonably and efficiently identify URF in polycentric cities; (2) Chengdu exhibited a polycentric urban structure with a “main center-subcenter” pattern, where the URF was adjacent to the main and subcenters, assuming an overall annular wedge shape; (3) there was a significant expansion of the URF in the northeast–southwest direction from 2010 to 2020, accompanied by substantial land use changes. The evolution of the URF was driven by the dual mechanisms of urban suburbanization and rural urbanization, exhibiting characteristics such as singular urban functions, dispersed and chaotic land use, fragmented landscapes, and increasing complexity. This study extended the research on URFs, aiding in the understanding of urban spatial growth patterns and providing decision support for the integrated development of urban and rural areas.

Assessment and simulation of eco-environmental quality changes in rapid rural urbanization: Xiong’an New Area, China

Xiong’an New Area was established as a state-level new area in 2017 and serves as a typical representative area for studying the ecological evolution of rural areas under rapid urbanization in China. Remote sensing-based ecological index (RSEI) is a regional eco-environmental quality (EEQ) assessment index. Many studies have employed RSEI to achieve rapid, objective, and effective quantitative assessment of the spatio-temporal changes of regional EEQ. However, research that combines RSEI with machine learning algorithms to conduct multi-scenario simulation of EEQ is still relatively scarce. Therefore, this study assessed and simulated EEQ changes in Xiong’an and revealed that: (1) The large-scale construction has led to an overall decline in EEQ, with the RSEI decreasing from 0.648 in 2014 to 0.599 in 2021. (2) Through the multi-scenario simulation, the non-unidirectional evolution of RSEI during the process of urban-rural construction has been revealed, specifically characterized by a significant decline followed by a slight recovery. (3) The marginal effects of urban-rural construction features for simulated RSEI demonstrate an inverted “U-shaped” curve in the relationship between urbanization and EEQ. This indicates that urbanization and EEQ may not be absolute zero-sum. These findings can provide scientific insights for maintaining and improving the regional EEQ in urban-rural construction.

Comparative Outcomes of Peritoneal Dialysis across Different Hospital Settings: An Analysis of Urban Teaching, Urban Nonteaching, and Rural Hospitals

Comparative Outcomes of Peritoneal Dialysis across Different Hospital Settings: An Analysis of Urban Teaching, Urban Nonteaching, and Rural Hospitals

Non-receipt of targeted and immunotherapies in diverse patients with metastatic cancers.

93 Background: The rapid evolution of molecularly targeted kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in the treatment of metastatic cancer, coupled with high drug costs, raises potential for unwarranted variation in patient management. We evaluated correlates of non-receipt of TKIs and ICIs in a diverse, population-based sample of patients with metastatic non-small cell lung cancer (NSCLC), kidney and bladder (GU) cancer, and melanoma. Methods: We identified 2240 patients diagnosed in 2019 with metastatic NSCLC, GU cancer, or melanoma and reported to the Georgia or Los Angeles SEER registries. Using SEER registry data, we linked all patients to a managing oncology physician. We collected data from the managing physician regarding receipt of TKIs and ICIs. We used bivariate analyses and multivariable logistic regression models to assess associations between non-receipt of TKIs and ICIs and patient-level factors. Results: We present results for a preliminary sample (N=894). About half (55%) of the patients had NSCLC, 31% had GU cancer, and 14% had melanoma. The mean age was 62 (SD 12); 59% were male; 65% were White, 16% were Black, 11% were Hispanic, and 7% were Asian; 52% had Medicare, 29% had private insurance, 9% had Medicaid, and 4% had no insurance; 89% resided in urban areas, 11% resided in rural areas. 22% lived in a census tract area with >20% of the population living below the poverty level. The Table shows that in bivariate analyses, non-receipt of TKIs was associated with NSCLC, older age, male sex, non-white race, and non-private or no insurance (all p<0.05). After adjustment, non-receipt of TKIs was associated with NSCLC, older age, male sex, and race. Asian and Hispanic patients had lower rates of non-receipt, and Black patients had higher rates. In bivariate analyses, non-receipt of ICIs was associated with NSCLC and GU cancer (p=0.004); this association remained significant after adjustment. Conclusions: Non-receipt of TKIs was associated with important non-clinical factors including race and sex. Non-receipt of ICIs was associated only with cancer type. These findings suggest that policy-relevant factors such as out-of-pocket costs for oral cancer therapies and differential access to molecular sequencing may contribute to unwarranted variation in receipt of TKIs. Bivariate analyses of non-receipt. Did not Receive TKI Did not Receive ICI % P % P Cancer type NSCLC GU Melanoma 786572 0.002 313015 0.004 Age <50 50-64 65-74 75-84 85+ 5471757986 <0.001 2625302940 0.385 Sex Male Female 7670 0.048 2631 0.085 Race & Ethnicity White Black Hispanic Asian Other 7579655860 0.002 2329312927 0.981 Marital Status Married Unmarried 7373 0.645 2630 0.158 Insurance Medicare Medicaid Private Other government None 7075637080 <0.001 3130215031 0.101 Geography Urban Rural 7375 0.784 2826 0.567 % population below poverty level 0-5% 5-<10% 10-<20% 20-100% 69717774 0.314 29273222 0.138

Opposing Impacts of Greenspace Fragmentation on Land Surface Temperature in Urban and Surrounding Rural Areas: A Case Study in Changsha, China

Managing the amount of greenspace (i.e., increasing or decreasing greenspace coverage) and optimizing greenspace configuration (i.e., increasing or decreasing greenspace fragmentation) are cost-effective approaches to cooling the environment. The spatial variations in their impacts on the thermal environment, as well as their relative importance, are of great importance for greenspace planning and management but are far from thoroughly understood. Taking Changsha, China as an example, this study investigated the spatial variations of the impacts of greenspace amount (measured as a percent of greenspace) and greenspace fragmentation (measured by edge density of greenspace) on the Landsat-derived land surface temperature (LST) using geographically weighted regression (GWR), and also uncovered the spatial pattern of their relative importance. The results indicated that: (1) Greenspace amount showed significantly negative relationships with LST for 91.73% of the study area. (2) Both significantly positive and negative relationships were obtained between greenspace fragmentation and LST, covering 14.90% and 13.99% of the study area, respectively. (3) The negative relationship between greenspace fragmentation and LST is mainly located in the urban areas, while the positive relationship appeared in the rural areas. (4) Greenspace amount made a larger contribution to regulating LST than greenspace fragmentation in 93.31% of the study area, but the latter had stronger roles in about 6.69% of the study area, mainly in the city center. These findings suggest that spatially varied greenspace planning and management strategies should be adopted to improve the thermal environment.

The Impact of Digital Finance on the Urban–Rural Income Gap in China: The Mediating Role of Employment Structural Transformation

The Impact of Digital Finance on the Urban–Rural Income Gap in China: The Mediating Role of Employment Structural Transformation

Abstract B166: Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States

Abstract BACKGROUND: While overall colorectal cancer (CRC) rates have stabilized or declined in the United States (U.S.), early-onset CRC (EO-CRC), diagnoses before age 50, has increased. Rural U.S. residents face a higher CRC incidence (43.9 vs. 40.1 per 100,000) than urban residents. CRC mortality, once highest in the Northeast, is now most prevalent in the South and Midwest, particularly among Non-Hispanic Black populations. This geographic shift is also evident in EO-CRC. Existing literature lacks comprehensive analysis on the influence of rurality and age at CRC diagnosis. In this study, we sought to elucidate the relationships between age at diagnosis with CRC outcomes, while examining the moderating role of rurality. Methods: We used data from the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program. Rurality was defined using census tract level U.S. Department of Agriculture (USDA)’s 2010 Rural Urban Commuting Area (RUCA) codes: rural (codes 8, 9, 10) and urban (all other listed codes). We conducted multilevel regression modeling (logistic and Cox proportional hazards) to examine the associations between age at diagnosis, rurality, and CRC outcomes (late-stage diagnosis and survival), adjusting for race, marital status, sex, and year of diagnosis. Results: We identified 835,907 patients aged 20-79 from the 2006-2020 SEER program. Most patients lived in urban areas (86%), were non-Hispanic white (66%), and married (41%). After adjusting for marital status, race, sex, and diagnosis year, we found that patients aged 30-39 (aOR: 1.49, 95% CI: 1.44–1.55) and 40-49 (aOR: 1.43, 95% CI: 1.39–1.46) had over a 40% increased likelihood of late-stage CRC compared to patients aged 50-59. Urban patients aged 30-39 had a 52% higher likelihood of late-stage CRC (aOR: 1.52, 95% CI: 1.46–1.58). Patients aged 20-29 (aOR: 0.81, 95% CI: 0.77–0.86) had a reduced risk of CRC death compared to those aged 50-59. Conversely, patients aged 40-49 (aOR: 1.09, 95% CI: 1.07–1.11), 60-69 (aOR: 1.16, 95% CI: 1.14–1.17), and 70-79 (aOR: 1.39, 95% CI: 1.28–1.36) had increased risks of CRC death compared to patients aged 50-59. Rural patients aged 20-29 (aOR: 0.79, 95% CI: 0.68–0.94) and 30-39 (aOR: 0.95, 95% CI: 0.87–1.03) had a reduced risk of CRC death compared to rural patients aged 50-59. Conclusion: We observed that patients aged 30-49 were more likely to be diagnosed with late- stage CRC compared to those aged 50-59, particularly in urban areas. To reduce the burden of EO-CRC and prevent advanced-stage diagnoses in young adults, it is essential to enhance access to care and raise awareness of CRC symptoms among younger Americans. Future research should explore urban -rural barriers to healthcare access, including the role of healthcare infrastructure, transportation, and provider availability, to develop strategies for improving EO-CRC early detection and treatment outcomes. Citation Format: Meng-Han Tsai, Justin X. Moore, Caitlyn Grunert. Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B166.

Abstract A132: Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina

Abstract INTRODUCTION American Indians (AI) have much higher incidence rates of lung cancer (LC) compared with non-Hispanic Whites (NHW) in the US. While low-dose computed tomography (LDCT) screening facilitates early detection of lung cancer, it is unknown how available LDCT screenings are to racially and geographically diverse populations in North Carolina (NC). To address this gap in knowledge, we conducted a descriptive study to characterize incident LC cases among AIs and NHWs, the distance from their location at diagnosis to the nearest LDCT screening facility and explored whether distance was associated with late-stage LC diagnoses. Methods Data were obtained from the Cancer Information and Population Health Resource (CIPHR), which comprise data from NC Central Cancer Registry (CCR) as well as public and private health insurance claims for the state. We identified ZIP codes and dates of rendered service for facilities providing LDCT by searching through claims from 2015-20. In addition, we identified incident LC cases among AIs and NHWs aged ≥18 years, from 2015-19. We assembled lists of LDCT facilities that existed in the year prior to each incident LC case. We calculated the minimum centroid to centroid distance to all facilities. Clinical attributes included age at diagnosis, sex, histology, stage at diagnosis, and rurality as measured by Rural Urban Commuting Area. Risk ratios were calculated for late-stage LC diagnoses across a range of thresholds for patient’s distance to nearest LDCT screening facility for AIs and NHWs. Results We identified 388 AI and 26,867 NHW incident LC cases in NC between 2015-20. Compared to NHWs, the median age at diagnosis for AIs was 5 years younger (AI: 65 vs. NHW: 69); more frequently male (AI: 54% vs NHW: 51%); and almost twice as likely to reside in rural areas (AI: 52% vs. NHW: 28%). There were no differences in late-stage LC diagnoses (AI: 54% vs. NHW: 52%). For distance (in miles) to the nearest LDCT screening facility, the median [Interquartile range] was twice as high for AIs (9.9 miles [0.8, 16.30]) compared to NHWs (5.3 miles [0, 12.1]). Among NHWs, there were statistically significant associations between distance and late-stage LC diagnosis at the shortest distance threshold of 5 miles (RR=1.04; 95%CL: 1.02, 1.07) through the threshold of 30 miles (RR=1.10 95%CL: 1.05, 1.15). There was no association across any distance threshold among AI lung cancer patients. Conclusions The large difference in accessibility of LDCT screening was not strongly associated with metastatic lung cancer diagnoses, possibly because so many patients were diagnosed late, reflecting poor early detection across all populations. We found that 80% of AIs with LC lived more than 10 miles away from LDCT screening facilities. This geographic distance may increase difficulty accessing cancer care geographically, and contribute to suboptimal LC screening rates. If efforts are to be made to increase early detection and improve survival, accessibility needs to be addressed on different dimensions. Citation Format: Bradford E. Jackson, Marc Emerson, Daniel Carrizosa, Chris Baggett, Lisa Spees, Joel Begay, Ana Salas, Yadurshirni Raveendran, Tomi Akinyemiju, Rachel Denlinger-Apte, Stephanie Wheeler, Ronny Bell. Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A132.