scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p < .001) and 1.08-fold (95% CI = 1.05–1.10, p < .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p < .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p < .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p < .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

Characteristics of Hepatitis B virus induced Hepatocellular Carcinoma in Egyptian patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Mahmoud Fathy Barakat ◽  
Khalid Mahmoud AbdAlaziz ◽  
Mohamed Mahmoud Mahmoud El Tabbakh ◽  
Mohamed Kamal Alden Ali
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Hepatitis C ◽  
Hepatitis B ◽  
The United States ◽  
Age Difference ◽  
Co Morbidity ◽  
Incidence And Mortality

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as αfetoprotein at 6-month interval. Aim To compare characteristics and behavior of Hepatocellular carcinoma (HCC) in chronic HCV patients and HVB patients Patients and Methods The current study was conducted on patients with de HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and D ecember 2018, aged (18-70 years old) . Results eline characteristics of study population shown in Table 1 at enrolment, including gender, Education status, co-morbidity, underlying presence or absence of cirrhosis, Child-Pugh class of patients infected with viral hepatitis, and alpha-fetoprotein levels. Male proportion observed to be predominant in both HCV (62%) and HBV (75.4%) infected HCC population. Overall prevalence of HCV and HBV in patients having HCC was 65.95% and 34.04%, respectively. Presence of underlying liver cirrhosis was more significantly associated with HCV seropositives as compared to HBV seropositive patients (p0.05). Table 2 shows comparison of means between HCV and HBV seropositive patients with HCC. In univariate analysis, mean age difference (11.6 years), and total bilirubin levels (-1.91mg/dl) were the only statistically significant observations noted among HCV-HCC group (p = 0.05) Conclusion Hepatocellular carcinoma is mainly caused by Hepatitis C and Hepatitis B viruses, but latter showed predominance, comparatively worldwide and correlated HBV directly as a cause of HCC rather than HCV whose relation with HCC is still unclear (Shepard et al., 2006; Di Bisceglie, 2009). Because of the geographical differences and risk factors, the epidemiological burden of HCV and HBV has been observed different in different areas of the world. In developing countries due to high burden of HCV infection as compared to HBV such as in Taiwan (HCV 17.0%, HBV 13.8%) (Kao et al., 2011), Guam (HCV 19.6%, HBV 18%) (Haddock et al., 2013), and Pakistan (HCV 4.8%, HBV 2.5%) (Rehman et al., 1996; Raza et al., 2007; Qureshi et al., 2010; Butt et al., 2012;) will possibly

scholarly journals Cabbage and Sauerkraut Consumption in Adolescence and Adulthood and Breast Cancer Risk among US-Resident Polish Migrant Women

2021 ◽  
Vol 18 (20) ◽  
pp. 10795
Author(s):  
Dorothy Rybaczyk Pathak ◽  
Aryeh D. Stein ◽  
Jian-Ping He ◽  
Mary M. Noel ◽  
Larry Hembroff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Vegetable Intake ◽  
Conditional Logistic Regression ◽  
The United States ◽  
Population Based ◽  
Cook County ◽  
Migrant Women ◽  
Incidence And Mortality

Background: Breast cancer (BC) incidence and mortality are lower in Poland than in the United States (US). However, Polish-born migrant women to US approach the higher BC mortality rates of US women. We evaluated the association between consumption of cabbage/sauerkraut foods and BC risk in Polish-born migrants to US. Methods: We conducted a case–control study of BC among Polish-born migrants in Cook County and the Detroit Metropolitan Area. Cases (n = 131) were 20–79 years old with histological/cytological confirmation of invasive BC. Population-based controls (n = 284) were frequency matched to cases on age and residence. Food frequency questionnaires assessed diet during adulthood and age 12–13 years. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated with conditional logistic regression. Consumption of total, raw/short-cooked, and long-cooked cabbage/sauerkraut foods was categorized as low, medium, or high (frequency of servings/week). Results: Higher consumption of total and raw/short-cooked cabbage/sauerkraut foods, during both adolescence and adulthood, was associated with a significantly lower BC risk. Consumption of long-cooked cabbage/sauerkraut foods was low and not significantly associated with risk. The multivariate OR for total cabbage/sauerkraut consumption, high vs. low (> 4 vs. ≤ 2 servings/week) during adolescence was 0.36 (95% CI = 0.18–0.71, ptrend < 0.01) and 0.50 (95% CI = 0.23–1.06, ptrend = 0.08) during adulthood. For raw/short-cooked cabbage/sauerkraut (>3 vs. ≤1.5 servings/week), the ORs were 0.35 (95% CI = 0.16–0.72, ptrend < 0.01) during adolescence and 0.37 (95% CI = 0.17–0.78, ptrend < 0.01) during adulthood. For joint adolescent/adult consumption of raw/short-cooked cabbage/sauerkraut foods, (high, high) vs. (low, low), the OR was 0.23 (95% CI = 0.07–0.65). The significant association for high adolescent consumption of raw/short-cooked cabbage/sauerkraut foods and reduced BC risk was consistent across all levels of consumption in adulthood. Conclusion: Greater consumption of total and raw/short-cooked cabbage/sauerkraut foods either during adolescence or adulthood was associated with significantly reduced BC risk among Polish migrant women. These findings contribute to the growing literature suggesting a protective effect of a potentially modifiable factor, cruciferous vegetable intake, on breast cancer risk.

Why Do People Migrate?

On the Move ◽  
2016 ◽  
Author(s):  
Filiz Garip
Keyword(s):  
United States ◽  
Rural Communities ◽  
Urban Areas ◽  
The United States ◽  
Family Ties ◽  
Small Minority ◽  
The Third ◽  
Majority Group ◽  
First Time ◽  
Over Time

This chapter provides an overview of the migration field, and a brief review of Mexico–U.S. migration flows up to 1965, the year the analysis here begins. It describes the data and methods that led the author to discover four groups among first-time migrants from Mexico to the United States between 1965 and 2010. The first cluster—mostly uneducated and poor men from rural communities—was the majority in the 1970s but dropped to a small minority by the 1990s. The second cluster—many of them teenage boys from relatively better-off families—peaked in the 1980s, becoming the majority group at that time, but declined consistently in size thereafter. The third cluster—mostly women with family ties to former migrants—was increasing slowly in size until it experienced a sudden spike in the early 1990s. And the fourth cluster—mostly educated men from urban areas—grew persistently over time, grabbing the majority status among all first-time migrants in the early 1990s.

Temporal Trends in the Microbiological Characteristics of Sepsis in the United States: A Population Based Study

2021 ◽  
pp. 088506662110537
Author(s):  
Po-Yang Tsou ◽  
Chia-Hung Yo ◽  
Yenh-Chen Hsein ◽  
Gregory Yungtum ◽  
Wan-Ting Hsu ◽  
...  
Keyword(s):  
United States ◽  
Temporal Trends ◽  
Population Level ◽  
The United States ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Annual Increase ◽  
Gram Negative ◽  
Nationwide Inpatient Sample Database ◽  
Incidence And Mortality

Background Epidemiologic studies are needed for monitoring population-level trends in sepsis. This study examines sepsis-causing microorganisms from 2006 to 2014 in the United States using data from the Nationwide Inpatient Sample database. Methods 7 860 686 adults hospitalized with sepsis were identified using a validated ICD-9 coding approach. Associated microorganisms were identified by ICD-9 code and classified by major groups (Gram-positive, Gram-negative, fungi, anaerobes) and specific species for analysis of their incidence and mortality. Results The rate of sepsis incidence has increased for all four major categories of pathogens, while the mortality rate decreased. In 2014, Gram-negative pathogens had a higher incidence than Gram-positives. Anaerobes increased the fastest with an average annual increase of 20.17% (p < 0.001). Fungi had the highest mortality (19.28%) and the slowest annual decrease of mortality (−2.31%, p = 0.006) in 2013, while anaerobic sepsis had the highest hazard of mortality (adjusted HR 1.60, 95% CI 1.53-1.66). Conclusions Gram-negative pathogens have replaced Gram-positives as the leading cause of sepsis in the United States in 2014 during the study period (2006-2014). The incidence of anaerobic sepsis has an annual increase of 20%, while the mortality of fungal sepsis has not decreased at the same rate as other microorganisms. These findings should inform the diagnosis and management of septic patients, as well as the implementation of public health programs.

scholarly journals Willingness to Pay for Broadband Access by Kentucky Farmers

2012 ◽  
Vol 44 (3) ◽  
pp. 323-334 ◽  
Author(s):  
Chris Jeffcoat ◽  
Alison F. Davis ◽  
Wuyang Hu
Keyword(s):  
Rural Communities ◽  
Willingness To Pay ◽  
Urban Areas ◽  
The United States ◽  
Property Taxes ◽  
The Internet ◽  
Broadband Access ◽  
Broadband Internet ◽  
Infrastructure Investments ◽  
E Mail

Since the Internet's inception its impact has been felt across the United States, but the distribution and adoption of the Internet has not necessarily been uniform geographically. As more consumers and businesses rely on the Internet to access information, the data transmission requirements have also increased. Consequently, access to broadband has become increasingly more important since dial-up cannot realistically handle the increased requirements. The use of broadband in agriculture can provide better access to price, weather, and management information while also opening new markets. However, many rural communities lag behind urban areas in broadband access and adoption rates. This study evaluates, through the use of a producer survey, the level of broadband Internet use, motivations for its use, degree of access to broadband, and willingness-to-pay (WTP) to fund broadband infrastructure investments. Results from the producer survey suggested farmers utilize the Internet primarily for accessing weather reports, e-mail, market reports, and agricultural news. Notably, the survey's WTP questions allowed for the use of an interval regression to calculate producer WTP for varying demographics. The results suggested that producers who were younger, farmed larger farms, and those who currently use the Internet but do not have broadband access were WTP more in property taxes to support broadband infrastructure investments than those of a differing demographic. Because WTP levels varied drastically depending on the underlying demographics, it becomes difficult to pinpoint a WTP level for a one-time payment in property taxes that would be acceptable from a policy standpoint.

Survival Disparities in Patients with Lymphoma According to Place of Residence and Treatment Provider: A Population-Based Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 874-874
Author(s):  
Fausto R Loberiza ◽  
Anthony J Cannon ◽  
Dennis D Weisenburger ◽  
Julie M. Vose ◽  
Matt J. Moehr ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Rural Areas ◽  
Urban Areas ◽  
Population Based ◽  
Place Of Residence ◽  
Community Based ◽  
Risk Levels ◽  
Risk Of Death ◽  
Risk Patients

Abstract Objectives: We evaluated the association of the primary area of residence (urban vs. rural) and treatment (trt) provider (university-based vs. community-based) with overall survival in patients with lymphoma, and determined if there are patient subgroups that could benefit from better coordination of care. Methods: We performed a population-based study in 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states reported to the Nebraska Lymphoma Study Group between 1982 and 2006. Patient residential ZIP codes at the time to trt were used to determine rural/urban designation, household income and distance to trt center; while trt providers were categorized into university-based or community based. Multivariate analyses were used to group patients into risk levels based on 8 factors found to be associated with survival at the time of trt (age, performance score, Ann Arbor stage, presence of B symptoms, LDH levels, tumor bulk, nodal and extranodal involvement). The following categories were identified: low-risk (1–3 factors), intermediate risk (4–5 factors), and high-risk (≥6 factors). Cox proportional regression analyses, stratified by type of lymphoma (low-grade NHL, high-grade NHL and Hodgkin) were used to evaluate the association between place of residence and trt provider with overall survival. Results: Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB) and 861 (37%) were treated by community-based providers (RCB). Patients from rural areas were more likely to be older and Caucasian, with a lower median household income, greater travel distance to seek trt, and more likely to have high-risk disease when compared to patients from urban areas. In multivariate analysis, using all patients regardless of risk level, the relative risk of death (RR) among UUB, UCB and RUB was not statistically different. However, RCB had a higher risk of death RR 1.37, 95% CI 1.14–1.65, p=0.01; RR 1.18, 95% CI 1.04–1.33, p<0.01; and RR 1.26, 95% CI 1.06–1.49, p=0.01 when compared with UUB, UCB and RUB, respectively. This association remained true in both low- and intermediate-risk patients. Among high-risk patients, both RUB and RCB were at higher risk of death when compared with UUB or UCB, while UCB were not different from UUB. We found no differences in progression-free survival according to place of residence and trt provider. The use of stem cell transplantation was significantly higher in patients coming from urban and rural areas treated by university-based providers (UUB 19%, RUB 16%) compared to urban and rural patients treated by community-based providers (UCB 11%, RCB 10%, p < 0.01). Patients from rural areas (RUB and RCB) were slightly less likely to die from lymphoma-related causes than patients from urban areas (75% versus 80%, p=0.04). Conclusion: Overall survival in patients with lymphoma is inferior in patients coming from rural areas. This relationship varies according to treatment provider and pretreatment risk levels. Further studies in patients from rural areas are needed to understand how coordination of care is carried to design appropriate interventions that may improve the disparity noted.

Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: A population-based study

2006 ◽  
Vol 44 (1) ◽  
pp. 158-166 ◽  
Author(s):  
Hashem B. El-Serag ◽  
Abby B. Siegel ◽  
Jessica A. Davila ◽  
Yasser H. Shaib ◽  
Mikele Cayton-Woody ◽  
...  
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
The United States ◽  
Population Based ◽  
Population Based Study

scholarly journals Cancer incidence and mortality in the municipality of Pasto, 1998 – 2007

2012 ◽  
pp. 256-266 ◽  
Author(s):  
Maria Clara Yepez ◽  
Luis Eduardo Bravo ◽  
Arsenio Hidalgo Troya ◽  
Daniel Marcelo Jurado ◽  
Luisa Mercedes Bravo
Keyword(s):  
Cancer Incidence ◽  
Cancer Mortality ◽  
Urban Areas ◽  
Population Level ◽  
Cancer Registries ◽  
Population Based ◽  
Mortality Data ◽  
Major Health Problem ◽  
Incidence And Mortality ◽  
Cancer Morbidity

Introduction: In Colombia, information on cancer morbidity at the population level is limited. Incidence es­timates for most regions are based on mortality data. To improve the validity of these estimates, it is necessary that other population-based cancer registries, as well as Cali, provide cancer risk information. Objective: To describe the incidence and cancer mortality in the municipality of Pasto within the 1998-2007 period. Methodology: The study population belongs to rural and urban areas of the municipality of Pasto. Collection, processing, and systematization of the data were performed according to internationally standardized parame­ters for population-based cancer registries. The cancer incidence and mortality rates were calculated by gender, age, and tumor site. Results: During the 1998-2007 period 4,986 new cases of cancer were recorded of which 57.7% were in female. 2,503 deaths were presented, 52% in female. Neoplasm-associated infections are the leading cause of cancer morbidity in Pasto: stomach cancer in males and cervical cancer in females. Discussion: Cancer in general is a major health problem for the population of the municipality of Pasto. The overall behavior of the increasing incidence and cancer mortality in relation to other causes of death show the need to implement and strengthen prevention and promotion programs, focusing especially on tumors that produce greater morbidity and mortality in the population.

scholarly journals Higher Hospitalization and Mortality Rates Among SARS-CoV-2 infected Persons in Rural America

2021 ◽  
Author(s):  
Alfred Jerrod Anzalone ◽  
Ronald Horswell ◽  
Brian Hendricks ◽  
San Chu ◽  
William Hillegass ◽  
...  
Keyword(s):  
Rural Communities ◽  
Urban Areas ◽  
The United States ◽  
Hospitalized Patients ◽  
Rural America ◽  
Inpatient Mortality ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
All Cause Mortality ◽  
Hospital Systems

IMPORTANCE: Rural communities are among the most underserved and resource-scarce populations in the United States (US), yet there are limited data on COVID-19 mortality in rural America. Furthermore, rural data are rarely centralized, precluding comparability across urban and rural regions. OBJECTIVE: The purpose of this study is to assess hospitalization rates and all-cause inpatient mortality among persons with definitive COVID-19 diagnoses residing in rural and urban areas. DESIGN, SETTINGS, AND PARTICIPANTS: This retrospective cohort study from the National COVID Cohort Collaborative (N3C) examines a cohort of 573,018 patients from 27 US hospital systems presenting with SARS-CoV-2 infection between January 2020 and March 2021, of whom 117,897 were hospitalized. A sample of 450,725 hospitalized persons without COVID-19 diagnoses was identified for comparison. EXPOSURES: ZIP Codes provided by source hospital systems were classified by urban-rural gradient through a crosswalk to the US Department of Agriculture Rural-Urban Commuting Area Codes. MAIN OUTCOMES AND MEASURES: Primary outcomes were hospitalization and all-cause mortality among hospitalized patients. Kaplan-Meier analysis and mixed effects logistic regression were used to estimate 30-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient mortality while controlling for major risk factors. RESULTS: Rural patients were more likely to be older, white, have higher body mass index, and diagnosed with SARS-CoV-2 later in the pandemic compared with their urban counterparts. Rural compared with urban inhabitants had higher rates of hospitalization (23% vs. 19%) and all-cause mortality among hospitalized patients (16% vs. 11%). After adjustment for demographic and baseline differences, rural residents (both urban adjacent and non-adjacent) with COVID-19 were more likely to be hospitalized (Adjusted Odds Ratio (AOR) 1.41, 95% Confidence Interval (CI), 1.37-1.45 and AOR 1.42, CI 1.35-1.50) and to die or be transferred to hospice (AOR 1.62, CI 1.30-1.49 and 1.38, CI 1.30-1.49), respectively. Similar differences in mortality were noted for hospitalized patients without SARS-CoV-2 infection. CONCLUSIONS: Hospitalization and inpatient mortality are higher among rural compared with urban persons with COVID-19, even after adjusting for several factors, including age and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

Sign in / Sign up

Export Citation Format

Share Document