Demographic Disparities in Proximity to Certified Stroke Care in the United States

Background and Purpose: Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics. Methods: This cross-sectional study included population data by census tract from the United States Census Bureau’s 2014–2018 American Community Survey, stroke hospitals certified by a state or national body and providing intravenous thrombolysis, and geographic data from a public mapping service. Data were retrieved from March to November 2020. Quantile regression analysis was used to compare relationships between road distance to the nearest stroke center for each census tract and tract-level demographics of age, race, ethnicity, medical insurance status, median annual income, and population density. Results: Two thousand three hundred eighty-eight stroke centers and 71 929 census tracts including 316 995 649 individuals were included. Forty-nine thousand nine hundred eighteen (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in nonurban areas than urban areas. Higher representation of individuals with age ≥65 years was associated with increased median distance to a certified stroke center in nonurban areas (0.51 km per 1% increase [99.9% CI, 0.42–0.59]) but not in urban areas (0.00 km [−0.01 to 0.01]). In urban and nonurban tracts, median distance was greater with higher representation of American Indian (urban: 0.10 km per 1% increase [0.06–0.14]; nonurban: 1.06 km [0.98–1.13]) or uninsured populations (0.02 km [0.00–0.03]; 0.27 km [0.15–0.38]). Each $10 000 increase in median income was associated with a decrease in median distance of 5.04 km [4.31–5.78] in nonurban tracts, and an increase of 0.17 km [0.10–0.23] in urban tracts. Conclusions: Disparities were greater in nonurban areas than in urban areas. Nonurban census tracts with greater representation of elderly, American Indian, or uninsured people, or low median income were substantially more distant from certified stroke care.

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Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000121 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Evan Kolesnick ◽

Alfredo Munoz ◽

Kaiz Asif ◽

Santiago Ortega‐Gutierrez ◽

...

Keyword(s):

United States ◽

Acute Stroke ◽

Clinical Outcomes ◽

Healthcare Disparities ◽

Systems Of Care ◽

Stroke Care ◽

The United States ◽

Time Dependent ◽

Stroke Systems Of Care ◽

Stroke Center

Introduction : Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods : Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results : Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions : Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States.

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An Examination of Geographic Differences in Social Determinants of Health Among Women with Diagnosed HIV in the United States and Puerto Rico, 2017

The Open AIDS Journal ◽

10.2174/1874613602115010010 ◽

2021 ◽

Vol 15 (1) ◽

pp. 10-20

Author(s):

Ndidi Nwangwu-Ike ◽

Chan Jin ◽

Zanetta Gant ◽

Shacara Johnson ◽

Alexandra B. Balaji

Keyword(s):

United States ◽

Puerto Rico ◽

Health Insurance ◽

Social Determinants ◽

Census Tract ◽

The United States ◽

Adult Women ◽

Hiv Diagnosis ◽

Census Tracts ◽

Census Tract Level

Objective: To examine differences, at the census tract level, in the distribution of human immunodeficiency virus (HIV) diagnoses and social determinants of health (SDH) among women with diagnosed HIV in 2017 in the United States and Puerto Rico. Background: In the United States, HIV continues to disproportionately affect women, especially minority women and women in the South. Methods: Data reported in the National HIV Surveillance System (NHSS) of the Centers for Disease Control and Prevention were used to determine census tract-level HIV diagnosis rates and percentages among adult women (aged ≥18 years) in 2017. Data from the American Community Survey were combined with NHSS data to examine regional differences in federal poverty status, education level, income level, employment status, and health insurance coverage among adult women with diagnosed HIV infection in the United States and Puerto Rico. Results: In the United States and Puerto Rico, among 6,054 women who received an HIV diagnosis in 2017, the highest rates of HIV diagnoses generally were among those who lived in census tracts where the median household income was less than $40,000; at least 19% lived below the federal poverty level, at least 18% had less than a high school diploma, and at least 16% were without health insurance. Conclusion: This study is the first of its kind and gives insight into how subpopulations of women are affected differently by the likelihood of an HIV diagnosis. The findings show that rates of HIV diagnosis were highest among women who lived in census tracts having the lowest income and least health coverage.

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American Indian placenames in the United States

Onoma ◽

10.2143/ono.38.0.2002551 ◽

2003 ◽

Vol 38 (0) ◽

pp. 15-37

Author(s):

William BRIGHT

Keyword(s):

United States ◽

American Indian ◽

The United States

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Examining Disparities in Food Access Between Historically Black Colleges and Universities and Non-Historically Black Colleges and Universities

American Journal of Health Promotion ◽

10.1177/08901171211024412 ◽

2021 ◽

pp. 089011712110244

Author(s):

Mariah Kornbluh ◽

Shirelle Hallum ◽

Marilyn Wende ◽

Joseph Ray ◽

Zachary Herrnstadt ◽

...

Keyword(s):

United States ◽

Historically Black ◽

Food Access ◽

The United States ◽

Black Colleges ◽

Colleges And Universities ◽

Historically Black Colleges ◽

Census Tracts ◽

Neighborhood Socioeconomic Status ◽

Black Colleges And Universities

Purpose: Examine if Historically Black Colleges and Universities (HBCUs) are more likely to be located in low food access area (LFA) census tracts compared to public non-HBCUs. Design: ArcGIS Pro was utilized to capture food environments and census tract sociodemographic data. Setting: The sample included 98 HBCUs and 777 public non-HBCUs within the United States. 28.9% of study census tracts were classified as LFA tracts. Measures: University data were gathered from the National Center for Education Statistics. Census tract-level LFA classification was informed by the United States Department of Agriculture’s Food Access Research Atlas. Covariates included population density and neighborhood socioeconomic status of census tracts containing subject universities. Analysis: Multilevel logistic regression was employed to examine the relationship between university type and LFA classification. Results: A higher percentage of HBCUs (46.9%) than public non-HBCUs (26.6%) were located in LFAs. After adjusting for population density and neighborhood socioeconomic status, university type was significantly associated with food access classification (B=0.71;p=.0036). The odds of an HBCU being located in LFA tracts were 104% greater than for a public non-HBCU (OR=2.04;95% CI=1.26,3.29). Conclusion: Findings underscore the need for policy interventions tailored to HBCU students to promote food security, environmental justice, and public health.

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A Confluence of Policy Inequality: Health Disparities in Old Age Among American Indian and Alaska Native Populations

Innovation in Aging ◽

10.1093/geroni/igaa057.120 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 37-37

Author(s):

Sadie Giles

Keyword(s):

United States ◽

Health Disparities ◽

Life Course ◽

American Indian ◽

Old Age ◽

Alaska Native ◽

Political History ◽

The United States ◽

The Political ◽

The Life Course

Abstract Racial health disparities in old age are well established, and new conceptualizations and methodologies continue to advance our understanding of health inequality across the life course. One group that is overlooked in many of these analyses, however, is the aging American Indian/Native Alaskan (AI/NA) population. While scholars have attended to the unique health inequities faced by the AI/NA population as a whole due to its discordant political history with the US government, little attention has been paid to unique patterns of disparity that might exist in old age. I propose to draw critical gerontology into the conversation in order to establish a framework through which we can uncover barriers to health, both from the political context of the AI/NA people as well as the political history of old age policy in the United States. Health disparities in old age are often described through a cumulative (dis)advantage framework that offers the benefit of appreciating that different groups enter old age with different resources and health statuses as a result of cumulative inequalities across the life course. Adding a framework of age relations, appreciating age as a system of inequality where people also gain or lose access to resources and status upon entering old age offers a path for understanding the intersection of race and old age. This paper will show how policy history for this group in particular as well as old age policy in the United States all create a unique and unequal circumstance for the aging AI/NA population.

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Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063315 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3315

Author(s):

Leah H. Schinasi ◽

Helen V. S. Cole ◽

Jana A. Hirsch ◽

Ghassan B. Hamra ◽

Pedro Gullon ◽

...

Keyword(s):

United States ◽

Census Tract ◽

Household Income ◽

The United States ◽

Effect Modification ◽

Ethnic Composition ◽

Housing Cost ◽

Census Tract Level ◽

Specific Distribution ◽

Meta Analyses

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.

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Identification of Potential Freight Parking Locations in Urban Areas

Transportation Research Record Journal of the Transportation Research Board ◽

10.1177/03611981211013027 ◽

2021 ◽

pp. 036119812110130

Author(s):

Glenn Vorhes ◽

Ernest Perry ◽

Soyoung Ahn

Keyword(s):

United States ◽

Information System ◽

Satellite Imagery ◽

Urban Areas ◽

The United States ◽

Truck Drivers ◽

Short List ◽

Automated Processes ◽

Parking Facilities ◽

Urban Sites

Truck parking is a crucial element of the United States’ transportation system as it provides truckers with safe places to rest and stage for deliveries. Demand for truck parking spaces exceeds supply and shortages are especially common in and around urban areas. Freight operations are negatively affected as truck drivers are unable to park in logistically ideal locations. Drivers may resort to unsafe practices such as parking on ramps or in abandoned lots. This report seeks to examine the potential parking availability of vacant urban parcels by establishing a methodology to identify parcels and examining whether the identified parcels are suitable for truck parking. Previous research has demonstrated that affordable, accessible parcels are available to accommodate truck parking. When used in conjunction with other policies, adaptation of urban sites could help reduce the severity of truck parking shortages. Geographic information system parcel and roadway data were obtained for one urban area in each of the 10 Mid America Association of Transportation Officials region states. Area and proximity filters were applied followed by spectral analysis of satellite imagery to identify candidate parcels for truck parking facilities within urban areas. The automated processes created a ranked short list of potential parcels from which those best suited for truck parking could be efficiently identified for inspection by satellite imagery. This process resulted in a manageable number of parcels to be evaluated further by local knowledge metrics such as availability and cost, existing infrastructure and municipal connections, and safety.

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