Geographic and racial disparities in the utilization of low-volume cystectomy hospitals for bladder cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 302-302
Author(s):  
Martin Francis Casey ◽  
Tal Gross ◽  
Kristian D. Stensland ◽  
William K. Oh ◽  
Matt D. Galsky
Keyword(s):  
New York ◽  
Bladder Cancer ◽  
Racial Disparities ◽  
High Volume ◽  
The United States ◽  
Travel Distance ◽  
Increased Risk ◽  
Low Volume ◽  
The Impact ◽  
Over Time

302 Background: Extensive research has demonstrated volume-outcome benefits for select cancer surgeries, such as cystectomy. However, barriers to the use of high volume cystectomy hospitals have not been comprehensively explored. Methods: The New York Statewide Planning and Research Cooperative System was utilized to obtain data on all inpatients who underwent cystectomy for bladder cancer from 1997-2011. Volume status was defined by dividing patients into quintiles based on the number of cystectomies performed by each hospital in 1997-2001. Multiple logistic regression was used to assess the impact of distance and race on use of low volume hospitals. Driving distances were calculated using a geographic information system. Race was stratified by the racial profile of a subject’s community to explore the underlying causes of racial disparities. Results: A cohort of 8,712 cystectomy patients was identified. The number of available high volume hospitals increased over time, consistent with regionalization of surgeries. Minimum travel distance to high volume hospitals decreased over time for the general population, but living >21 miles still increased risk for low volume hospital utilization (see Table). Racial disparities were most prominent among blacks living in black communities, despite generally living closer to high volume hospitals (median travel distance of 5.3 miles versus 16.6 miles for whites living in white communities). Conclusions: Regionalization of cystectomies has occurred in New York State, as has been observed in multiple other regions of the United States. However, geographic and racial disparities exist in the use of high volume cystectomy hospitals. [Table: see text]

565 Suicidality After Burn Injuries: A Systematic Review

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
Sheera F Lerman ◽  
C Scott Hultman ◽  
Carrie A Cox ◽  
Julie Caffrey
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
The United States ◽  
Burn Injuries ◽  
Psychiatric Comorbidities ◽  
Completed Suicide ◽  
Increased Risk ◽  
Burn Survivors ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn injuries are associated with substantial pain and disability and may lead to significant long term psychological distress including suicidality. Suicide is among the leading causes of death in the United States and burn survivors may be at increased risk due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as assessment of risk and protective factors for these behaviors. Methods MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched using search terms regarding suicide, suicidality and burn. Studies evaluating self-immolation were excluded unless they also measured suicidality after the injury. Fourteen observational and population-based studies which measured any type of suicidality (ideation, attempts or completed suicide) post-burn injuries underwent critical appraisal. Results Few studies directly measure suicidality after burn injuries, and even fewer measure changes in suicidality over time. Overall, burn survivors demonstrate elevated suicidal ideations with rates as high as 32%. Pain at discharge, perceived level of disfigurement and premorbid psychiatric comorbidities are among the significant risk factors for suicidal ideations. There is mixed evidence as to rates of completed suicide post-burn injury, though rates appear to be relatively low. Conclusions Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors. This is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, post-traumatic stress disorder, social isolation and depression which are linked to suicidality in the general population. In addition, individuals with self-inflicted burns may be at even higher risk given that previous suicide attempts are of the strongest predictor of future suicidality. More research is needed to better understand the impact of these risk factors in burn survivors and inform their care. Applicability of Research to Practice There is high importance in screening burn survivors for suicidal ideations at discharge from the hospital and following them over time in order to understand the magnitude of this phenomena and offer targeted interventions to vulnerable individuals.

Racial/ethnic disparities in the use of high-volume centers for hepatobiliary and pancreatic cancer surgery.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 457-457
Author(s):  
Susanna W de Geus ◽  
Teviah E. Sachs ◽  
Sing Chau W Ng ◽  
David B. McAneny ◽  
Jennifer F. Tseng
Keyword(s):  
High Volume ◽  
Cancer Surgery ◽  
Travel Distance ◽  
Cancer Center ◽  
Tumor Type ◽  
Cancer Data ◽  
Race Ethnicity ◽  
Low Volume ◽  
The Impact ◽  
Hispanic White

457 Background: The impact of hospital volume on the outcomes of cancer surgery has been well established. The present studies investigates how race/ethnicity influences the utilization of high-volume centers for hepatobiliary and pancreatic surgery. Methods: Patients that underwent surgery for hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), ampullary adenocarcinoma (AC), or pancreatic ductal adenocarcinoma (PDAC) between 2006 and 2015 were identified from the National Cancer Data Base. Hospitals were divided into low- and high-volume centers based on the medium number of cancer surgeries per year. Multivariable logistic regression analyses predicting receipt of care at a low-volume center based on age, sex, race/ethnicity, comorbidities, insurance, income, travel distance, geographic location, urban/metro location, and tumor stage were performed. All analyses were performed separately by tumor type. Results: 8,962 patients with HCC, 2,119 with ICC, 3,973 with ECC, 5,125 with AC, and 25,231 with PDAC were identified. Non-Hispanic black patients were more likely to undergo resection for AC (vs. non-Hispanic white: AOR, 1.326; p = 0.0125) or PDAC (vs. non-Hispanic white: AOR, 1.187; p = 0.0002) at a low volume centers. Hispanic patients more often underwent surgery for ECC (vs. non-Hispanic white: AOR, 1.731; p < 0.0001) or PDAC (vs. non-Hispanic white: 2.030; p < 0.0001) cancer at a low-volume center. Patients of Asian descent were significantly less often treated for HCC at a low volume center (vs. non-Hispanic white: AOR, 0.644; p < 0.0001) compared to non-Hispanic whites. Non-Hispanic black, Hispanic, or Asian race/ethnicity did not impact the likelihood of receiving care at a low volume center for any other tumor types. Conclusions: The results of this study suggest that race/ethnicity influences the likelihood of receiving care at a high-volume cancer center, even after controlling for other barriers to access to care, including insurance status, income and travel distance.

The Role of Vascular Aging in Atherosclerotic Plaque Development and Vulnerability

2019 ◽  
Vol 25 (29) ◽  
pp. 3098-3111 ◽  
Author(s):  
Luca Liberale ◽  
Giovanni G. Camici
Keyword(s):  
Atherosclerotic Plaque ◽  
Molecular Mechanisms ◽  
Driving Forces ◽  
Plaque Burden ◽  
Vascular Aging ◽  
Age Related ◽  
Plaque Development ◽  
Increased Risk ◽  
The Impact ◽  
Over Time

Background: The ongoing demographical shift is leading to an unprecedented aging of the population. As a consequence, the prevalence of age-related diseases, such as atherosclerosis and its thrombotic complications is set to increase in the near future. Endothelial dysfunction and vascular stiffening characterize arterial aging and set the stage for the development of cardiovascular diseases. Atherosclerotic plaques evolve over time, the extent to which these changes might affect their stability and predispose to sudden complications remains to be determined. Recent advances in imaging technology will allow for longitudinal prospective studies following the progression of plaque burden aimed at better characterizing changes over time associated with plaque stability or rupture. Oxidative stress and inflammation, firmly established driving forces of age-related CV dysfunction, also play an important role in atherosclerotic plaque destabilization and rupture. Several genes involved in lifespan determination are known regulator of redox cellular balance and pre-clinical evidence underlines their pathophysiological roles in age-related cardiovascular dysfunction and atherosclerosis. Objective: The aim of this narrative review is to examine the impact of aging on arterial function and atherosclerotic plaque development. Furthermore, we report how molecular mechanisms of vascular aging might regulate age-related plaque modifications and how this may help to identify novel therapeutic targets to attenuate the increased risk of CV disease in elderly people.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

2021 ◽  
pp. 088626052199083
Author(s):  
Aaron J. Kivisto ◽  
Samantha Mills ◽  
Lisa S. Elwood
Keyword(s):  
Black Women ◽  
Ethnic Minority ◽  
Racial Disparities ◽  
White Women ◽  
The United States ◽  
Intimate Partner ◽  
Intimate Partner Homicide ◽  
Homicide Victimization ◽  
Increased Risk ◽  
Racial Ethnic

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention’s National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

Do Stock Markets Catch the Flu?

2013 ◽  
Vol 48 (3) ◽  
pp. 979-1000 ◽  
Author(s):  
Brian C. McTier ◽  
Yiuman Tse ◽  
John K. Wald
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
Stock Markets ◽  
The United States ◽  
Trading Activity ◽  
Market Makers ◽  
International Data ◽  
The Impact ◽  
Bid Ask Spreads

AbstractWe examine the impact of influenza on stock markets. For the United States, a higher incidence of flu is associated with decreased trading, decreased volatility, decreased returns, and higher bid-ask spreads. Consistent with the flu affecting institutional investors and market makers, the decrease in trading activity and volatility is primarily driven by the incidence of influenza in the greater New York City area. However, the effect of the flu on bid-ask spreads and returns is related to the incidence of flu nationally. International data confirm our findings of a decrease in trading activity and returns when flu incidence is high.

340 Trends and Disparities in Cervical Spine Fusion Procedure Utilization in the New York State

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Rui Feng ◽  
Mark Finkelstein ◽  
Eric Karl Oermann ◽  
Michael Palese ◽  
John M Caridi
Keyword(s):  
New York ◽  
African American ◽  
Cervical Spine ◽  
New York State ◽  
High Volume ◽  
Spine Fusion ◽  
York State ◽  
High Volume Hospital ◽  
Low Volume ◽  
Cervical Spine Fusion

Abstract INTRODUCTION There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. METHODS We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics. RESULTS >African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (P = 0.0020) and post-operative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). CONCLUSION Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.

Strangers in the City: Transmigration from Eastern Europe and its Impact on Berlin and Hamburg 1880–1914

2016 ◽  
Vol 2 (2) ◽  
pp. 223-246
Author(s):  
Tobias Brinkmann
Keyword(s):  
United States ◽  
New York ◽  
Eastern Europe ◽  
The United States ◽  
Urban Traffic ◽  
European Cities ◽  
Massive Growth ◽  
Transit Migration ◽  
The Impact ◽  
The City

This article examines the impact of transit migration from the Russian and Austro-Hungarian Empires on Berlin and Hamburg between 1880 and 1914. Both cities experienced massive growth during the last three decades of the nineteenth century, and both served as major points of passage for Eastern Europeans travelling to (and returning from) the United States. The rising migration from Eastern Europe through Central and Western European cities after 1880 coincided with the need to find adequate solutions to accommodate a rapidly growing number of commuters. The article demonstrates that the isolation of transmigrants in Berlin, Hamburg (and New York) during the 1890s was only partly related to containing contagious disease and ‘undesirable’ migrants. Isolating transmigrants was also a pragmatic response to the increasing pressure on the urban traffic infrastructure.

History and Current Trends in the Electronic Cigarette Retail Marketplace in the United States: 2010–2016

2018 ◽  
Vol 22 (5) ◽  
pp. 843-847 ◽  
Author(s):  
Jennifer Cantrell ◽  
Jidong Huang ◽  
Marisa Greenberg ◽  
Jeffrey Willett ◽  
Elizabeth Hair ◽  
...  
Keyword(s):  
Tobacco Industry ◽  
The United States ◽  
Retail Market ◽  
Current Trends ◽  
Published Evidence ◽  
The Us ◽  
Industry Response ◽  
Market Trends ◽  
The Impact ◽  
Over Time

Abstract Introduction The US market for electronic nicotine delivery systems (ENDS) has grown rapidly in the last decade. There is limited published evidence examining changes in the ENDS marketplace prior to the US Food and Drug Administration’s (FDA) deeming rule in 2016. This study describes US ENDS retail market trends from 2010 to 2016. Methods National data were obtained from Nielsen retail scanners for five product types: (1) disposables, (2) rechargeables, (3) cartridge replacements, (4) e-liquid bottle refills, and (5) specialty vapor products. We examined dollar sales, volume, price, brand, and flavor. Results Adjusted national sales increased from $11.6 million in 2010 to $751.2 million in 2016. The annual rate of sales growth rapidly increased before slowing through 2015. The rate of growth spiked in 2016. Market share for menthol products and other assorted flavors increased from 20% in 2010 to 52.1% by 2016. NJOY’s early market dominance shifted as tobacco industry brands entered the market and eventually captured 87.8% of share by 2016. Rechargeables and accompanying products comprised an increased proportion of total volume sold over time while disposable volume declined. Specialty vapor products appeared at retail in 2015. Conclusions Findings show strong early growth in the ENDS retail market followed by considerable slowing over time, despite a slight uptick in 2016. Trends reflect shifts to flavored products, newer generation “open-system” devices, lower prices, and tobacco industry brands. This study provides a baseline against which to compare the impact of FDA’s 2016 deeming rule and future actions on the ENDS marketplace. Implications This study uses market scanner data from US retail outlets to describe trends in the ENDS retail market from 2010 to 2016, providing a baseline against which to compare the impact of FDA’s 2016 deeming rule and future actions on the ENDS marketplace. Understanding historical market trends is valuable in assessing how future regulatory efforts and advances in ENDS technology may impact industry response and consumer uptake and use.

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