The Difference in the Incidence and the Trend of Malignant Lymphomas in Japan and the United States.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2695-2695
Author(s):  
Dai Chihara ◽  
Hidemi Ito ◽  
Tomohiro Matsuda ◽  
Akiko Shibata ◽  
Tomotaka Sobue ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Hematologic Malignancies ◽  
The United States ◽  
Cumulative Exposure ◽  
Malignant Lymphomas ◽  
Annual Percent Change ◽  
Percent Change ◽  
Nodular Sclerosis ◽  
The Us ◽  
The Difference

Abstract Abstract 2695 Background: Malignant lymphomas (ML) are heterogeneous groups that the detailed classification is evolving dramatically. An incidence of malignant disease in certain population reflects cumulative exposure to environment, genetics and their combination overtime. Therefore, a comparison of incidences in various population and their secular trends is very helpful to understand etiology of disease. The aim of this study is to assess the incidence and the trend of each ML subtypes and to evaluate the difference between Japan and US. Materials and Methods: We used the data from a population-based cancer registry in Japan and from the Surveillance Epidemiology and End Results (SEER) program 9. Registry data of the US, SEER 9 included 95,155 cases and the data of Japan included 48,658 cases. The period covered in this analyses was 1993 to 2006 in Japan and 1993 to 2008 in the US. Rates of sex-specific, age-standardized incidence with 95% confidence intervals were estimated and standardized by age-adjustment according to the world standard population. We also estimated the annual percent change using joinpoint regression analysis and evaluated the significance of the trend. Results: The overall age-standardized incidence rate of all malignant lymphomas per 100,000 in 2006 was 22.4 for males and 16.0 for females in the US, 7.4 for males and 4.9 for females in Japan. The incidence is higher in the US than Japan with most of the subtypes especially for the nodular sclerosis HL, CLL/SLL and FL. In general, B-cell lymphomas showed large difference in incidence while T-cell lymphomas (TCL) showed similar incidence between Japan and the US. The total numbers of ML are constantly increasing in Japan but not in the US as shown in the figure {annual percent change (95%CI), Japan; +2.6% (2.1, 3.1), US; +0.2% (−0.0, 0.4)}. As for details, follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma and the total numbers of TCL are constantly increasing in both countries. Conclusion: In conclusion, we showed the marked difference in the incidence and the trend of hematologic malignancies between Japan and the US. The incidence of hematologic malignancies is lower in Japan than the US, but is increasing significantly. The most remarkable difference in the incidence was seen with nodular sclerosis HL, CLL/SLL and FL which was consistent with previous reports. Even with the TCL, the incidence seems to be similar to higher in the US except for the ATLL. The improvement in the quality of cancer registry systems and the organization of these registries between countries enables us to unite the data worldwide that will bring us new insights. Solid line and circle are the data of the US. Dashed line and hollow circle are the data of Japan. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Stroke‐Related Mortality in the United States–Mexico Border Area of the United States, 1999 to 2018

2021 ◽  
Author(s):  
Safi U. Khan ◽  
Ankur Kalra ◽  
Siva H. Yedlapati ◽  
Sourbha S. Dani ◽  
Michael D. Shapiro ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
The United States ◽  
Annual Percent Change ◽  
Border Area ◽  
Percent Change ◽  
The Us ◽  
Mexico Border ◽  
Related Mortality ◽  
Us Mexico Border

BACKGROUND The United States (US)‐Mexico border is a socioeconomically underserved area. We sought to investigate whether stroke‐related mortality varies between the US border and nonborder counties. METHODS AND RESULTS We used death certificates from the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database to examine stroke‐related mortality in border versus nonborder counties in California, Texas, New Mexico, and Arizona. We measured average annual percent changes (AAPCs) in age‐adjusted mortality rates (AAMRs) per 100 000 between 1999 and 2018. Overall, AAMRs were higher for nonborder counties, older adults, men, and non‐Hispanic Black adults than their counterparts. Between 1999 and 2018, AAMRs reduced from 55.8 per 100 000 to 34.4 per 100 000 in the border counties (AAPC, −2.70) and 64.5 per 100 000 to 37.6 per 100 000 in nonborder counties (AAPC, −2.92). The annual percent change in AAMR initially decreased, followed by stagnation in both border and nonborder counties since 2012. The AAPC in AAMR decreased in all 4 states; however, AAMR increased in California’s border counties since 2012 (annual percent change, 3.9). The annual percent change in AAMR decreased for older adults between 1999 and 2012 for the border (−5.10) and nonborder counties (−5.01), followed by a rise in border counties and stalling in nonborder counties. Although the AAPC in AAMR decreased for both sexes, the AAPC in AAMR differed significantly for non‐Hispanic White adults in border (−2.69) and nonborder counties (−2.86). The mortality decreased consistently for all other ethnicities/races in both border and nonborder counties. CONCLUSIONS Stroke‐related mortality varied between the border and nonborder counties. Given the substantial public health implications, targeted interventions aimed at vulnerable populations are required to improve stroke‐related outcomes in the US‐Mexico border area.

The Kurdish Civil War and Peace Negotiations, 1994–1998

2021 ◽  
pp. 002190962110624
Author(s):  
Dana Ali Salih ◽  
Hawre Hasan Hama
Keyword(s):  
Civil War ◽  
Democratic Party ◽  
The United States ◽  
War And Peace ◽  
Peace Agreement ◽  
Peace Negotiations ◽  
Contingency Model ◽  
The Us ◽  
The Difference ◽  
The Military

The Kurdish Civil War between the military forces of the Kurdistan Democratic Party (KDP) and the Patriotic Union of Kurdistan (PUK) began in 1994. Despite frequently occurring peace talks throughout the conflict, negotiations failed to bring about a durable settlement until the United States brokered the Washington Peace Agreement in 1998. This research explores why the earlier negotiations were unsuccessful, and whether it was only the US mediation in 1998 which made the difference. Although the US mediation was clearly an important factor, by employing the contingency model this research argues that both contextual variables and process variables determined the success of negotiations in 1998. Furthermore, they can explain the failure of the previous 4 years of negotiations.

scholarly journals Melanoma Incidence Among Non-Hispanic Whites in All 50 US States From 2001 Through 2015

2019 ◽  
Vol 112 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Aaron P Thrift ◽  
Franciska J Gudenkauf
Keyword(s):  
Incidence Rate ◽  
Birth Cohort ◽  
Sun Exposure ◽  
The United States ◽  
Incidence Rates ◽  
Birth Cohorts ◽  
Annual Percent Change ◽  
Incidence Trends ◽  
Percent Change ◽  
Melanoma Incidence

Abstract Background The United States has large regional variation in primary prevention campaigns for skin cancer. We collected data from all 50 states to examine changes in melanoma incidence and performed age-period-cohort analyses to describe the simultaneous effects of age, period, and cohort on incidence rates. Methods Annual melanoma incidence rates for non-Hispanic whites from 2001 to 2015 were extracted from the US Cancer Statistics registry. Secular trends were examined overall and by sex and state. We used joinpoint regression to compute annual percent change and average annual percent change and corresponding 95% confidence intervals (CIs). We also analyzed incidence trends by 5-year age group and birth cohort using incidence rate ratios and age-period-cohort modeling. Results Melanoma incidence increased from 20.7 per 100 000 (95% CI = 20.5 to 20.9) in 2001 to 28.2 per 100 000 (95% CI = 28.0 to 28.5) in 2015, increasing by 3.90% (95% CI = 2.36% to 5.48%) annually between 2001 and 2005 and 1.68% (95% CI = 1.37% to 1.99%) annually from 2005 through 2015. The average annual percent change in melanoma incidence rates were similar for men (2.34%, 95% CI = 1.91 to 2.78) and women (2.25%, 95% CI = 1.60 to 2.91). Age-specific relative risk by birth cohort increased from circa 1921 to 1981 before decreasing. Compared with adults born circa 1956, those born circa 1991 had lower melanoma risk (incidence rate ratio  = 0.85; 95% CI = 0.77 to 0.94). Geographic variation was observed; some states still have melanoma rates trending upwards in all birth cohorts. Conclusions The continued increase in melanoma incidence among non-Hispanic whites, particularly in states where rates continue to rise among recent and current birth cohorts, underscores the need for increased public health campaigns aimed at reducing sun exposure.

Neoliberal Redistributive Policy: The US Net Social Wage in the Early Twenty-First Century

2019 ◽  
Vol 51 (4) ◽  
pp. 581-605 ◽  
Author(s):  
Katherine A. Moos
Keyword(s):  
Social Reproduction ◽  
The United States ◽  
Jel Classification ◽  
First Century ◽  
Redistributive Policy ◽  
Early Twenty ◽  
The Us ◽  
Twenty First Century ◽  
The Difference ◽  
Social Wage

This paper estimates the net social wage—the difference between labor benefits and labor taxation—from 1959 to 2012 in the United States using two different methodologies. During this period the average NSW1/GDP and NSW2/GDP ratio are 1.3 and −3.8 percent, respectively. This paper finds a deviation in the net social wage data starting in 2002, suggesting greater redistribution to US workers in the early twenty-first century than in the twentieth century. This paper argues that the increase in the US net social wage in the early twenty-first century is being caused by a combination of cyclical, structural, and secular factors. US redistributive policy should be understood as stabilizing and subsidizing the social reproduction of labor. JEL Classification: H5, E62, B5

scholarly journals Dietary Sodium Intake and Sodium Density in the United States: Estimates From NHANES 2005–2006 and 2015–2016

2020 ◽  
Vol 33 (9) ◽  
pp. 825-830
Author(s):  
Jiun-Ruey Hu ◽  
Shivani Sahni ◽  
Kenneth J Mukamal ◽  
Courtney L Millar ◽  
Yingfei Wu ◽  
...  
Keyword(s):  
United States ◽  
Odds Ratio ◽  
Sodium Intake ◽  
The United States ◽  
Dietary Sodium ◽  
Health And Nutrition ◽  
Hispanic Adults ◽  
The Us ◽  
The Difference ◽  
Total Sodium

Abstract BACKGROUND In the United States, current guidelines recommend a total sodium intake <2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories. METHODS In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations (<2,300 mg/day) and corresponding sodium density intake (<1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005–2006 (n = 5,060) and 2015–2016 (n = 5,266) survey periods. RESULTS In 2005–2006, 23.1% (95% confidence interval [CI]: 21.5, 24.9) of the US population consumed <2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed <1.1 mg/kcal in sodium density. In 2015–2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015–2016, compared with 2005–2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P < 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults. CONCLUSIONS Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.

Incidence trends for human papillomavirus-related (HPV-R) and unrelated (HPV-U) head and neck squamous cell carcinomas (HNSCC) in the United States (US)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6001-6001 ◽  
Author(s):  
A. Chaturvedi ◽  
E. Engels ◽  
W. Anderson ◽  
M. Gillison
Keyword(s):  
The United States ◽  
Underlying Disease ◽  
Birth Cohorts ◽  
Anatomic Site ◽  
Annual Percent Change ◽  
Absolute Increase ◽  
Incidence Trends ◽  
The Us ◽  
Smoking Behaviors ◽  
Regional Disease

6001 Background: HNSCC are etiologically heterogeneous, with one subset primarily attributable to HPV and another to tobacco and alcohol. Methods: Data from SEER9 program registries were used to investigate the potential influence of HPV on incidence and survival of HNSCC in the US from 1973–2003. HNSCCs (N=58,158) were classified by anatomic site as potentially HPV-R (base of tongue; tonsil; oropharynx; N=16,712) or HPV-U (lip; tongue; gum; floor of mouth; palate; other mouth; hypopharynx; ill-defined sites of lip, oral cavity, and pharynx; N=41,446). Joinpoint regression was used to assess incidence trends and life-table methods were used to compare survival for HPV-R and HPV-U HNSCCs. Results: For HPV-R HNSCCs, age-adjusted incidence increased significantly from 1973–2003 (annual percent change [APC] = 0.65), particularly among males (APC=1.02), whites (APC=0.89), and younger ages (APCs for 30–39 = 1.46; 40- 49=1.92; 50–59=0.61, and =60= -0.66). By contrast, HPV-U HNSCC incidence was stable from 1973–1983 and then decreased significantly from 1983–2003 (APC= -2.42). Mean age at diagnosis was younger for HPV-R HNSCC than HPV-U (61.1 vs. 64.5 years; p<0.001), and from 1973- 2003, decreased significantly for HPV-R, but increased for HPV-U. Improvements in overall survival (OS) were observed for HPV-R (all stages) and HPV-U (regional and distant) HNSCC treated by radiotherapy (RT) from 1973–2003, but were more marked for HPV-R HNSCC, e.g. absolute increase in two-year OS for regional disease of 24.4% (vs. 5.8% for HPV-U). OS for HPV-R (local and regional) was significantly better than HPV-U HNSCC if treated by RT, but worse if not so treated. Conclusions: The proportion of HNSCC that is potentially HPV- R increased in the US from 1973–2003, particularly among recent birth cohorts, perhaps due to changing sexual and smoking behaviors. Recent improvements in locoregional control with RT-based therapy may be due in part to a gradual shift in the etiology of the underlying disease. No significant financial relationships to disclose.

Use of hospice services among Medicare beneficiaries with acute and chronic leukemias.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 68-68
Author(s):  
Thomas William LeBlanc ◽  
Adam J. Olszewski
Keyword(s):  
Quality Measures ◽  
Hematologic Malignancies ◽  
Time Of Death ◽  
Medicare Beneficiaries ◽  
Annual Percent Change ◽  
Percent Change ◽  
Binomial Regression ◽  
Hospice Use ◽  
Eol Care ◽  
Over Time

68 Background: Studies show lower rates of hospice use among patients (pts) with hematologic malignancies. Our objective was to describe trends in hospice use and in quality measures for end-of-life (EOL) care among Medicare beneficiaries with leukemias. Methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we selected pts with acute (myeloid or lymphoblastic) or chronic (lymphocytic, myeloid, or myelomonocytic) leukemias diagnosed in 1996-2011 who died in 2001-2011. We identified hospice enrollment at death, duration of hospice enrollment, inpatient deaths, intensive care unit (ICU) admissions within 30 days of death, and chemotherapy use in the last 14 days of life. We summarized linearized trends by year of death using log-binomial regression, reporting average annual percent change (APC). Results: Among 38,038 leukemia pts (41% acute, median age 78 years) 81% died, after median 2.8 months from diagnosis (95%CI, 2.7-2.9) for acute and 49.1 months (95%CI, 47.9-50.1) for chronic leukemias. Among pts who died in 2001-2011 ( N= 23,941), 42% were enrolled in hospice at the time of death. This proportion significantly increased between 2001 and 2011, from 33% to 48% (APC +4.1%, P< .001), both for acute and chronic leukemias ( Pinteraction= .25). Median time on hospice was 8 days, and the proportion of pts with < 3 days on hospice increased from 20% to 24% between 2001 and 2001 (APC +1.2%, P= .05). Inpatient deaths significantly decreased from 54% to 39%, respectively (APC -3.2%, P< .001), but ICU use at EOL increased from 34% to 41% (APC +2.4%, P< .001). Chemotherapy use at EOL was more frequent in acute (17%) than chronic (6%) leukemia, and decreased for both (overall from 15% to 10%, APC -3.2%, P< .001). Conclusions: The use of hospice services among older pts with leukemia has increased, suggesting its wider acceptance over time. However, the increasing proportion of brief, terminal hospice admissions, and increasing rate of ICU use at EOL reflect persistent barriers to early enrollment in this population. Some measures of aggressiveness of care (inpatient deaths, chemotherapy at EOL) are lower in the community than previously reported from academic centers (El-Jawahri, Cancer 2015).

scholarly journals Home hours in the United States and Europe

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Lei Fang ◽  
Cara McDaniel
Keyword(s):  
United States ◽  
Time Use ◽  
Time Allocation ◽  
The United States ◽  
European Countries ◽  
The Past ◽  
The Us ◽  
The Difference ◽  
Using Data

AbstractUsing data from the Multinational Time Use Study, this paper documents the trend and level of time allocation, with a focus on home hours, for the US and European countries. Three patterns emerge. First, home hours per person have declined in both the US and European countries over the past 50 years. Second, female time allocation contributes more to the difference in time allocation per person between the US and European countries than does male time allocation. Third, the time allocation between the US and European countries is more similar for prime-age individuals than for young and old individuals.

scholarly journals Imigran dan Warga Keturunan Jepang di Amerika Serikat: Sentimen-Sentimen Terhadapnya Dulu dan Kini

KIRYOKU ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 63-73
Author(s):  
Rifka Pratama
Keyword(s):  
United States ◽  
Physical Violence ◽  
The United States ◽  
Chinese Exclusion ◽  
Japanese Immigrants ◽  
The Us ◽  
Asian Descent ◽  
The Difference ◽  
Legal Policies ◽  
Exclusion Act

Abstrak Sejarah mencatat sentimen rasial yang tertuang dalam produk undang-undang Amerika Serikat seperti Chinese Exclusion Act 1882, pada masanya turut menyasar para imigran dan warga keturunan Jepang. Beragam tindakan kekerasan verbal maupun fisik dan diskriminasi dialami imigran Asia, dalam konteks ini Cina dan Jepang, ketika itu. Lebih lanjut, merebaknya Covid-19 dalam kurun dua tahun ini kembali memunculkan masalah sosial serupa bagi komunitas imigran dan warga keturunan Asia, termasuk Jepang. Isu berhembus memojokan para pendatang dan warga keturunan Asia sebagai tertuduh pembawa virus Covid-19. Dengan demikian, aksi-aksi rasis, diskriminatif, dan xenophobic terrekam pada dua konteks waktu yang berbeda. Dengan mengumpulkan data-data melalui metode studi pustaka dan kemudian mengolahnya, diketahui terdapat perbedaan dan kesamaan fenomena di tengah sentimen-sentimen yang menarget imigran maupun warga keturunan Jepang di Amerika. Perbedaan yang dimaksud merujuk pada aspek pemicu. Pada masa-masa awal kedatangannya, sentimen terhadap imigran Jepang di Amerika Serikat dipicu oleh masalah kesempatan kerja dan kecurigaan bernuansa politik. Sementara itu, pada kurun waktu pandemi Covid-19 sentimen anti-Asian dipicu oleh isu penyebaran virus Covid-19. Di sisi lain, terdapat kesamaan dalam munculnya sentimen-setimen anti-Asian dulu dan kini yaitu tersebarnya informasi palsu dan provokatif, merebaknya prasangka dan diskriminasi rasial, adanya peran tokoh publik dalam menyebarkan kebencian, dan adanya kebijakan hukum yang diambil oleh otoritas untuk merespon isu terkait.  Kata Kunci: Amerika Serikat, Jepang, Imigran, Xenophobia, Covid-19 AbstractChinese Exclusion Act of 1882, which was one of the US Federal Laws restricting immigration, was meant to target Chinese immigrants at that time. Being among the Asian communities in the US, the Japanese immigrants were unsurprisingly affected. Racial discrimination and hatred began to arise as the implementation of the law was going on. Various acts of verbal and physical violence suffered by the Asian (Chinese and Japanese) immigrants at that time. Further, the outbreak of Covid-19 in the past two years has raised similar social problems for the immigrant communities and people of Asian descent including Japanese. The issue of cornering the immigrants and the residents of this descent as being accused of carrying the Covid-19 virus arises. Various acts of hatred begin to target the immigrants and citizens of Asian descent. Applying the library research method and processing the relevant data, there found differences and similarities amidst the sentiments targeting the immigrants and citizens of Japanese descent in America. The difference refers to the triggering aspect. In the early days of their arrival, the anti-Japanese immigrant sentiment in the United States was more motivated by the problems of job opportunity and political suspicions. Meanwhile, during the Covid-19 pandemic, anti-Asian sentiment was triggered by the issue of the spread of the Covid-19 virus. On the other hand, there are similarities to the emergence of anti-Asian sentiments today including the spread of false and provocative information, the spread of racial prejudice and discrimination, the role of public figures in spreading hatred, and the existence of legal policies taken by authorities to respond to the related issues.  Keywords: the United States, Japanese, Immigrants, Xenophobia, Covid-19

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 (&lt;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.

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