Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort.

BACKGROUND: Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS: We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS: We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.

GIS mapping of agricultural plastic waste in southern Europe.

The escalating use of plastics in agriculture, driven by global population growth and increasing food demand, has concurrently led to a rise in Agricultural Plastic Waste (APW) production. Effective waste management is imperative, prompting this study to address the initial step of management, that is the quantification and localization of waste generated from different production systems in diverse regions. Focused on four Southern European countries (Italy, Spain, Greece, and Portugal) at the regional level, the study uses Geographic Information System (GIS), land use maps, indices tailored to each specific agricultural application and each crop type for plastic waste mapping. Furthermore, after the data was employed, it was validated by relevant stakeholders of the mentioned countries. The study revealed Spain, particularly the Andalusia region, as the highest contributor to APW equal to 324,000 tons per year, while Portugal's Azores region had the lowest estimate equal to 428 tons per year. Significantly, this research stands out as one of the first to comprehensively consider various plastic applications and detailed crop cultivations within the production systems, representing a pioneering effort in addressing plastic waste management in Southern Europe. This can lead further on to the management of waste in this area and the transfer of the scientific proposition to other countries.

Environmental determinants of health: Measuring multiple physical environmental exposures at the United States census tract level.

Physical environment plays a key role in determining human health risks. Exposure to toxins, weather extremes, degraded air and water quality, high levels of noise and limited accessibility to green areas can negatively affect health. Furthermore, adverse environmental exposures are often correlated with each other and with socioeconomic status, thereby compounding disadvantages in marginalized populations. Moreover, despite their importance in determining human health risks, the role of multiple environmental exposures is not well studied, and only a few resources contain aggregate environmental exposure data and only for selected areas of the contiguous US. To fill these gaps, we took a cumulative approach to measuring the environment by generating a composite Multi-Exposure Environmental Index (MEEI) as a US Census Tract-level summary of key environmental factors with known health effects. This measure quantifies multiple environmental exposures in the same area that can result in additive and synergistic effects on health outcomes. This information is crucial to better understand and possibly leverage environmental determinants of health for informed policy-making and intervention.

Linking the 1940 US Census to the NSHAP: Novel Opportunity to Understand the Effects of Childhood Residential Environment on Cognitive Aging.

OBJECTIVE: The 1940 Census is a valuable resource for understanding various aspects of historical populations in the United States. Recently, the National Social Life, Health and Aging Project (NSHAP) integrated 1940 Census data into its extensive dataset, providing researchers with an opportunity to explore new avenues of life course investigation. We leverage the newly-introduced measures of childhood residential environment and evaluate their potential predictive utility in older adult cognitive functioning net of childhood and adulthood characteristics known to be key risk factors for poor cognition. METHOD: We analyzed 777 respondents who were children in 1940 (age<17) that have been linked to the 1940 U.S. Census. We used childhood geographic location, homeownership status, household composition, and parental nativity as predictors. Cognitive function was measured using the Montreal Cognitive Assessment. RESULTS: Regression analysis showed that growing up in an urban area was associated with better cognitive function, while being born in the South was linked to poorer cognitive function, even after controlling for childhood health, parental education, educational attainment, stroke, and smoking status. Additionally, childhood multigenerational household was associated with better cognitive function, and childhood family size was associated with poorer cognitive function. However, these associations became statistically insignificant with the inclusion of educational attainment. We did not find homeownership and parental nativity to be associated with cognitive function. DISCUSSION: The findings may shed light on the potential long-term effects of childhood circumstances on cognitive aging processes. Implications for current literature and directions for future research are discussed.

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.

BACKGROUND: Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. OBJECTIVE: The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. METHODS: We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior-based questions (encompassing anal or oral sex) for 3 recall periods-past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. RESULTS: The percentage of MSM varied by recall period: 3.3% (95% CI 1.7%-4.9%) indicated sex with another male in the past 12 months, 4.7% (95% CI 0.0%-33.8%) in the past 5 years, and 6.2% (95% CI 2.9%-9.5%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4%, 95% CI 2.2%-4.6%) or who indicated that they are attracted to other men (4.9%, 95% CI 3.1%-6.7%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). CONCLUSIONS: We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis.

Development of esophagogastroduodenoscopy in China: results from the national census in 2013 and 2020.

Background: Given the significant burden of upper digestive diseases, there has been a substantial increase in the utilization of esophagogastroduodenoscopy (EGD) in China from 2012 to 2019. The objective of this study is to investigate the development, practice, and factors influencing the widespread use of EGD during this period. Methods: Two national censuses were conducted among all hospitals in mainland China that perform gastrointestinal endoscopy. These censuses aimed to extract information on the infrastructure, volume, and quality of EGD. The analysis of potential factors influencing EGD practice was based on real-world data from open access sources. Results: From 2012 to 2019, the number of hospitals performing EGD in mainland China increased from 1,518 to 2,265 (1.49-fold) in tertiary hospitals and from 3,633 to 4,097 (1.12-fold) in secondary hospitals, respectively. The national utilization rate of EGD also increased from 1,643.53 to 2,018.06 per 100,000 inhabitants, indicating a 1.23-fold increase. Regions with more endoscopists per 100,000 inhabitants (OR 9.61, P<0.001), more tertiary hospitals performing EGD per million inhabitants (OR 2.43, P<0.001), higher incidence of esophageal and gastric cancer (OR 2.09, P=0 016), and higher number of hospitals performing EGD per million inhabitants (OR 1.77, P=0.01) tended to provided more numerous and qualitied EGD. And hospital grading, regional GDP, incidence of esophageal and gastric cancer and the volume of EGD were observed as the significantly relevant factors of malignant dictation rate (MDR) (P<0.05), but not the number and educational background of endoscopists. Conclusion: Over the past seven years, China has made significant progress in EGD. However, challenges persist in terms of quality and inequality.

Eligible offender samples are missing in CODIS: A statewide approach to performing a lawfully owed DNA census.

In 2019, the Texas Department of Public Safety (TXDPS) Texas Ranger Division (TRD) identified approximately 3300 registered sex offenders (RSOs) from whom a "lawfully owed" DNA sample was missing from the Federal Bureau of Investigation's Combined DNA Index System (CODIS). Lawfully owed DNA (LODNA) is defined as a DNA sample from a qualifying offender who should have had their sample entered into CODIS, but for unknown reasons did not. As a result of those findings, TXDPS then applied for and was awarded a grant from the Bureau of Justice Assistance's Sexual Assault Kit Initiative to collect DNA specimens from these RSOs, and to perform a statewide LODNA census. TXDPS TRD sought to determine: Are the missed DNA collection problems limited to RSO's or are they occurring among individuals with a qualifying arrest or conviction as specified by state law too? What processes are used to identify individuals who are eligible for DNA sample collection? How is an individuals' DNA collection eligibility conveyed to external agencies? The findings from TXDPS' LODNA census, identified 43,245 individuals who were likely eligible for DNA collection between 1995 and 2020, therefore indicating statewide DNA collection issues. Over 4 years, collection efforts pertaining to the aforementioned lawfully owed census, have yielded 5183 LODNA sample collections, and 276 CODIS hits. This manuscript aims to create an awareness within other agencies of the importance of implementing best practices to ensure the collection and upload of LODNA from every eligible individual.

Regional variation in financial hardship among US veterans during the COVID-19 pandemic.

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.

Exploring COVID-19 census burdens by US hospital characteristics: Implications of quality reporting at rural and critical access hospitals.

PURPOSE: By assessing longitudinal associations between COVID-19 census burdens and hospital characteristics, such as bed size and critical access status, we can explore whether pandemic-era hospital quality benchmarking requires risk-adjustment or stratification for hospital-level characteristics. METHODS: We used hospital-level data from the US Department of Health and Human Services including weekly total hospital and COVID-19 censuses from August 2020 to August 2023 and the 2021 American Hospital Association survey. We calculated weekly percentages of total adult hospital beds containing COVID-19 patients. We then calculated the number of weeks each hospital spent at Extreme (≥20% of beds occupied by COVID-19 patients), High (10%-19%), Moderate (5%-9%), and Low (<5%) COVID-19 stress. We assessed longitudinal hospital-level COVID-19 stress, stratified by 15 hospital characteristics including joint commission accreditation, bed size, teaching status, critical access hospital status, and core-based statistical area (CBSA) rurality. FINDINGS: Among n = 2582 US hospitals, the median(IQR) weekly percentage of hospital capacity occupied by COVID-19 patients was 6.7%(3.6%-13.0%). 80,268/213,383 (38%) hospital-weeks experienced Low COVID-19 census stress, 28% Moderate stress, 22% High stress, and 12% Extreme stress. COVID-19 census burdens were similar across most hospital characteristics, but were significantly greater for critical access hospitals. CONCLUSIONS: US hospitals experienced similar COVID-19 census burdens across multiple institutional characteristics. Evidence-based inclusion of pandemic-era outcomes in hospital quality reporting may not require significant hospital-level risk-adjustment or stratification, with the exception of rural or critical access hospitals, which experienced differentially greater COVID-19 census burdens and may merit hospital-level risk-adjustment considerations.

Golden lion tamarin metapopulation dynamics five years after heavy losses to yellow fever.

The golden lion tamarin (GLT) is an Endangered primate endemic to Brazil's lowland Atlantic Forest. After centuries of deforestation and capture for the pet trade, only a few hundred individuals survived, all in isolated forest fragments 85 km from Rio de Janeiro city. Intensive conservation actions, including reintroduction of zoo-born tamarins, increased numbers to about 3700 in 2014. The most severe yellow fever epidemic/epizootic in Brazil in 80 years reduced two of the largest GLT populations by over 90%. Herein we report the results of a 2023 survey of GLTs designed to examine the dynamics of population recovery following yellow fever. Results indicate that populations hard hit by yellow fever are recovering due in part to immigration from adjacent forest fragments. No local extirpations were observed. About 4800 GLTs live in the survey area. This represents a 31% increase since the baseline survey completed in 2014. Two factors explain most of the increase: four large areas that had no GLTs or very low-density populations in 2014 are now at moderate density (three areas) or low density (one area), explaining 71% of overall increase since 2014. Increase in forest area within our survey area may explain up to 16% of the increase in GLT numbers since 2014. Results of computer simulations suggest that strengthening forest connectivity will facilitate metapopulation resilience in the face of mortality factors such as yellow fever.

Differential Privacy Protections in 2020 U.S. Decennial Census Data Do Not Impede Measurement of Racial and Ethnic Disparities.

Census data are vital to health care research but must also protect respondents' confidentiality. The 2020 decennial Census employs a new Differential Privacy framework; this study examines its effect on the accuracy of an important tool for measuring health disparities, the Bayesian Improved Surname and Geocoding (BISG) algorithm, which uses Census Block Group data to estimate race and ethnicity when self-reported data are unavailable. Using self-reported race and ethnicity data as our standard, we compared the accuracy of BISG estimates calculated using the original 2010 Census counts to the accuracy of estimates calculated using 2010 data but with 2020 Differential Privacy in place. The Differential Privacy methodology slightly decreases BISG accuracy for American Indian and Alaska Native people but has little effect for other groups, suggesting that the methodology will not impede health disparities research that employs BISG and similar methods.

Development and status quo of digestive endoscopy in China: An analysis based on the national census in 2013 and 2020.

Background and Objectives: Technique and practice of digestive endoscopy are undergoing speedy development all over the world. This study aimed to evaluate its status quo and development in China. Methods: All hospitals performing digestive endoscopy in mainland China participated in the national census in 2013 and 2020. Retrospective data of hospitals, endoscopists, volumes, and qualities were collected via an online structured questionnaire, and its accuracy and rationality were verified by logical tests and manual reviews. Data from other countries were used to compare with that of China. Results: From 2012 to 2019, the number of hospitals performing digestive endoscopy increased from 6,128 to 7,470 (1.22-fold), in which primary healthcare played a minor role. The median hospitals per 100,000 inhabitants per provincial region increased from 0.49 (IQR, 0.39-0.57) to 0.55 (IQR, 0.49-0.63). The endoscopists increased from 26,203 to 39,638 (1.51-fold), but their average workload even expanded. Overall volume increased from 28.8 million to 44.5 million (1.55-fold), and most types of endoscopic procedures recorded a high growth rate. Contrastingly, the specific utilization rates were low and paled in comparison with some developed countries. Nationwide, regional utilization rates showed a significant correlation with GDP per capita (P <0.001). Overall qualities of digestive endoscopy were excellent, but certain results of quality indicators posed a huge challenge, such as the detection rates of adenoma and early cancers. Conclusions: Impressive progress has been made in digestive endoscopy with rapidly expanding economy in China. However, primary healthcare, utilization rates, and income-related inequality of regional services were needed to be improved to promote public health better.

Utilizing social determinants of health to identify most vulnerable neighborhoods-Latent class analysis and GIS map.

OBJECTIVES: Public Health officials are often challenged to effectively allocate limited resources. Social determinants of health (SDOH) may cluster in areas to cause unique profiles related to various adverse life events. The authors use the framework of unintended teen pregnancies to illustrate how to identify the most vulnerable neighborhoods. METHODS: This study used data from the U.S. American Community Survey, Princeton Eviction Lab, and Connecticut Office of Vital Records. Census tracts are small statistical subdivisions of a county. Latent class analysis (LCA) was employed to separate the 832 Connecticut census tracts into four distinct latent classes based on SDOH, and GIS mapping was utilized to visualize the distribution of the most vulnerable neighborhoods. GEE Poisson regression model was used to assess whether latent classes were related to the outcome. Data were analyzed in May 2021. RESULTS: LCA's results showed that class 1 (non-minority non-disadvantaged tracts) had the least diversity and lowest poverty of the four classes. Compared to class 1, class 2 (minority non-disadvantaged tracts) had more households with no health insurance and with single parents; and class 3 (non-minority disadvantaged tracts) had more households with no vehicle available, that had moved from another place in the past year, were low income, and living in renter-occupied housing. Class 4 (minority disadvantaged tracts) had the lowest socioeconomic characteristics. CONCLUSIONS: LCA can identify unique profiles for neighborhoods vulnerable to adverse events, setting up the potential for differential intervention strategies for communities with varying risk profiles. Our approach may be generalizable to other areas or other programs. KEY MESSAGES: What is already known on this topic Public health practitioners struggle to develop interventions that are universally effective. The teen birth rates vary tremendously by race and ethnicity. Unplanned teen pregnancy rates are related to multiple social determinants and behaviors. Latent class analysis has been applied successfully to address public health problems. What this study adds While it is the pregnancy that is not planned rather than the birth, access to pregnancy intention data is not available resulting in a dependency on teen birth data for developing public health strategies. Using teen birth rates to identify at-risk neighborhoods will not directly represent the teens at risk for pregnancy but rather those who delivered a live birth. Since teen birth rates often fluctuate due to small numbers, especially for small neighborhoods, LCA may avoid some of the limitations associated with direct rate comparisons. The authors illustrate how practitioners can use publicly available SDOH from the Census Bureau to identify distinct SDOH profiles for teen births at the census tract level. How this study might affect research, practice or policy These profiles of classes that are at heightened risk potentially can be used to tailor intervention plans for reducing unintended teen pregnancy. The approach may be adapted to other programs and other states to prioritize the allocation of limited resources.

Unveiling value patterns via deep reinforcement learning in heterogeneous data analytics.

Artificial intelligence has substantially improved the efficiency of data utilization across various sectors. However, the insufficient filtering of low-quality data poses challenges to uncertainty management, threatening system stability. In this study, we introduce a data-valuation approach employing deep reinforcement learning to elucidate the value patterns in data-driven tasks. By strategically optimizing with iterative sampling and feedback, our method is effective in diverse scenarios and consistently outperforms the classic methods in both accuracy and efficiency. In China's wind-power prediction, excluding 25% of the overall dataset deemed low-value led to a 10.5% improvement in accuracy. Utilizing just 42.8% of the dataset, the model discerned 80% of linear patterns, showcasing the data's intrinsic and transferable value. A nationwide analysis identified a data-value-sensitive geographic belt across 10 provinces, leading to robust policy recommendations informed by variances in power outputs and data values, as well as geographic climate factors.

Exposure of wetlands important for nonbreeding waterbirds to sea-level rise in the Mediterranean.

Sea-level rise (SLR) is expected to cause major changes to coastal wetlands, which are among the world's most vulnerable ecosystems and are critical for nonbreeding waterbirds. Because strategies for adaptation to SLR, such as nature-based solutions and designation of protected areas, can locally reduce the negative effects of coastal flooding under SLR on coastal wetlands, it is crucial to prioritize adaptation efforts, especially for wetlands of international importance for biodiversity. We assessed the exposure of coastal wetlands important for nonbreeding waterbirds to projected SLR along the Mediterranean coasts of 8 countries by modeling future coastal flooding under 7 scenarios of SLR by 2100 (from 44- to 161-cm rise) with a static inundation approach. Exposure to coastal flooding under future SLR was assessed for 938 Mediterranean coastal sites (≤30 km from the coastline) where 145 species of nonbreeding birds were monitored as part of the International Waterbird Census and for which the monitoring area was delineated by a polygon (64.3% of the coastal sites monitored in the Mediterranean region). Thirty-four percent of sites were threatened by future SLR, even under the most optimistic scenarios. Protected study sites and study sites of international importance for waterbirds were, respectively, 1.5 and 2 times more exposed to SLR than the other sites under the most optimistic scenario. Accordingly, we advocate for the development of a prioritization scheme to be applied to these wetlands for the implementation of strategies for adaptation to SLR to anticipate the effects of coastal flooding. Our study provides major guidance for conservation planning under global change in several countries of the Mediterranean region.

Exposición de los humedales de importancia para las aves acuáticas no reproductoras al incremento del nivel del mar en el Mediterráneo Resumen Se espera que el incremento en el nivel del mar (INM) cause cambios importantes en los humedales costeros, los cuales se encuentran entre los ecosistemas más vulnerables y son críticos para las aves acuáticas no reproductoras. Es crucial la priorización de los esfuerzos de adaptación, especialmente en los humedales con importancia internacional para la biodiversidad, ya que las estrategias de adaptación ante el INM, como las soluciones basadas en la naturaleza y la designación de áreas protegidas, pueden reducir localmente los efectos negativos de las inundaciones costeras por INM en los humedales costeros. Evaluamos la exposición de los humedales costeros con importancia para las aves acuáticas no reproductoras ante el INM proyectado en las costas del Mediterráneo en ocho países con un modelo de inundaciones costeras en el futuro bajo siete escenarios de INM para el año 2100 (de 44 a 161 cm) con un enfoque de inundación estática. Evaluamos la exposición a las inundaciones costeras bajo el INM futuro en 938 sitios costeros del Mediterráneo (≤ 30 km a partir de la costa), en donde monitoreamos a 145 especies de aves no reproductoras como parte del Censo Internacional de Aves Acuáticas y para los cuales el área de monitoreo estuvo delineada con un polígono (64.3% de los sitios costeros monitoreados en la región Mediterránea). El 34% de los sitios se vio amenazado por el INM en el futuro, incluso con los escenarios más optimistas. Los sitios de estudio protegidos y los sitios de estudio de importancia internacional para las aves acuáticas estuvieron expuestos 1.5 y 2 veces más al INM que otros sitios con el escenario más optimista. De acuerdo con esto, abogamos por el desarrollo de un esquema de priorización para aplicarse en estos humedales para la implementación de estrategias de adaptación al INM para anticipar los efectos de las inundaciones costeras. Nuestro estudio proporciona información importante para la planeación de la conservación bajo el cambio global en varios de los países del Mediterráneo.

Environmental Justice Index and adverse pregnancy outcomes.

BACKGROUND: The Environmental Justice Index is a tool released by the Centers for Disease Control and Prevention that quantifies and ranks the environmental burden and social vulnerability of each census tract. Racial and ethnic disparities in adverse pregnancy outcomes are well established. The relative contributions of individual (person-level) and environmental (neighborhood-level) risk factors to disease prevalence remain poorly understood. OBJECTIVE: This study aimed to determine whether the Environmental Justice Index is associated with adverse pregnancy outcomes after adjustment for individual clinical and sociodemographic risk factors. STUDY DESIGN: This was a retrospective cross-sectional study of all patients who delivered a singleton newborn at ≥23 weeks of gestation between January 2019 and February 2022 at 7 hospitals within a large academic health system in New York. Patients were excluded if their home address was not available, if the address could not be geocoded to a census tract, or if the census tract did not have corresponding Environmental Justice Index data. Patients were also excluded if they had preexisting diabetes or hypertension. For patients who had multiple pregnancies during the study period, only the first pregnancy was included for analysis. Clinical and demographic data were obtained from the electronic medical record. Environmental Justice Index score, the primary independent variable, ranges from 0 to 1. Higher Environmental Justice Index scores indicate communities with increased cumulative environmental burden and increased social vulnerability. The primary outcome was adverse pregnancy outcome, defined as the presence of ≥1 of any of the following conditions: hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth restriction, low birthweight, small for gestational age newborn, placental abruption, and stillbirth. Multivariable logistic regression was performed to investigate the relationship between Environmental Justice Index score and adverse pregnancy outcome, adjusting for potential confounding variables, including body mass index group, race and ethnicity group, advanced maternal age, nulliparity, public health insurance, and English as the preferred language. RESULTS: A total of 65,273 pregnancies were included for analysis. Overall, adverse pregnancy outcomes occurred in 37.6% of pregnancies (n=24,545); hypertensive disorders of pregnancy (13.4%) and gestational diabetes (12.2%) were the most common adverse pregnancy outcome conditions. On unadjusted analysis, the strongest associations between Environmental Justice Index score and individual adverse pregnancy outcome conditions were observed for stillbirth (odds ratio, 1.079; 95% confidence interval, 1.025-1.135) and hypertensive disorders of pregnancy (odds ratio, 1.052; 95% confidence interval, 1.042-1.061). On multivariable logistic regression, every 0.1 increase in Environmental Justice Index score was associated with 1.4% higher odds of adverse pregnancy outcome (adjusted odds ratio, 1.014; 95% confidence interval, 1.007-1.021). The strongest associations with adverse pregnancy outcomes were observed with well-established clinical and social risk factors, including class 3 obesity (adjusted odds ratio, 1.710; 95% confidence interval, 1.580-1.849; reference: body mass index <25 kg/m2) and certain race and ethnicity groups (reference: non-Hispanic White), particularly Asian and Pacific Islander (adjusted odds ratio, 1.817; 95% confidence interval, 1.729-1.910), and non-Hispanic Black (adjusted odds ratio, 1.668; 95% confidence interval, 1.581-1.760) people. CONCLUSION: Environmental Justice Index score is positively associated with adverse pregnancy outcomes, and most strongly associated with stillbirth and hypertensive disorders of pregnancy. Geospatial analysis with Environmental Justice Index may help to improve our understanding of health inequities by identifying neighborhood characteristics that increase the risk of pregnancy complications.

Disadvantaged groups have greater spatial access to pharmacies in New York state.

BACKGROUND: The accessibility of pharmacies has been associated with overall health and wellbeing. Past studies have suggested that low income and racial minority communities are underserved by pharmacies. However, the literature is inconsistent in finding links between area-level income or racial and ethnic composition and access to pharmacies. Here we aim to assess area-level spatial access to pharmacies across New York State (NYS), hypothesizing that Census Tracts with higher poverty rates and higher percentages of Black and Hispanic residents would have lower spatial access. METHODS: The population weighted mean shortest road network distance (PWMSD) to a pharmacy in 2018 was calculated for each Census Tract in NYS. This statistic was calculated from the shortest road network distance to a pharmacy from the centroid of each Census block within a tract, with the mean across census blocks weighted by the population of the census block. Cross-sectional analyses were conducted to assess links between Tract-level socio demographic characteristics and Tract-level PWMSD to a pharmacy. RESULTS: Overall the mean PWMSD to a pharmacy across Census tracts in NYS was 2.07 Km (SD = 3.35, median 0.85 Km). Shorter PWMSD to a pharmacy were associated with higher Tract-level % poverty, % Black/African American (AA) residents, and % Hispanic/Latino residents and with lower Tract-level % of residents with a college degree. Compared to tracts in the lowest quartile of % Black/AA residents, tracts in the highest quartile had a 70.7% (95% CI 68.3-72.9%) shorter PWMSD to a pharmacy. Similarly, tracts in the highest quartile of % poverty had a 61.3% (95% CI 58.0-64.4%) shorter PWMSD to a pharmacy than tracts in the lowest quartile. CONCLUSION: The analyses show that tracts in NYS with higher racial and ethnic minority populations and higher poverty rates have higher spatial access to pharmacies.

Intra- and post-pandemic impact of the COVID-19 outbreak on Stanford Health Care.

Stanford Health Care, which provides about 7% of overall healthcare to approximately 9 million people in the San Francisco Bay Area, has undergone significant changes due to the opening of a second hospital in late 2019 and, more importantly, the COVID-19 pandemic. We examine the impact of these events on anatomic pathology (AP) cases, aiming to enhance operational efficiency in response to evolving healthcare demands. We extracted historical census, admission, lab tests, operation, and AP data since 2015. An approximately 45% increase in the volume of laboratory tests (P < 0.0001) and a 17% increase in AP cases (P < 0.0001) occurred post-pandemic. These increases were associated with progressively increasing (P < 0.0001) hospital census. Census increase stemmed from higher admission through the emergency department (ED), and longer lengths of stay mostly for transfer patients, likely due to the greater capability of the new ED and changes in regional and local practice patterns post-pandemic. Higher census led to overcapacity, which has an inverted U relationship that peaked at 103% capacity for AP cases and 114% capacity for laboratory tests. Overcapacity led to a lower capability to perform clinical activities, particularly those related to surgical procedures. We conclude by suggesting parameters for optimal operations in the post-pandemic era.

Survival analysis under imperfect record linkage using historic census data.

BACKGROUND: Advancements in linking publicly available census records with vital and administrative records have enabled novel investigations in epidemiology and social history. However, in the absence of unique identifiers, the linkage of the records may be uncertain or only be successful for a subset of the census cohort, resulting in missing data. For survival analysis, differential ascertainment of event times can impact inference on risk associations and median survival. METHODS: We modify some existing approaches that are commonly used to handle missing survival times to accommodate this imperfect linkage situation including complete case analysis, censoring, weighting, and several multiple imputation methods. We then conduct simulation studies to compare the performance of the proposed approaches in estimating the associations of a risk factor or exposure in terms of hazard ratio (HR) and median survival times in the presence of missing survival times. The effects of different missing data mechanisms and exposure-survival associations on their performance are also explored. The approaches are applied to a historic cohort of residents in Ambler, PA, established using the 1930 US census, from which only 2,440 out of 4,514 individuals (54%) had death records retrievable from publicly available data sources and death certificates. Using this cohort, we examine the effects of occupational and paraoccupational asbestos exposure on survival and disparities in mortality by race and gender. RESULTS: We show that imputation based on conditional survival results in less bias and greater efficiency relative to a complete case analysis when estimating log-hazard ratios and median survival times. When the approaches are applied to the Ambler cohort, we find a significant association between occupational exposure and mortality, particularly among black individuals and males, but not between paraoccupational exposure and mortality. DISCUSSION: This investigation illustrates the strengths and weaknesses of different imputation methods for missing survival times due to imperfect linkage of the administrative or registry data. The performance of the methods may depend on the missingness process as well as the parameter being estimated and models of interest, and such factors should be considered when choosing the methods to address the missing event times.

Best Practices in Evolving Privacy Frameworks for Patient Age Data: Census Data Study.

BACKGROUND: Over the previous 4 decennial censuses, the population of the United States has grown older, with the proportion of individuals aged at least 90 years old in the 2010 census being more than 2 and a half times what it was in the 1980 census. This suggests that the threshold for constraining age introduced in the Safe Harbor method of the HIPAA (Health Insurance Portability and Accountability Act) in 1996 may be increased without exceeding the original levels of risk. This is desirable to maintain or even increase the utility of affected data sets without compromising privacy. OBJECTIVE: In light of the upcoming release of 2020 census data, this study presents a straightforward recipe for updating age-constrained thresholds in the context of new census data and derives recommendations for new thresholds from the 2010 census. METHODS: Using census data dating back to 1980, we used group size considerations to analyze the risk associated with various maximum age thresholds over time. We inferred the level of risk of the age cutoff of 90 years at the time of HIPAA's inception in 1996 and used this as a baseline from which to recommend updated cutoffs. RESULTS: The maximum age threshold may be increased by at least 2 years without exceeding the levels of risk conferred in HIPAA's original recommendations. Moreover, in the presence of additional information that restricts the population in question to a known subgroup with increased longevity (for example, restricting to female patients), the threshold may be increased further. CONCLUSIONS: Increasing the maximum age threshold would enable the data user to gain more utility from the data without introducing risk beyond what was originally envisioned with the enactment of HIPAA. Going forward, a recurring update of such thresholds is advised, in line with the considerations detailed in the paper.