Abstract P142: The Impact of Regional Socioeconomic Status on Stroke Center Certification in the Northeastern United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emily Chapman ◽  
Kurt Yaeger ◽  
J D Mocco
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Household Income ◽  
Stroke Care ◽  
Median Household Income ◽  
Northeastern United States ◽  
Stroke Incidence ◽  
The Impact ◽  
The Relationship ◽  
The U.S

Introduction: The northeastern United States has been a national leader in stroke healthcare delivery. The current roster of designated comprehensive, primary, thrombectomy-capable and acute stroke ready centers is the result of respective state initiatives. Access to certified stroke centers (SCs) varies by county as states have widely varied certification processes and typically rely on certifying organizations (COs) to identify stroke centers. Previous research has found an association at the national level between likelihood of stroke certification and local socioeconomic status. Objective: This study describes the relationship between socioeconomic status of patient populations in the Northeast U.S. and their access to quality stroke care by comparing median household income and wealth in counties with and without certified SCs. Methods: Population and median household income for 218 counties in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont were collected from the U.S. Census (2010), stroke epidemiological data were collected from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within the U.S.) were collected from the Neighborhood Atlas, a project that quantifies disadvantage. Median household income has been used to quantify local population wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs, and yielded 259 certified centers. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality. Results: Higher income (p<0.001) and lower ADI (p<0.001) were associated with having more certified SCs (p<0.001). Counties with a higher stroke incidence had significantly more certified SCs (p=0.01). Conclusions: Throughout the counties of the Northeastern U.S., access to quality stroke care depends on local wealth and resources. At the same time, the current analysis indicates that SC certification distribution does appear to correlate to those counties where stroke incidence is highest.

Abstract 20: Patterns of Stroke Center Certification and the Impact on Stroke Mortality in Counties of New York State

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emily Chapman ◽  
Kurt A Yaeger ◽  
J D Mocco
Keyword(s):  
New York ◽  
Socioeconomic Status ◽  
Household Income ◽  
New York State ◽  
Stroke Care ◽  
Stroke Mortality ◽  
Median Household Income ◽  
Stroke Incidence ◽  
York State ◽  
The Relationship

Introduction: To establish a statewide stroke system in March 2019, New York State (NYS) created the Stroke Designation Program. Stroke centers (SCs) must be certified by a state-approved certifying organization (CO), which is tasked with initial designation and ongoing re-certification. Previous research has found an association at the national level between socioeconomic status and access to higher levels of acute stroke care. Objective: This study characterizes the relationship between socioeconomic status of NYS populations and stroke care level access by comparing median household income and wealth in counties with and without certified SCs. Methods: Population and median household income from the U.S. Census (2010), stroke epidemiological data from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within NYS) from the Neighborhood Atlas, a project that quantifies disadvantage by census tract, were collected and averaged for each county. Income has been used to assess local wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs. Student’s t-tests compared income and ADI in counties with at least one certified SC to those without. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality. Results: All 62 counties in NYS were investigated to yield 40 certified SCs. Counties with at least one certified SC had a significantly higher income ($68,183.63 vs. $57,155.12; p=0.03) and lower ADI (5.90 vs. 7.37; p=0.004) compared to counties with no certified SC. Higher income (p<0.001) and lower ADI (p<0.001) were also associated with more certified SCs. Counties with fewer certified SCs had significantly higher stroke mortality (p<0.001) despite having similar stroke incidence. Conclusion: Socioeconomic heterogeneity in NYS counties is correlated to differential access to certified SCs and quality stroke care, as fewer centers are found in lower-income and disadvantaged communities. Although populations with less access experience stroke at similar rates, this study finds higher death rates in these counties.

Neighborhood Socioeconomic Status and Stroke Incidence: A Systematic Review

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011892
Author(s):  
Yeonwoo Kim ◽  
Erica Twardzik ◽  
Suzanne E. Judd ◽  
Natalie Colabianchi
Keyword(s):  
United States ◽  
Systematic Review ◽  
Socioeconomic Status ◽  
Stroke Risk ◽  
Keyword Search ◽  
The United States ◽  
Stroke Incidence ◽  
Neighborhood Socioeconomic Status ◽  
Modifiable Factors ◽  
The Impact

ObjectiveTo summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on incidence stroke and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and incident stroke, independent of individual socioeconomic status (SES).MethodsFour electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the three broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and incident stroke as an outcome). We coded study methodology and findings across the eight studies.ResultsThe results provide evidence for the overall nSES and incident stroke association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-incident stroke association stratified by race. We found evidence for the mediating role of biological factors in the nSES-incident stroke association.ConclusionsHigher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics, neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the nSES and incident stroke association, which could serve as intervention points.

scholarly journals Neighbourhood characteristics and health outcomes: evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City

2017 ◽  
Vol 27 (e1) ◽  
pp. e19-e24 ◽  
Author(s):  
Panagis Galiatsatos ◽  
Cynthia Kineza ◽  
Seungyoun Hwang ◽  
Juliana Pietri ◽  
Emily Brigham ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Low Income ◽  
Household Income ◽  
Spatial Regression ◽  
Median Household Income ◽  
Baltimore City ◽  
Education Status ◽  
The Relationship

IntroductionSeveral studies suggest that the health of an individual is influenced by the socioeconomic status (SES) of the community in which he or she lives. This analysis seeks to understand the relationship between SES, tobacco store density and health outcomes at the neighbourhood level in a large urban community.MethodsData from the 55 neighbourhoods of Baltimore City were reviewed and parametric tests compared demographics and health outcomes for low-income and high-income neighbourhoods, defined by the 50th percentile in median household income. Summary statistics are expressed as median. Tobacco store density was evaluated as both an outcome and a predictor. Association between tobacco store densities and health outcomes was determined using Moran’s I and spatial regression analyses to account for autocorrelation.ResultsCompared with higher-income neighbourhoods, lower-income neighbourhoods had higher tobacco store densities (30.5 vs 16.5 stores per 10 000 persons, P=0.01), lower life expectancy (68.5 vs 74.9 years, P<0.001) and higher age-adjusted mortality (130.8 vs 102.1 deaths per 10 000 persons, P<0.001), even when controlling for other store densities, median household income, race, education status and age of residents.ConclusionIn Baltimore City, median household income is inversely associated with tobacco store density, indicating poorer neighbourhoods in Baltimore City have greater accessibility to tobacco. Additionally, tobacco store density was linked to lower life expectancy, which underscores the necessity for interventions to reduce tobacco store densities.

Development of Hydrologic Concepts in the Northeastern United States

1983 ◽  
Vol 2 (2) ◽  
pp. 165-168
Author(s):  
Martina Johnson
Keyword(s):  
United States ◽  
Analytical Techniques ◽  
The United States ◽  
Northeastern United States ◽  
Mineral Springs ◽  
Erie Canal ◽  
Therapeutic Benefits ◽  
The Impact ◽  
The Relationship

Significant contributions to hydrogeology from the Northeastern United States have resulted from studies of natural phenomena, the occurrence of mineral springs, and two man-made events - the drilling in 1824 of the first fresh water well in the U.S., and the building of the Erie Canal. Development of chemical analytical techniques was prompted by interest in the therapeutic benefits of Saratoga and similar mineral springs, which were used as spas and sources of bottled water. The fundamental concept that the chemical character of ground water is controlled by lithology and by source and movement of water evolved from efforts to explain the origin and chemical differences of springs that were believed to have different medicinal benefits. The first drilled well, at the mouth of the Raritan River, led to the study of saltwater encroachment in the United States. The concept that explains the relationship between freshwater head and the position of the saltwater interface was developed to explain the ebbing and flowing of the well. Although the early hydrologic work was undertaken primarily by chemists and engineers, it was largely the challenge of understanding the position and movement of the saltwater interface that required the talents of geologists from whose studies evolved fundamental hydrogeologic concepts. Even now, evaluation of the role of the zone of dispersion in diagenesis, ore deposition, and geomorphic processes is at the forefront of hydrogeologic research. The building of the Erie Canal demonstrated the delicate ecologic balance of water systems and the need to anticipate the impact of man-made structures on this balance. Hydrologic engineering was advanced during its construction owing to the challenge of controlling the volume of water as well as its depth and velocity.

The Impact of Socioeconomic Status on Voice Outcomes in Patients With Spasmodic Dysphonia Treated With Botulinum Toxin Injections

2019 ◽  
Vol 128 (4) ◽  
pp. 316-322 ◽  
Author(s):  
Dianne Valenzuela ◽  
Joel Singer ◽  
Terry Lee ◽  
Amanda Hu
Keyword(s):  
Socioeconomic Status ◽  
Botulinum Toxin ◽  
Household Income ◽  
Spasmodic Dysphonia ◽  
Median Household Income ◽  
Botulinum Toxin Injections ◽  
The Impact ◽  
The Voice ◽  
Professional Voice ◽  
Validated Instrument

Objectives: To determine the impact of socioeconomic status (SES) on voice outcomes for spasmodic dysphonia (SD) patients treated with botulinum toxin injections. Methods: This was a prospective cross-sectional study in a tertiary care, academic voice clinic in Canada. Adult SD patients returning to the voice clinic for their botulinum toxin injections were recruited from October 2017 to April 2018. Patients completed a questionnaire on demographic data, the Hollingshead Four-Factor Index for socioeconomic status (validated instrument based on education, occupation, gender, and marital status), and the Voice-Handicap Index 10 (VHI-10) (validated instrument on self-reported vocal handicap). Primary outcome was the association between VHI-10 and Hollingshead Index. Secondary variables were median household income by postal code, duration of disease, gender, age, and professional voice user. Descriptive statistics and multiple linear regression were conducted. Results: One hundred and one patients (age = 62.8 ± 13.7 years, 20.8% male) were recruited with VHI-10 of 22.1 ± 8.1 (out of 40) and Hollingshead Index of 46.3 ± 11.7 (range, 8-66). Median household income was $75 875 ± $16 393, which was above the Canadian average of $70 336. About 91.1% were Caucasian, 54.4% had university degree, 86.1% spoke English, and 43.5% were employed. In multiple linear regression, there was mild to moderate negative correlation (r = −.292, P = .004) between VHI-10 and Hollingshead Index when controlling for disease duration, age, gender, and professional voice use. Conclusion: SD patients treated with botulinum toxin were mostly affluent, Caucasian, well educated, and English speakers. Lower self-perceived vocal handicap was associated with higher socioeconomic status.

scholarly journals Influence of socio-economic, demographic and climate factors on the regional distribution of dengue in the United States and Mexico

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Matthew J. Watts ◽  
Panagiota Kotsila ◽  
P. Graham Mortyn ◽  
Victor Sarto i Monteys ◽  
Cesira Urzi Brancati
Keyword(s):  
United States ◽  
Household Income ◽  
Local Level ◽  
Demographic Factors ◽  
The United States ◽  
Regional Level ◽  
Ageing Population ◽  
Life Expectancy At Birth ◽  
The Impact ◽  
The Relationship

Abstract Background This study examines the impact of climate, socio-economic and demographic factors on the incidence of dengue in regions of the United States and Mexico. We select factors shown to predict dengue at a local level and test whether the association can be generalized to the regional or state level. In addition, we assess how different indicators perform compared to per capita gross domestic product (GDP), an indicator that is commonly used to predict the future distribution of dengue. Methods A unique spatial-temporal dataset was created by collating information from a variety of data sources to perform empirical analyses at the regional level. Relevant regions for the analysis were selected based on their receptivity and vulnerability to dengue. A conceptual framework was elaborated to guide variable selection. The relationship between the incidence of dengue and the climate, socio-economic and demographic factors was modelled via a Generalized Additive Model (GAM), which also accounted for the spatial and temporal auto-correlation. Results The socio-economic indicator (representing household income, education of the labour force, life expectancy at birth, and housing overcrowding), as well as more extensive access to broadband are associated with a drop in the incidence of dengue; by contrast, population growth and inter-regional migration are associated with higher incidence, after taking climate into account. An ageing population is also a predictor of higher incidence, but the relationship is concave and flattens at high rates. The rate of active physicians is associated with higher incidence, most likely because of more accurate reporting. If focusing on Mexico only, results remain broadly similar, however, workforce education was a better predictor of a drop in the incidence of dengue than household income. Conclusions Two lessons can be drawn from this study: first, while higher GDP is generally associated with a drop in the incidence of dengue, a more granular analysis reveals that the crucial factors are a rise in education (with fewer jobs in the primary sector) and better access to information or technological infrastructure. Secondly, factors that were shown to have an impact of dengue at the local level are also good predictors at the regional level. These indices may help us better understand factors responsible for the global distribution of dengue and also, given a warming climate, may help us to better predict vulnerable populations on a larger scale.

Decentralized Administration

2018 ◽  
Author(s):  
Craig Arceneaux
Keyword(s):  
United States ◽  
The United States ◽  
Institutional Setting ◽  
General Survey ◽  
National Perspective ◽  
The Impact ◽  
The Relationship ◽  
The U.S ◽  
Cross National ◽  
Laws And Regulations

Chapter 9 explores the diversity of electoral practices, laws, and regulations across 50 U.S. states and thousands of localities. The chapter starts by laying out guidelines for assessing how federalism affects electoral integrity, both in cross-national perspective and in the U.S. case. The argument itself is rather simple: the impact of federalism varies because federalism itself can be designed in many different ways and because the impact of these arrangements is also affected by the broader institutional setting. Though simple, the consequences of the argument are more complex: federalism does indeed weigh upon electoral integrity, but its significance must be appreciated in the context of the country under consideration. The chapter offers a general survey on the relationship between federalism and electoral integrity and draws evidence from selected cases of federalism in the Americas—specifically from Canada, Mexico, and Brazil—for comparison with the United States.

Educational Attainment and Suicide Rates in the United States

2005 ◽  
Vol 97 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Ernest L. Abel ◽  
Michael L. Kruger
Keyword(s):  
Higher Education ◽  
United States ◽  
Educational Attainment ◽  
Suicide Rate ◽  
Household Income ◽  
College Graduates ◽  
The United States ◽  
Median Household Income ◽  
Suicide Rates ◽  
The Relationship

We examined the relationship between educational attainment and suicide rate in the United States for 2001. Suicide rates, adjusted for age, were compared with percentage of college graduates, median household income, and poverty in 50 states in 2001. The correlations of suicide rates with educational attainment and median household income were both negative and statistically significant. Poverty was not significantly related to suicide rates. We concluded that higher education and income were associated with a decrease in suicide rates in 2001. Data from other years require examination for this conclusion to be generalizable.

Impact of Domain Size on Modeled Ozone Forecast for the Northeastern United States

2008 ◽  
Vol 47 (2) ◽  
pp. 443-461 ◽  
Author(s):  
Pius Lee ◽  
Daiwen Kang ◽  
Jeff McQueen ◽  
Marina Tsidulko ◽  
Mary Hart ◽  
...  
Keyword(s):  
United States ◽  
Air Quality ◽  
The United States ◽  
Skill Score ◽  
Northeastern United States ◽  
Forecast System ◽  
Air Quality Forecast ◽  
Model Domain ◽  
The Impact ◽  
The U.S

Abstract This study investigates the impact of model domain extent and the specification of lateral boundary conditions on the forecast quality of air pollution constituents in a specific region of interest. A developmental version of the national Air Quality Forecast System (AQFS) has been used in this study. The AQFS is based on the NWS/NCEP Eta Model (recently renamed the North American Mesoscale Model) coupled with the U.S. Environmental Protection Agency Community Multiscale Air Quality (CMAQ) model. This coupled Eta–CMAQ modeling system provided experimental air quality forecasts for the northeastern region of the United States during the summers of 2003 and 2004. The initial forecast over the northeastern United States was approved for operational deployment in September 2004. The AQFS will provide forecast coverage for the entire United States in the near future. In a continuing program of phased development to extend the geographical coverage of the forecast, the developmental version of AQFS has undergone two domain expansions. Hereinafter, this “developmental” domain-expanded forecast system AQFS will be dubbed AQFS-β. The current study evaluates the performance of AQFS-β for the northeastern United States using three domain sizes. Quantitative comparisons of forecast results with compiled observation data from the U.S. Aerometric Information Retrieval Now (AIRNOW) network were performed for each model domain, and interdomain comparisons were made for the regions of overlap. Several forecast skill score measures have been employed. Based on the categorical statistical metric of the critical success index, the largest domain achieved the highest skill score. This conclusion should catapult the implementation of the largest domain to attain the best forecast performance whenever the operational resource and criteria permit.

THE INFLUENCE OF SCOTTISH ACCOUNTANTS IN THE UNITED STATES: THE EARLY CASE OF THE SOCIETY OF ACCOUNTANTS IN EDINBURGH

1997 ◽  
Vol 24 (1) ◽  
pp. 117-141 ◽  
Author(s):  
T. A. LEE
Keyword(s):  
United States ◽  
General Theory ◽  
Research Program ◽  
The United States ◽  
The World ◽  
Early Case ◽  
The Impact ◽  
Chartered Accountants ◽  
The U.S

This study represents part of a long-term research program to investigate the influence of U.K. accountants on the development of professional accountancy in other parts of the world. It examines the impact of a small group of Scottish chartered accountants who emigrated to the U.S. in the late 1800s and early 1900s. Set against a general theory of emigration, the study's main results reveal the significant involvement of this group in the founding and development of U.S. accountancy. The influence is predominantly with respect to public accountancy and its main institutional organizations. Several of the individuals achieved considerable eminence in U.S. public accountancy.

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