Epidemiology of Food Insecurity in a Nationally Representative Sample of Lymphoma Patients.

BACKGROUND: In 2020, the United States had approximately 85,000 new diagnoses of Hodgkin and Non-Hodgkin lymphoma. Food insecurity is both a direct and indirect detriment to health outcomes. The rate and risk factors for food insecurity among lymphoma patients are unknown, as the unemployment rate soars far above pre-COVID19 pandemic levels further heightening the economic stresses of a lymphoma diagnosis. METHODS: Data regarding the food security status were obtained from the cross-sectional National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention. A raw score compiled from a series of 10 food security questions was used to determine the Food Secure and Food Insecure groups. Respondents who reported a history of lymphoma from 2011 to 2019 were included in the analysis. RESULTS: Of the 921 patients reporting a history of lymphoma 9.06% were considered Food Insecure. The sociodemographic subgroups with the highest risk of being Food Insecure included respondents living below 100% of the Federal Poverty Level, non-US citizens, the uninsured, and those on Medicare. CONCLUSION: Food insecurity is common among lymphoma patients. Therefore, oncologists across the country should be aware of the sociodemographic risk factors for food insecurity in order to assist in mediation, maximizing the efficacy of treatments. Research regarding the impact of food insecurity on therapy compliance and patient outcomes is warranted in future studies.

Risk Factors for Cost-Related Delays to Medical Care Among Lymphoma Patients: A 22-Year Analysis of a Nationally Representative Sample.

BACKGROUND: An estimated 85,000 cases of lymphoma (Hodgkin and non-Hodgkin lymphoma) were diagnosed in the United States in 2020. Financial insecurity is known to negatively impact health outcomes. In 2021, as Americans continue to file for unemployment at rates far above pre-COVID-19 pandemic peak levels, there is a persistent need to address the economic burden of diagnoses and threat of financial stressors and its related conditions, which are already known to cause substantial economic burden. PATIENTS AND METHODS: Data were obtained from the National Health Interview Survey (NHIS), a cross-sectional survey conducted annually by the National Center for Health Statistics. Two questions were asked of patients to identify potential risk factors of financial insecurity regarding patients' ability to pay medical bills. NHIS respondents between the years 1997 and 2018 self-reporting a history of lymphoma diagnoses was included in the analysis. RESULTS: Among over 2 million respondents to the NHIS between 1997 and 2018, 1619 individuals reported a history of lymphoma; 9.95% reported delaying medical care due to cost within the previous 12 months; and 6.52% reported not being able to afford medical care in the previous 12 months. Among the subgroups that had the highest risk of delaying medical care were patients between the ages of 25 and 64 years and the uninsured. CONCLUSION: Financial burdens impede patients' abilities to access and adhere to care, which can contribute to poorer health outcomes. As financially insecure patients continue to present with lymphoma diagnoses, it is vital for practicing hematologists to understand the links among health care, financial insecurity, and demographic risk factors in order to devise and implement appropriate interventions.

Geospatial Distribution of Neurosurgeons Age 60 and Older Relative to the Spread of COVID-19.

OBJECTIVE: To perform an ecological study to analyze the geospatial distribution of neurosurgeons ≥60 years old and compare these data with the spread of 2019 novel coronavirus disease (COVID-19) across the United States. METHODS: Data regarding distribution of COVID-19 cases were collected from the Environmental Systems Research Institute, and demographic statistics were collected from the American Association of Medical Colleges 2019 State Workforce Reports. These figures were analyzed using geospatial mapping software. RESULTS: As of July 5, 2020, the 10 states with the highest number of COVID-19 cases showed older neurosurgical workforce proportions (the proportion of active surgeons ≥60 years old) of 20.6%-38.9%. Among states with the highest number of COVID-19 deaths, the older workforce proportions were 25.0%-43.4%. Connecticut demonstrated the highest with 43.4% of neurosurgeons ≥60 years old. CONCLUSIONS: Regional COVID-19 hotspots may coincide with areas where a substantial proportion of the neurosurgical workforce is ≥60 years old. Continuous evaluation and adjustment of local and national clinical practice guidelines are warranted throughout the pandemic era.

Geospatial Mapping of Orthopaedic Surgeons Age 60 and Over and Confirmed Cases of COVID-19.

BACKGROUND: Although elective surgical procedures in the United States have been suspended because of the coronavirus disease 2019 (COVID-19) pandemic, orthopaedic surgeons are being recruited to serve patients with COVID-19 in addition to providing orthopaedic acute care. Older individuals are deemed to be at higher risk for poor outcomes with COVID-19. Although previous studies have shown a high proportion of older providers nationwide across medical specialties, we are not aware of any previous study that has analyzed the age distribution among the orthopaedic workforce. Therefore, the purposes of the present study were (1) to determine the geographic distribution of U.S. orthopaedic surgeons by age, (2) to compare the distribution with other surgical specialties, and (3) to compare this distribution with the spread of COVID-19. METHODS: Demographic statistics from the most recent State Physician Workforce Data Reports published by the Association of American Medical Colleges were extracted to identify the 2018 statewide proportion of practicing orthopaedic surgeons ≥60 years of age as well as age-related demographic data for all surgical specialties. Geospatial data on the distribution of COVID-19 cases were obtained from the Environmental Systems Research Institute. State boundary files were taken from the U.S. Census Bureau. Orthopaedic workforce age data were utilized to group states into quintiles. RESULTS: States with the highest quintile of orthopaedic surgeons ≥60 years of age included states most severely affected by COVID-19: New York, New Jersey, California, and Florida. For all states, the median number of providers ≥60 years of age was 105.5 (interquartile range [IQR], 45.5 to 182.5). The median proportion of orthopaedic surgeons ≥60 years of age was higher than that of all other surgical subspecialties, apart from thoracic surgery. CONCLUSIONS: To our knowledge, the present report provides the first age-focused view of the orthopaedic workforce during the COVID-19 pandemic. States in the highest quintile of orthopaedic surgeons ≥60 years old are also among the most overwhelmed by COVID-19. As important orthopaedic acute care continues in addition to COVID-19 frontline service, special considerations may be needed for at-risk staff. Appropriate health system measures and workforce-management strategies should protect the subset of those who are most potentially vulnerable. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.