Zip Code Of Residence Research Articles

Relationship between Regular Leisure-Time Physical Activity and Underweight and Overweight Status in Taiwanese Young Adults: A Cross-Sectional Study.

The aim of this study was to determine the association between regular leisure-time physical activity (LTPA) and various body mass index (BMI) categories in Taiwanese young adults. A total of 10,802 young adults (18-44 years) were enrolled in a national telephone survey. The questionnaire data from this survey included socio-demographic characteristics, zip code of residence, LTPA behaviors, self-reported health status, and self-evaluated anthropometric measurements, which included height, body weight, and BMI. Regular and non-regular LTPA behaviors were defined as follows: (1) Regular LTPA: participants who reported breathing quickly and sweating when participating in 150-300 min per week of moderate-intensity LTPA or 75-150 min per week of vigorous-intensity LTPA. (2) Non-regular LTPA: the rest of the participants. The various BMI categories were defined as (1) underweight (BMI < 18.5 kg/m2), (2) normal weight (18.5 ≤ BMI < 24 kg/m2), (3) overweight (24 ≤ BMI < 27 kg/m2), and (4) obese (BMI ≥ 27 kg/m2). When compared with participants with non-regular LTPA, participants with regular LTPA exhibited lower risks of being overweight (odds ratio [OR], 0.837; 95% confidence interval [CI] 0.738-0.948) and underweight (OR, 0.732; 95% CI 0.611-0.876). However, there was no significant relationship between regular LTPA and obesity risk when using non-regular LTPA as the baseline after adjusting for potential confounders. The study results revealed that regular LTPA effectively reduced the risks of being underweight and overweight. However, for people with obesity, regular LTPA was unable to significantly decrease their obesity risk.

Influence of Sociodemographic Determinants on the Hodgkin Lymphoma Baseline Characteristics in Long Survivors Patients Enrolled in the Prospective Phase 3 Trial AHL2011.

Whereas numerous studies on several cancers describe the link between social conditions and disease severity, little is known about the social and demographic characteristics of Hodgkin lymphoma (HL) patients. At diagnosis, 10-15% of the patients in the advanced stages have a well-known poor outcome owing to their chemoresistance, but the determinants of the more advanced stages remain elusive. The objective of the present study was to decipher the potential impact of social disparities on the disease features at diagnosis and analyze how the sociodemographic patient features could impact the HL outcome of patients with advanced-stage HL enrolled in the AHL2011 trial. This ancillary study was conducted on a cohort of patients from French centers that had recruited more than five patients in the phase III AHL2011 study (NCT0135874). Patients had to be alive at the time of the ancillary study and had to have given their consent to answer the questionnaire. Pre-treatment data (age, gender, stage, B symptoms, IPS), the treatment received, the responses to PET-CT, and the presence of serious adverse events (serious adverse events-SAEs) were all extracted from the AHL2011 trial database. Sociodemographic data-marital status, living area, level of education, socio-professional category, and professional situation-were extracted from the questionnaires. The population density at the point of diagnosis was determined based on ZIP Code, and the distance from the reference medical center was then calculated by the road network. Baseline PET acquisition was performed before any treatment. PET images at baseline were centrally reviewed. The total metabolic tumor volume (TMTV) at the baseline was calculated using a 41% SUVmax cutoff for each lesion. Progression-free survival was defined as the time from randomization to the first progression, relapse, or death from any cause or the last follow-up. The data cutoff for the analyses presented here was 31 October 2017. The progression-free survival was analyzed on an intention-to-treat basis. Among the 823 patients enrolled in the AHL2011 study, the questionnaire was sent to 394 patients, of whom 232 (58.9%) responded. At the time of HL diagnosis, 61.9% (N = 143) of patients declared that they were not socially isolated, 38.1% (N = 88) that they were single, 163 (71.2%) had a professional activity, and 66 (28.8%) were inactive owing to unemployment, retirement, or sick leave. Of the patients, 31.1% (N = 71) lived in a rural region, compared to 68.9% (N = 157) that lived in an urban region. The residence ZIP Code at the time of HL diagnosis was available for 163 (70%). Sociodemographic characteristics did not influence the presence of usual prognostic factors (ECOG, B symptoms, bulky mass, IPS) except for professional activity, which was associated with more frequent low IPS (0-2) (79 (48.5%) active versus 20 (30.3%) inactive patients; p = 0.012). Likewise, no correlation was observed between TMTV and sociodemographic characteristics. However, the TMTV quartile distribution was different according to the living area, with the two upper quartiles being enriched with patients living in a rural area (p = 0.008). Moreover, a negative correlation between the average number of the living area's inhabitants and TMTV (R Pearson = -0.29, p = 0.0004) was observed. This study focused on sociodemographic parameters in advanced-stage HL patients and shows that professional activity is associated with more favorable disease features (low IPS), while patients living in rural or low-populated areas are more likely to have an unfavorable HL presentation with a high tumor burden (high TMTV). These data suggest that some patient sociodemographic characteristics might impact either access to medical care or environmental exposure, leading to a higher frequency of unfavorable presentations. Further prospective sociodemographic studies are necessary to confirm these preliminary results.

FOOD INSECURITY AMONG OLDER ADULTS IN NEW YORK CITY: DOES LOCATION MATTER?

Abstract Having access to adequate and appropriate food sources is essential to addressing food insecurity among older adults. However, the role of locational characteristics in explaining food insecurity remains unclear, especially in urban areas. This study investigated the association of distance to grocery stores, neighborhood disadvantage, and social cohesion with food insecurity among older adults in New York City. Individual-level data were drawn from a 2-year Poverty Tracker Study. The sample included New York City residents aged 65 or older (baseline N = 710). Based on the respondents’ residential address and neighborhood ZIP codes, the individual-level data were merged with two spatial datasets: American Community Survey and ReferenceUSA. ArcGIS 10 (near analysis) was used to manage spatial data and calculate the distance to grocery stores. Hierarchical logistic regression models were employed for analyses. Descriptive results show that more older adults in neighborhoods with economic disadvantage and lower level of social cohesion reported more food insecurity. Logistic regressions suggested that after controlling for individual-level characteristics (e.g., age, gender, race and ethnicity, and education), living farther (0.26–0.50 miles and 0.51–0.70 miles) from the nearest grocery store was positively associated with food insecurity. Residing in economically disadvantaged neighborhoods also increased the odds of food insecurity. Community social cohesion was a marginally significant protective factor against food insecurity. Findings suggest that locational characteristics play a significant role in predicting food insecurity in New York City, suggesting that community outreach and grocery delivery programs are needed to mitigate the risk.

Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes.

The aim of this study was to determine possible associations between demographic and socioeconomic factors and graft survival after penetrating keratoplasty (PK). This study was a retrospective chart review of patients undergoing PK at a tertiary-care corneal practice at Wills Eye Hospital between May 1, 2007, and September 1, 2018. The first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Demographic and socioeconomic factors included yearly average adjusted gross income (AGI) based on residential zip code, age, sex, and race. Two income groups were created: 1) individuals from neighborhoods with the lowest 10% of AGI (N = 82, AGI=$32,100 ± 4000) and 2) the remaining 90% of individuals (N = 740, AGI=$86,900 ± 52,200). Logistic regression analysis was performed to identify factors predictive of graft prognosis. The 822 patients (822 eyes) included had a mean age of 57.1 ± 22.1 years at the time of PK. Over an average of 4.2 ± 3.1 years of follow-up, graft failure occurred in 35.3%. Age, sex, and follow-up duration were comparable between income groups (all P > 0.05). Black race was disproportionately represented in the lower-income group (50.0% vs. 11.5%, P < 0.001). Multivariable analysis identified predictors of graft failure including residing in a lower-income neighborhood [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.24-4.19, P = 0.008], younger age (HR = 0.99, 95% CI = 0.98-1.00, P = 0.046), and Black race (HR = 1.63, 95% CI = 1.03-2.56, P = 0.035). Individuals with a lower income, younger age, and Black race may be more vulnerable to graft failure after PK. Further studies are warranted to identify reasons for these associations.

Exploring patient-borne costs and wait times for obstructive sleep apnea (OSA) care among rural and urban adults

RATIONALE: Geography is an increasingly recognized barrier to the diagnosis and treatment of chronic diseases, yet no prior studies have investigated its influence on the patient-borne burden of obstructive sleep apnea (OSA) care. OBJECTIVE: We aimed to determine if wait times and costs of OSA care differ between rural and urban adults. METHODS: We conducted a secondary analysis of data from a prospective cohort study comparing OSA treatment outcomes among urban and rural adults. Participants were recruited at the time of continuous positive airway pressure (CPAP) initiation for uncomplicated OSA. Residential postal codes were translated into geographic census areas to classify participants as urban (community size > 100,000) or rural. Participants were administered a questionnaire exploring wait times and costs of OSA care at baseline and three months. RESULTS: We enrolled 242 participants (100 rural). Twenty-six percent of respondents waited at least six months to seek medical attention for possible OSA, with no difference between groups. Wait times for diagnosis and treatment were three months or less for 91 and 93% of respondents, respectively. However, rural respondents experienced longer delays from first assessment to diagnosis and from diagnosis to treatment. Fewer individuals with rural residence were supported by government funding for diagnostic testing or CPAP. Rural participants more commonly reported additional appointment-related costs and greater total costs of care. CONCLUSION: Rural patients experience longer wait times and a greater financial burden for OSA care. The findings of this study will inform the development of novel models of OSA care sensitive to the needs of unique populations.

266: INTERHOSPITAL TRANSFER TRENDS AMONG ADULT PATIENT WITH SEPSIS IN FLORIDA

Introduction: The interhospital transfer of sepsis patients to better capable hospitals has the potential to improve outcomes but may inadvertently worsen outcomes due to care potential care delays. We sought to determine temporal trends in (i) the prevalence of interhospital transfer among adult patients with sepsis and (ii) hospital mortality among transferred patients with sepsis. Methods: We performed a serial cross-sectional study of adult (≥ 18 years) sepsis hospital encounters between October 2015 and December 2019, using the Florida State In-Patient Databases. Our primary exposure variable was time, based on calendar-year quarters. Our primary outcome was interhospital transfer. Our secondary outcome was hospital mortality among transferred patients. We collected data on age, gender, race, severity of illness (using the Elixhauser comorbidity index), primary insurance payer, median income in Zip code of residence, and rurality of residence. We used multivariable regression models with generalized estimating equations, adjusted for patient demographic and clinical covariates, and with specified Poisson distribution with robust variance estimates, to estimate quarterly risk ratios and adjusted rates for our primary and secondary outcomes. We used the 4th quarter of 2015 as the reference year. Results: Among 480,491 sepsis hospitalizations over the study period, 207,384 (43.2%) were transferred. The demographic and clinical characteristics among transferred patients changed significantly over the study period, with the exception of the Elixhauser comorbidity index. Risk-adjusted rates of interhospital transfer increased over the study period (43.0% in 2016Q1, 47.4% in 2019Q4, average increase 1% per quarter; P for trend <.001). Among transferred patients, risk-adjusted hospital mortality also increased over the study period (2.7% in 2016Q1, 3.9% in 2019Q4, average increase 2.5% per quarter; P for trend .03). Conclusions: Roughly half of adult sepsis encounters in Florida involve interhospital transfer. The rate of transfer of sepsis patients and mortality rates among transferred sepsis patients has increased significantly over time. Comparative studies of the effectiveness of interhospital transfer among sepsis patients are needed to better justify this practice.

1035: GEOSPATIAL FACTORS INTERACT WITH BASELINE HEALTH TO IMPACT COVID-19 MORTALITY (COMMUNITY HOSPITAL)

Introduction: Social determinants of health have been under-reported in critically ill patients during the pandemic. We hypothesized that geospatial factors and baseline health status in our community would significantly impact outcomes from Covid-19 infection. Methods: We conducted an urban, single-center, observational study of patients with Covid-19 infection admitted to our adult ICU over ten months (March 23, 2020 to January 21, 2021, after approval by our hospital’s Institutional Review Board. Weekly prospective data on the Covid-19 study population were entered in our ICU’s quality assurance database. Data specific to test our hypothesis—zip code of residence, functional status, and Canadian Frailty Score (1-7)—were collected from retrospective chart review. The studied population was dichotomized to access patients who resided in long-term care facilities or home residence. Five zip code regions based on sample size and the distance from the patient’s residence to the hospital allowed random sampling. Statistical significance was determined using ANOVA and T-test as indicated. Results: A total of 300 patients were enrolled. Across the designated cohort-based zip code regions, the mean frailty score of patients who resided at home differed significantly (2.9± SE.98 vs. 3.8± SE. 1.28, p< 0.01). Favorable frailty scores of 1-2 had a combined death and hospice rate of 23%. Of the survivors, 30% were transferred to skilled nursing facilities (SNF) and 26% were discharged to home. Patients with frailty scores of 6-7 had a final mortality rate of 83%. Of the survivors, only 2% were transferred to a SNF and 6% were discharged to home. Compared to admitting frailty scores between 1-3, a frailty score of 4 or greater (which represented 35% of all Covid ICU patients admitted from home) had a 1.8 relative risk of death (p< 0.0001). Conclusions: In our adult Covid-19 population, geospatial factors were associated with significant variances in frailty determined on ICU admission. Worsening frailty scores were associated with marked differences in both survival and final disposition, with combined death and hospice rates as high as 80%. We recommend that these metrics be added to routine data reporting to help better characterize ICU populations and stimulate efforts to improve frailty in vulnerable populations.

Temporal and Regional Trends in Obstructive Sleep Apnea Using Administrative Health Data in Alberta, Canada.

Rationale: Obstructive sleep apnea (OSA) is a common treatable condition with important health and societal consequences. Objectives: We aimed to assess the annual incidence and prevalence of clinically recognized and geographic clustering of OSA in Alberta, Canada, using administrative health data case definitions. Methods: We used two administrative health databases in Alberta to identify ICD-9 and ICD-10 (International Classification of Diseases, Ninth and 10th Revisions, respectively) diagnostic codes for adults and children at least 2 years old diagnosed with OSA between 2003 and 2020. We defined OSA using an algorithm developed and validated in Alberta: at least three claims or one hospitalization within 2 years. We mapped residential postal codes to 70 subregional health authorities (SRHAs). Crude, age group- and sex-specific incidence and prevalence, and age group- and sex-standardized rates were calculated for Alberta and SRHAs. Spatial scan statistics identified clusters of SRHAs in which OSA cases were higher (hot spots) or lower (cold spots) than expected. Results: Between 2003 and 2020, OSA prevalence increased from 0.14% to 4.59%. The annual incidence of OSA increased after 2013. Incidence and prevalence were higher in older adults and children aged 2-11 years compared with 12-17 years. Cluster analysis revealed regional variation in OSA incidence and prevalence over time with no consistent pattern except for cold spots in one large metropolitan center (Calgary). Conclusions: From 2003 to 2020, the incidence and prevalence of clinically recognized OSA increased but varied by geography. Administrative health data can be used to guide interventions aimed at improving health service delivery and the quality of OSA care.

Access to Pulmonary Rehabilitation among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease.

Rationale: Pulmonary rehabilitation (PR) remains substantially underused as a treatment modality for chronic obstructive pulmonary disease (COPD). A major barrier to the uptake of PR is the poor availability of and access to PR. Objectives: To quantify patients' access to PR centers in the United States. Methods: Using the 100% Medicare population with coverage for 2018, four geodesic distance-based buffers of 10-, 15-, 25-, and 50-mi radii around the geographic centroid of each ZIP code with at least one beneficiary with COPD were created. Street addresses of PR centers across the continental United States were geocoded. We calculated the distance between the residential ZIP code centroid and the closest PR center. The proportions of individuals with at least one PR center available within the four distance buffers were calculated overall as well as in metropolitan, micropolitan, small-town, and rural areas. Results: Of 62,930,784 Medicare beneficiaries, 10,376,949 (16.5%) had COPD. There were 1,696 PR centers across the United States, with one PR center for every 6,030 individuals with COPD. Mean distance to the nearest PR center was 12.4 (standard deviation, 16.6) mi. Overall, the proportions of individuals with COPD who had PR centers available within 10-, 15-, 25-, and 50-mi radii were 61.5%, 73.2%, 86.6%, and 97.1%, respectively. Proportions for rural areas were 11.3%, 24.3%, 53.4%, and 88.6%, respectively. Compared with those living in metropolitan areas, those living in rural areas were 95% less likely to have PR centers within 10 mi of their residences (odds ratio, 0.048 [95% confidence interval, 0.039-0.057]). Conclusions: In a nationally representative sample of Medicare beneficiaries, we found that two-fifths of adults with COPD overall, and eight in nine of those in rural areas, have poor access to PR.

Persistent inequalities in consultation incidence and prevalence of low back pain and osteoarthritis in England between 2004 and 2019.

We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient's registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic status within the study period, whereas inequalities in OA prevalence widened markedly over socioeconomic status between 2004 and 2019. The widest gap in low back pain incidence and prevalence over socioeconomic status was observed in populations resident in northern English regions and London and in those of working age, peaking at 45-54 years. We found persistent, and generally increasing, socioeconomic inequalities in the rate of adults presenting to primary care in England with low back pain and OA between 2004 and 2019.

Increased Dementia Incidence among Black and Hispanic Veterans across Regions of the United States

AbstractBackgroundAlthough the US military is increasingly diverse, the association of race/ethnicity and geographical region with incidence of dementia diagnosis among older Veterans is unknown.MethodWe identified a random sample of 1,869,090 patients age ≥ 55 years [mean age: 69.4 (standard deviation 7.9), 2% female] who received care at the Veterans Health Administration (VHA), the largest integrated health care system in the United States, between October 1, 1999 and September 30, 2019. Participants self‐reported race/ethnicity: White: 88.6% (n = 1,655,376); Black, 9.5% (n = 176,795); Hispanic (1.0%, n = 20,663), Asian (0.5%, n = 9,391), or American Indian/Alaska Native [AIAN (0.4%, n = 6,895). US region was derived using residential ZIP codes and categorized based on 10 Center for Disease Control and Prevention Health Promotion regions. Incident dementia was defined using International Classification of Diseases, 9th (ICD‐9) and 10th (ICD‐10) edition codes; age‐adjusted dementia incidence was estimated using direct standardization to compare rates by race/ethnicity overall and by US region.ResultOver a mean follow‐up of 10.1 years, 243,272 (13%) participants received a diagnosis of dementia. Age‐adjusted incidence per 1,000 person‐years was 14.2 [95% confidence interval (CI), 13.3‐15.1] for AIAN participants, 12.4 (95% CI, 11.7‐13.1) for Asian participants, 19.4 (95% CI, 19.2‐19.6) for Black participants, 20.7 (95% CI, 20.1‐21.3) for Hispanic participants, and 11.5 (95% CI, 11.4‐11.6) for White participants. Across US regions, a similar pattern was observed; compared to White participants, rates were significantly higher for Black participants across all regions (15.5 to 20.7, p values &lt;0.001), and for Hispanic participants in all regions except the Southeast (14.0 to 21.7, p values ≤ 0.03). Across most regions, AIAN (8.6 to 16.2,) and Asian participants (8.4 to 15.6,) showed a pattern of rates that was similar to or slightly higher than for White participants (9.8 to 12.0, p values &gt;0.05).ConclusionAmong older Veterans receiving care at VHA, where access to care for enrollees is held relatively equal, differences in dementia incidence were observed based on race/ethnicity. Across US regions, rates varied, but incidence was consistently higher for Black and Hispanic Veterans. Further research is needed to elucidate drivers of these differences.

The Impact of Travel Distance on Rhegmatogenous Retinal Detachment Presentation and Outcomes

Rhegmatogenous retinal detachment (RRD) requires urgent surgical intervention. The effect of travel distance on RRD outcomes is unclear. This retrospective cohort study included 642 patients who underwent RRD repair at Cole Eye Institute from 2012 to 2020. Google Maps was used to calculate the travel distance in miles from the residential zip code to the presenting and surgery location addresses. Multivariable logistic and bivariate linear regressions were used to compare macula-off status and best-corrected visual acuity (BCVA) in ETDRS letters at presentation and at 6-month follow-up, with patient travel distance divided into < 25 miles, 25 to 50 miles, and > 50 miles. Four hundred sixty-two patients were examined in the final cohort. The retinal reattachment rate was 94.3% for less than 25 miles, 96.3% for 25 to 50 miles, and 95.9% for greater than 50 miles (P = 0.63). In multivariable analysis, distance to presenting location was not associated with macula-off status (P = 0.69) or BCVA at follow-up (P = 0.27). Oneway analysis of distance and time from presentation to surgery in days revealed that distance to surgical site was associated with longer time to surgery (P = 0.003). Subset analysis of patients with income less than $25,520 (n = 18) revealed greater distance to presenting and surgical location was associated with longer time to surgery (P < .0001), but was not associated with BCVA at follow-up (P = 0.53). This data suggests that patients who live further from the hospital achieve equivalent outcomes from RRD repair, despite delays in surgery. [Ophthalmic Surg Lasers Imaging Retina 2022;53:666-672.].

Injury by knife crime amongst children is associated with socioeconomic deprivation: an observational study

PurposeChildren who live in areas of socioeconomic deprivation may be at higher risk of being victims of violent crime such as knife wounds. The current study investigated whether socioeconomic disparity was associated with higher risk of knife crime.MethodsAn observational study included patients aged ≤ 17 years at a UK Major Trauma Centre injured by knife trauma from 2016 to 2022. Indices of deprivation were recorded according to the zip code of residence and compared with those of all of England. These included Index of Multiple Deprivation (IMD); income; employment; education and skills; health and disability; crime; barriers to housing and services; living environment; and Income Deprivation Affecting Children Index (IDACI).ResultsThere were 139 patients (96% male) with median age of 16 years. When compared with the whole of England, patients had worse indices of IMD (p = 0.021); income (p < 0.001); employment (p < 0.001); education and skills (p < 0.001); health and disability; and IDACI (p < 0.001). There were no significant differences in indices of crime, barriers to housing and services or living environment.ConclusionsPaediatric knife injury was associated with poor socioeconomic status in multiple domains. Focussed efforts to address socioeconomic disparities should be a priority as a public health measure for vulnerable children.

Geographic Information System Mapping of Social Risk Factors and Patient Outcomes of Pediatric Glaucoma

This study aimed to use Geographic Information System (GIS) mapping to present the geospatialdistribution of visual outcomes and sociodemographic risk factors of a cohort of pediatric glaucoma patients. Retrospective cohort study. 233 eyes of 177 pediatric glaucoma patients treated at UC Davis Medical Center. We reviewed the medical records of pediatric patients (aged less than 18 years) with the diagnosis of pediatric glaucoma or any adult with a prior history of pediatric glaucoma at UC Davis Medical Center from 2001 to 2019. Patient sociodemographic information and ocular health data were recorded. Patients were mapped to their residential home 3-digit zip code prefix using ArcGIS software to generate geographic representations of the pediatric glaucoma database. Statistical analyses were performed to identify significant risk factors to poor visual outcome. The primary outcome was the patient's final visual acuity (VA), defined as a binary variable based on the World Health Organization's criteria: good VA (better than 20/200) or poor VA (worse than 20/200). The secondary outcome was final intraocular pressure (IOP) at patients' final follow-ups. Risk factors for poor vision and higher IOP were assessed. At final follow-up, 65 eyes (27.9%) had poor vision and 168 eyes (72.1%) had good vision. In the multivariate analysis, the odds ratio of good VA decreased by 4% for every 1 mmHg increase in initial IOP (P= 0.03), and the odds of good VA decreased by 6% for every year increase in age (P= 0.04). Patients with private insurance had a 3.5 mmHg lower final IOP than those with Medicaid (P= 0.004). Travel distance was not associated with a poorer visual outcome. Private insurance patients had lower final IOP than Medicaid patients. Age and initial IOP were significant negative predictors of VA. Despite travel distance appearing to be associated with poorer visual outcomes by GIS mapping, it was not statistically significant. Geographic information system mapping of patient outcomes is an innovative way to visualize patient demographics and risk factors. Geographic information system may prove particularly useful in larger nationwide disease and surgical registries, especially for rare disorders like pediatric glaucoma. Proprietary or commercial disclosure may be found after the references.

Health service use for young males and females with a mental disorder is higher than their peers in a population-level matched cohort

BackgroundTo inform healthcare planning and resourcing, population-level information is required on the use of health services among young people with a mental disorder. This study aims to identify the health service use associated with mental disorders among young people using a population-level matched cohort.MethodA population-based matched case-comparison retrospective cohort study of young people aged ≤ 18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia was conducted using linked birth, health, and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated for key demographics and mental disorder type by sex.ResultsEmergency department visits, hospital admissions and ambulatory mental health service contacts were all higher for males and females with a mental disorder than matched peers. Further hospitalisation risk was over 10-fold higher for males with psychotic (ARR 13.69; 95%CI 8.95–20.94) and anxiety (ARR 11.44; 95%CI 8.70-15.04) disorders, and for both males and females with cognitive and behavioural delays (ARR 10.79; 95%CI 9.30-12.53 and ARR 14.62; 95%CI 11.20-19.08, respectively), intellectual disability (ARR 10.47; 95%CI 8.04–13.64 and ARR 11.35; 95%CI 7.83–16.45, respectively), and mood disorders (ARR 10.23; 95%CI 8.17–12.80 and ARR 10.12; 95%CI 8.58–11.93, respectively) compared to peers.ConclusionThe high healthcare utilisation of young people with mental disorder supports the need for the development of community and hospital-based services that both prevent unnecessary hospital admissions in childhood and adolescence that can potentially reduce the burden and loss arising from mental disorders in adult life.

"...Paying to be a Patient in the Hospital and the Parking Lot": Dyadic Perspectives on Multiple Myeloma-Related Healthcare Access Barriers

Background Older adults with multiple myeloma (MM) experience healthcare access barriers resulting from functional impairments, geographic access limits, and socioeconomic and sociocultural factors. Detailed qualitative data are required to fully understand the interrelated and complex drivers of disparate access to healthcare in this population. Informal caregivers are integral to qualitative inquiry, given their critical role in providing multidimensional social support to older adults with MM. However, research focused on dyadic (patient-informal caregiver) perspectives of barriers to accessing high-quality MM care is limited. We, therefore, examined these perspectives in a diverse cohort of older adult dyads. Methods From November 2021-April 2022, we recruited adults aged ≥ 55 diagnosed with MM, paired with a single informal caregiver, and receiving care at a Comprehensive Cancer Center. Patient participants were recruited during any phase of their disease and participated in a single semi-structured 60-90 minutes interview via videoconferencing. The interview guide explored topics about MM and MM-therapies, function, quality of life, and barriers to care. Interviews were transcribed verbatim, and Atlas ti software was used for data analysis. Data were analyzed using the Sort and Sift, Think, and Shift approach (Maietta et al., 2021), which allowed the research team to first "dive into" the data to understand its meaning using memos and diagrams and "step back" using the knowledge gained to guide the next steps. We stratified our dyadic transcripts based on participants' zip code of residence linked to an aggregate county-level measure of community social factors (Centers for Disease Control and Prevention's social vulnerability index). We applied the National Institute on Minority Health and Health Disparities framework to categorize multilevel factors driving barriers to healthcare access. Results We interviewed 42 (11 Black and 10 White dyads) of 44 enrolled participants [(mean age, patients: 70 years (range = 57-90), caregivers: 68 years (range = 37-88). Most (90%) caregivers were intimate partners. Thirty-eight percent of all participants had less than a college degree, and 26% had a median annual household outcome < $50,000. Thirty-seven percent of dyads resided in moderate or high social vulnerability communities. We identified the following healthcare access barriers, 1) accessibility and transportation, 2) financial, 3) delayed MM diagnoses, 4) delayed referrals to a hematology/oncology specialist, and 5) clinic appointment scheduling (Table 1). Dyads living in moderate or high social vulnerability communities often reported accessibility barriers (Figure 1). Secondly, dyads living in high social vulnerability communities often reported financial barriers. Regarding accessibility, most dyads reported challenges in accessing the Cancer Center due to lengthy travel times and costs associated with parking. For financial barriers, dyads expressed worries and uncertainty about their financial future. Limited patient and provider knowledge about MM, led to delays in making the diagnosis and subsequent referrals for specialist care. Scheduling barriers led to frustration with the timing and frequency of Cancer Center visits. Conclusion We identified several healthcare access barriers among dyads affected by MM. Residents of communities with high social vulnerability often reported accessibility and financial concerns. This finding supports a need for more targeted efforts to support better the needs of those considered most vulnerable. Multilevel interventions targeting individual, organizational, community, and policy are needed to address these barriers. Such interventions include enhanced community transportation assistance programs, access to financial navigators, and improved appointment scheduling (e.g., using an embedded geo distance calculator in the electronic medical record for estimating travel distance to the cancer center from a patient's residence). Furthermore, increased community outreach and education efforts are needed to enhance patient and non-specialty clinicians' knowledge of MM. In combination, these efforts could reduce the barriers that limit access to high-quality care for vulnerable populations. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Racial, Ethnic and Socioeconomic Disparity in Outcomes of Patients with Chronic Graft-Versus-Host Disease: A CIBMTR Analysis

Introduction: Prior studies have demonstrated that racial/ethnic minority groups and patients with low socioeconomic status (SES) have worse overall survival (OS) after allogeneic hematopoietic stem cell transplant (allo-HCT). Whether the racial and SES disparity in outcomes persists and possibly may even be exacerbated in allo-HCT recipients with chronic graft-versus-host disease (cGVHD) is unknown. Certain aspects of cGVHD such as the need for long term care, prolonged immunosuppressive treatment, and close follow up for complications may exacerbate racial and SES disparities. In the current study, we analyzed the association of race/ethnicity and SES with the incidence of cGVHD and compared the long-term outcomes of allo-HCT survivors with cGVHD by race/ethnicity and SES. Methods: The study population comprised 14,825 adults with acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndrome (MDS), or myeloproliferative neoplasm (MPN) who received first allo-HCT between 2008-2018 in the United States. Residential ZIP code at the time of allo-HCT was used to estimate annual household income as the measure of SES. Patients with relapse of the primary disease prior to diagnosis of cGVHD were excluded. The incidence of cGVHD was calculated using the cumulative incidence estimator. Cox regression models were used to determine whether race/ethnicity and SES were associated with overall survival (OS), treatment related mortality (TRM) and relapse among patients with cGVHD. A stepwise backward variable selection was used to develop models for each outcome with a threshold of 0.05 for retention in the model. The main variable was then forced into the models. Interactions between the main variable and the adjusted covariates were tested at the significance level of 0.01. Results: Patients were reported to be Non-Hispanic White (W) (n=11,796), Non-Hispanic Black (B) (n=1,009), Hispanic (H) (n=1,325), and Asian (A) (n=695). A total of 5,600 relapse-free allo-HCT recipients developed cGVHD. There was no significant difference in cumulative incidence of cGVHD based on race/ethnicity (p=0.49, Table 1) or SES (p=0.44). In the multivariable analysis, we observed no significant differences in OS (p=0.15), TRM (p=0.11) and relapse (p=0.03) in patients with cGVHD based on race and ethnicity adjusted for patient-, disease- and transplant-related covariates. SES (household income, with or without adjustment for health insurance status) was significantly associated with OS (p<0.0001) and TRM (p=0.0006). More specifically, the highest quartile of household income (≥ $80,000) was associated with improved OS (HR 0.78, CI 0.71-0.86, p< 0.0001) and reduced TRM (HR 0.75, CI 0.66-0.86, p< 0.0001) compared with the lowest household income quartile (< $48,000) (Table 2). There was no association between the SES and relapse among patients with cGVHD (p=0.29). Conclusions: Our study highlights that low SES, regardless of race/ethnicity, has a negative impact on outcomes after diagnosis of cGVHD. Disparities in outcomes solely based on race/ethnicity were not evident among patients with cGVHD. Future studies are needed to determine if people with low SES and cGVHD have disproportionately worse outcomes than those with low SES without cGVHD. If they do, then optimizing the health care resources available to cGVHD patients with low SES may improve long-term outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Sanitary sewage overflows, boil water advisories, and emergency room and urgent care visits for gastrointestinal illness: a case-crossover study in South Carolina, USA, 2013-2017.

Sanitary sewage overflows (SSOs) release raw sewage, which may contaminate the drinking water supply. Boil water advisories (BWAs) are issued during low or negative pressure events, alerting customers to potential contamination in the drinking water distribution system. We evaluated the associations between SSOs and BWAs and diagnoses of gastrointestinal (GI) illness in Columbia, South Carolina, and neighboring communities, 2013-2017. A symmetric bi-directional case-crossover study design was used to assess the role of SSOs and BWAs on Emergency Room and Urgent Care visits with a primary diagnosis of GI illness. Cases were considered exposed if an SSO or BWA occurred 0-4 days, 5-9 days, or 10-14 days prior to the diagnosis, within the same residential zip code. Effect modification was explored via stratification on participant-level factors (e.g., sex, race, age) and season (January-March versus April-December). There were 830 SSOs, 423 BWAs, and 25,969 cases of GI illness. Highest numbers of SSOs, BWAs and GI cases were observed in a zip code where >80% of residents identified as Black or African-American. SSOs were associated with a 13% increase in the odds of a diagnosis for GI illness during the 0-4 day hazard period, compared to control periods (Odds Ratio: 1.13, 95% Confidence Interval: 1.09, 1.18), while no associations were observed during the other hazard periods. BWAs were not associated with increased or decreased odds of GI illness during all three hazard periods. However, in stratified analyses BWAs issued between January-March were associated with higher odds of GI illness, compared to advisories issued between April-December, in all three hazard periods. SSOs (all months) and BWAs (January-March) were associated with increased odds of a diagnosis of GI illness. Future research should examine sewage contamination of the drinking water distribution system, and mechanisms of sewage intrusion from SSOs. Sewage contains pathogens, which cause gastrointestinal (GI) illness. In Columbia, South Carolina, USA, between 2013-2017, there were 830 sanitary sewage overflows (SSOs). There were also 423 boil water advisories, which were issued during negative pressure events. Using case-crossover design, SSOs (all months) and boil water advisories (January-March) were associated with increased odds of Emergency Room and Urgent Care diagnoses of GI illness, potentially due to contamination of the drinking water distribution system. Lastly, we identified a community where >80% of residents identified as Black or African-American, which experienced a disproportionate burden of sewage exposure, compared to the rest of Columbia.

Abstract 12790: The Role of Social Determinants of Health in Rural Hf Outcomes

Background: Over 6.5 million Americans suffer from heart failure (HF) and 20% of these, 1.5 million Americans, live in rural areas. Compared to urban patients with HF, rural patients have higher rates of hospitalization and higher mortality. The reasons for these disparities are not well understood. In this study, we aimed to determine how much of the variation in urban/rural 30-day mortality could be explained by: 1) comorbidities; 2) guideline directed medical therapy (GDMT) use and 3) social determinants of health (SDOH). Methods: Using 100% Medicare Parts A and B and a random 40% sample of Part D, a cohort of 356,194 fee-for-service beneficiaries with ≥1 hospitalization for HFrEF between 2008 and 2016 was created. Rurality was determined using the beneficiaries’ ZIP code of residence and the Rural/Urban Commuting Areas (RUCA) classification. Hierarchical, logistic regression modeling, we then examined the association between 1) comorbidities; 2) GDMT use; and 3) the area deprivation index (ADI), a summary variable capturing multiple SDOH, and 30-day death after hospital discharge among HF patients in urban vs. rural areas. Results: When adjusting only for age, sex and race, rural patients have 15% higher odds of death (95% CI 12%, 19%, p&lt;0.001) in the 30 days after discharge for HFrEF. When comorbidities are added, the odd increase to 18% - an unexpected finding since comorbidity burdens are higher in rural areas. When GDMT use is added, the odds increase to 20%, also unexpected since prior work has shown GDMT is higher in rural areas. When ADI is added, the odds decrease to 14% (95% CI 10%, 18%, p&lt;0.001), suggesting that unlike comorbidities and GDMT use, ADI explains much of variation in urban/rural 30-day death rates. Conclusion: Living in a rural area is associated with a higher risk of 30-day death following a HFrEF hospitalization. Unlike comorbidities and GDMT use, SDOH appear to explain much of this difference in 30-day death rates.

Abstract 12781: Trends in Remote Monitoring for Patients With Hf and Identification of Opportunities to Expand Rural Access

Introduction: Limited access, due to geographic and/or transportation barriers, is one of the most significant challenges to chronic disease management in rural areas. Remote monitoring is a potential solution that allows a patients’ implanted devices to be interrogated for arrhythmia and non-invasive hemodynamics without the patient travelling to clinic. The aim of this study is to describe recent trends in remote monitoring among patients with HFrEF and to identify barriers and expand access in rural areas. Methods: We created annual, cross-sectional cohorts of patients with HF in each year from 2013 to 2018 with approximately 5 million patients/year by requiring ≥1 inpatient or ≥2 outpatient ICD9/10 codes for HF in the 2 years prior. Remote interrogation was determined using ICD-9/10 and CPT codes. Rurality was determined using the beneficiaries’ ZIP code of residence and the Rural/Urban Commuting Areas (RUCA) classification. The outcome of interest was the number of HFrEF patients with ≥1 remote monitoring visit in each year between 2013 and 2018. Results: The use of remote monitoring increased 21% between 2013 and 2018 in patients with HFrEF. By 2018, 9.3% of patients had ≥1 remote monitoring event (Figure 1). After multivariable adjustment for patient factors, living in a rural area was associated with a 14% greater odds (95% CI 1.13, 1.14, p&lt;0.001) of remote monitoring. However when hospital referral region (HRR), a geographic delineation of health care markets, was added to the model, living in an urban area became associated with a 7.8% greater odds of remote monitoring (95% CI 1.07, 1.08, p&lt;0.001). Conclusion: Remote monitoring is used by approximately 10% of patients with HFrEF. The most significant driver of remote monitoring is the HRR, or health care market, that the beneficiary resides in. To increase remote monitoring for rural patients, hospitals in predominately rural HRR’s should be incentivized to expand remote monitoring services.