scholarly journals Rural-Urban Disparities in Place of Death in Hematologic Malignancies in the US from 2003 to 2019

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4137-4137
Author(s):  
Syed M. Qasim Hussaini ◽  
Arjun Gupta
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
Rural Areas ◽  
Hospice Care ◽  
Metropolitan Areas ◽  
Hematologic Malignancies ◽  
The United States ◽  
Medical Facility ◽  
Nursing Facility ◽  
The Us

Abstract Background: more than 60,000 people die annually from hematologic malignancies in the united states (us). Patients with hematologic malignancies more frequently receive aggressive care toward the end-of-life and are more likely to die in a hospital compared to those with a solid tumor. Appropriate care of such patients is very dependent on an existing healthcare infrastructure. There are notable challenges to rural healthcare in the united states which contains less than 1/5th of all hospices in the us. In this study, we sought to investigate rural-urban disparities in place of death the us in individuals that died from hematologic malignancies. Methods: we utilized the us centers for disease control and prevention wide-ranging online data for epidemiologic research database to analyze all deaths from hematologic malignancies in the us from 2003 to 2019. A population classification utilizing the 2013 us census was made using the national center for health statistics urban-rural classification scheme. These classifications included: large metropolitan area (1 million), small- or medium-sized metropolitan area (50 000-999 999), and rural area (<50 000). We estimated deaths in a medical facility, hospice, home, or nursing care facility. We stratified the results by age, sex, and race/ethnicity. The annual percentage change (apc) in deaths was estimated. All data was publicly available and de-identified. Findings: from 2003-2019, there were a total 1,088,589 deaths form hematologic malignancies in the united states, predominantly in large metropolitan areas (50.2%), followed by small or medium sized metropolitan areas (31.7%) and rural areas (18.2%). All regions noted decreases in medical facility and nursing facility related deaths, and increase in hospice and home deaths. While rural areas demonstrated the quickest uptake of hospice care (apc 61.5), they had the lowest overall presence of hospice care (8.3% of all rural deaths in 2019 vs. 14.9% for small or medium metropolitan vs. 12% for large metropolitan) and larger share of nursing facility related deaths (15.8% of all rural deaths in 2019 vs 12.3% for small or medium metropolitan vs 10.6% for large metropolitan). Discussion: we demonstrate end-of-life disparities in hematologic malignancies based on where an individual resides in the us with rural areas having notably lower share of deaths in hospice facilities. Older infrastructure, inadequate access to care, and financial barriers add to the medical complexity of care for all patients, and especially hematologic patients with high needs and complex treatment planning. These have been aggravated by rural hospital closures in the previous 18 months. The us senate is currently debating a bipartisan infrastructure that may add billions in building rural healthcare infrastructure to state budgets. Our findings are timely in helping inform congressional policy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Spatial Clustering of County-Level COVID-19 Rates in the U.S

2021 ◽  
Vol 18 (22) ◽  
pp. 12170
Author(s):  
Marcus R. Andrews ◽  
Kosuke Tamura ◽  
Janae N. Best ◽  
Joniqua N. Ceasar ◽  
Kaylin G. Battey ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Rural Areas ◽  
Metropolitan Areas ◽  
Spatial Clustering ◽  
The United States ◽  
County Level ◽  
Communities Of Color ◽  
States Data ◽  
The U.S

Despite the widespread prevalence of cases associated with the coronavirus disease 2019 (COVID-19) pandemic, little is known about the spatial clustering of COVID-19 in the United States. Data on COVID-19 cases were used to identify U.S. counties that have both high and low COVID-19 incident proportions and clusters. Our results suggest that there are a variety of sociodemographic variables that are associated with the severity of COVID-19 county-level incident proportions. As the pandemic evolved, communities of color were disproportionately impacted. Subsequently, it shifted from communities of color and metropolitan areas to rural areas in the U.S. Our final period showed limited differences in county characteristics, suggesting that COVID-19 infections were more widespread. The findings might address the systemic barriers and health disparities that may result in high incident proportions of COVID-19 clusters.

The Enduring Significance of Segregation

2018 ◽  
pp. 58-74
Author(s):  
Jason Q. Purnell
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Residential Segregation ◽  
Metropolitan Area ◽  
Metropolitan Areas ◽  
Well Being ◽  
The United States ◽  
Local Context ◽  
Geographic Concentration ◽  
Health And Well Being

Residential segregation remains a perennial problem in major metropolitan areas across the United States. Many researchers have focused on the effects of segregation on housing patterns, educational disparities, and the geographic concentration of poverty. This chapter explores how these and other results of residential segregation affect population health. Using as its backdrop the St. Louis, Missouri, metropolitan area—one of the most segregated metropolitan areas in the nation—this chapter reviews the scientific literature on segregation and health outcomes. It also discusses potential strategies for addressing segregation in this local context and nationally. Much of the local discussion draws on For the Sake of All, a landmark study on the health and well-being of African Americans in St. Louis. An analysis of the cultural, psychological, political, and practical barriers to integration is also presented.

scholarly journals Social Disadvantage, Politics, and Severe Acute Respiratory Syndrome Coronavirus 2 Trends: A County-level Analysis of United States Data

2020 ◽  
Author(s):  
Ahmad Mourad ◽  
Nicholas A Turner ◽  
Arthur W Baker ◽  
Nwora Lance Okeke ◽  
Shanti Narayanasamy ◽  
...  
Keyword(s):  
United States ◽  
Severe Acute Respiratory Syndrome ◽  
Metropolitan Areas ◽  
Belief Systems ◽  
The United States ◽  
Social Disadvantage ◽  
County Level ◽  
The Us ◽  
Black Residents ◽  
Social Demographic

Abstract Background Understanding the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for public health control efforts. Social, demographic, and political characteristics at the United States (US) county level might be associated with changes in SARS-CoV-2 case incidence. Methods We conducted a retrospective analysis of the relationship between the change in reported SARS-CoV-2 case counts at the US county level during 1 June–30 June 2020 and social, demographic, and political characteristics of the county. Results Of 3142 US counties, 1023 were included in the analysis: 678 (66.3%) had increasing and 345 (33.7%) nonincreasing SARS-CoV-2 case counts between 1 June and 30 June 2020. In bivariate analysis, counties with increasing case counts had a significantly higher Social Deprivation Index (median, 48 [interquartile range {IQR}, 24–72]) than counties with nonincreasing case counts (median, 40 [IQR, 19–66]; P = .009). Counties with increasing case counts were significantly more likely to be metropolitan areas of 250 000–1 million population (P < .001), to have a higher percentage of black residents (9% vs 6%; P = .013), and to have voted for the Republican presidential candidate in 2016 by a ≥10-point margin (P = .044). In the multivariable model, metropolitan areas of 250 000–1 million population, higher percentage of black residents, and a ≥10-point Republican victory were independently associated with increasing case counts. Conclusions Increasing case counts of SARS-CoV-2 in the US during June 2020 were associated with a combination of sociodemographic and political factors. Addressing social disadvantage and differential belief systems that may correspond with political alignment will play a critical role in pandemic control.

scholarly journals Flood exposure and social vulnerability in the United States

2021 ◽  
Author(s):  
Eric Tate ◽  
Md Asif Rahman ◽  
Christopher T. Emrich ◽  
Christopher C. Sampson
Keyword(s):  
United States ◽  
Rural Areas ◽  
Social Vulnerability ◽  
Spatial Association ◽  
The United States ◽  
Mitigation Strategies ◽  
Us South ◽  
Flood Exposure ◽  
The Us ◽  
High Flood

AbstractHuman exposure to floods continues to increase, driven by changes in hydrology and land use. Adverse impacts amplify for socially vulnerable populations, who disproportionately inhabit flood-prone areas. This study explores the geography of flood exposure and social vulnerability in the conterminous United States based on spatial analysis of fluvial and pluvial flood extent, land cover, and social vulnerability. Using bivariate Local Indicators of Spatial Association, we map hotspots where high flood exposure and high social vulnerability converge and identify dominant indicators of social vulnerability within these places. The hotspots, home to approximately 19 million people, occur predominantly in rural areas and across the US South. Mobile homes and racial minorities are most overrepresented in hotspots compared to elsewhere. The results identify priority locations where interventions can mitigate both physical and social aspects of flood vulnerability. The variables that most distinguish the clusters are used to develop an indicator set of social vulnerability to flood exposure. Understanding who is most exposed to floods and where, can be used to tailor mitigation strategies to target those most in need.

scholarly journals An Examination of the Employment Recovery in the United States in the Wake of the COVID-19 Pandemic

2021 ◽  
Vol 6 (4) ◽  
pp. 170-175
Author(s):  
David C. Wyld
Keyword(s):  
United States ◽  
Rural Areas ◽  
Metropolitan Areas ◽  
Recovery Period ◽  
The United States ◽  
Labor Statistics ◽  
Government Data ◽  
Urban And Rural Areas ◽  
Bureau Of Labor Statistics ◽  
The U.S

The “shock” of the onset of the COVID-19 pandemic set about wholesale changes across American life, impacting the way we socialized, shopped, and yes, worked. There were significant disruptions across the business landscape in the United States, accompanied by significant job losses, starting in March 2020. In this article, we examine the size and scope of the changes in employment that took place in the U.S. at the start of the COVID-19 pandemic and during the recovery period up through April 2021. Utilizing official government data from the Bureau of Labor Statistics, the author examines how the pandemic caused both widespread job losses and record-setting levels of unemployment but had differential effects across a variety of industries. Then, the author looks at the recovery period, examining the recovery in employment has been unequally distributed across the United States, with differentiations between both urban and rural areas and between metropolitan areas across the county. The article concludes with a look at what this means for the future of work and for management moving forward - hopefully - into the post-pandemic period.

scholarly journals Analyzing the Factors Affecting the COVID-19 Risk Level in the US Counties

2021 ◽  
Author(s):  
Samira Ziyadidegan ◽  
Moein Razavi ◽  
Homa Pesarakli ◽  
Amir Hossein Javid
Keyword(s):  
United States ◽  
Rural Areas ◽  
Pearson Correlation ◽  
The United States ◽  
Positive Case ◽  
Risk Level ◽  
Classification Models ◽  
Factors Affecting ◽  
The Us ◽  
Us Counties

The COVID-19 disease spreads swiftly, and nearly three months after the first positive case was confirmed in China, Coronavirus started to spread all over the United States. Some states and counties reported an extremely high number of positive cases and deaths, while some reported too few COVID-19 related cases and mortality. In this paper, the factors that could affect the transmission of COVID-19 and its risk level in different counties have been determined and analyzed. Using Pearson Correlation, K-means clustering, and several classification models, the most critical ones were determined. Results showed that mean temperature, percent of people below poverty, percent of adults with obesity, air pressure, percentage of rural areas, and percent of uninsured people in each county were the most significant and effective attributes.

scholarly journals The New Suburb: Multiethnic Racial Residential Integration in the United States

2019 ◽  
Author(s):  
Ankit Rastogi
Keyword(s):  
United States ◽  
Metropolitan Areas ◽  
Housing Stock ◽  
Leading Edge ◽  
The United States ◽  
Public University ◽  
The Us ◽  
American Society ◽  
Racial Lines ◽  
Residential Integration

This article examines the relatively widespread trend toward racial residential integration within suburbs in the 21st century across metropolitan areas in the United States. I investigate the racial and ethnic compositions of stably integrated communities as well as the characteristics that distinguish these places. Using the information theory index (H) among stably diverse places, I identify cities and suburbs that were racially integrated between 2000 and 2010. Integrated places cluster in highly diverse, coastal metropolitan areas and almost entirely within suburbs. Moreover, integration is firmly patterned along racial lines. Reflecting the antiblack nature of segregation in the US, the rate of black-white integration remains remarkably low (10.5%), but in multiethnic communities with Asians and Latinxs, the probability of black-white integration nearly quadruples (40.1%). Several critical features of place are positively associated with integration: military and public sector employment as well as public university enrollment; new housing stock; and metropolitan political fragmentation. This study shows that suburbs are at the leading edge of American diversification and integration and illuminates the existence of communities where American society transgresses persistent forms of racial discrimination.

The United States and the Iranian Nuclear Programme

2018 ◽  
Author(s):  
Steven Hurst
Keyword(s):  
United States ◽  
Decision Making ◽  
Domestic Politics ◽  
The United States ◽  
Nixon Administration ◽  
Comprehensive Plan ◽  
The Us ◽  
Nuclear Issue ◽  
The Relationship

The United States, Iran and the Bomb provides the first comprehensive analysis of the US-Iranian nuclear relationship from its origins through to the signing of the Joint Comprehensive Plan of Action (JCPOA) in 2015. Starting with the Nixon administration in the 1970s, it analyses the policies of successive US administrations toward the Iranian nuclear programme. Emphasizing the centrality of domestic politics to decision-making on both sides, it offers both an explanation of the evolution of the relationship and a critique of successive US administrations' efforts to halt the Iranian nuclear programme, with neither coercive measures nor inducements effectively applied. The book further argues that factional politics inside Iran played a crucial role in Iranian nuclear decision-making and that American policy tended to reinforce the position of Iranian hardliners and undermine that of those who were prepared to compromise on the nuclear issue. In the final chapter it demonstrates how President Obama's alterations to American strategy, accompanied by shifts in Iranian domestic politics, finally brought about the signing of the JCPOA in 2015.

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