Opioid Misuse in Missouri: Analyzing Emergency Department Use in Urban/Rural Areas

ObjectiveCompare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.IntroductionLike many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.MethodsThe 115 counties in Missouri were organized into the six-level urban-rural classification scheme developed by the National Center for Health Statistics (NCHS). The attached table shows the breakout of counties into the six different categories. The data years analyzed were 2012 through 2016. ED visits due to opioid overdose were identified using case definitions supplied by ESOOS. Overdoses were analyzed in three different categories—all opioids, heroin, and non-heroin opioids. The all opioid category combines heroin and non-heroin opioids. Non-heroin opioids includes prescription drugs such as oxycodone, hydrocodone, fentanyl, and fentanyl analogues. Annual rates per 10,000 were calculated for each county classification using population estimates. Confidence intervals (at 95%) were then calculated using either inverse gamma when the number of ED visits was under 500, or Poisson when the number was 500 or more. Changes over time were calculated using both a year over year method and a 5 year change method.ResultsOverall opioid rates have increased in all geographic areas during the 5 year period analyzed. Large Central Metro and Large Fringe Metro counties had the highest rates of ED visits due to opioid overdose. These two classifications also saw the largest increases in rates. The Large Central Metro counties collectively increased over 125%, while the Large Fringe Metro area increased 130%. Both areas experienced statistically significant increases year-to-year between 2014 and 2016 in addition to the overall 5 year period of 2012-2016.Analysis was also conducted for heroin and non-heroin subsets of opioid abuse. There were important differences in these two groups. For heroin ED visits, the highest rates were found in the Large Central Metro and Large Fringe Metro regions. However, the largest increase in percentage terms were found in the Medium Metropolitan, Micropolitan and Noncore regions which all saw increases of over 300%. Notably, every region experienced increases of over 150%. The Medium Metro had two consecutive years (2013/2014 and 2014/2015) where the heroin ED rate more than doubled.In contrast, non-heroin ED visits did not experience such a large increase over time. Most areas saw small fluctuations year-to-year with moderate overall increases over the 5-year time period. The exception to this trend is the Large Fringe Metro area, which saw increases every year most notably between 2014 and 2015 and had by far the largest 5 year increase at 82%.ConclusionsThe urban areas in Missouri continue to have the highest rates of opioid overdose, however all areas within the state have experienced very large increases in heroin ED visits within the past five years. The increase in heroin ED visits in the rural areas suggests the abuse of heroin has now spread throughout the state, as rates were much lower in 2012. The steady increase in non-heroin opioids unique to the Large Fringe Metro may be due to the availability of fentanyl in urban areas especially the St. Louis area. This possible finding would correspond with the increased deaths due to fentanyl experienced in and around the St. Louis urban area that has been identified through analysis of death certificate data.

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National trends in emergency department closures, mergers, and utilization, 2005-2015

PLoS ONE ◽

10.1371/journal.pone.0251729 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251729

Author(s):

Arjun K. Venkatesh ◽

Alexander Janke ◽

Craig Rothenberg ◽

Edwin Chan ◽

Robert D. Becher

Keyword(s):

Emergency Department ◽

Rural Areas ◽

Urban Areas ◽

Hospital Admissions ◽

The United States ◽

Relative Increase ◽

American Hospital ◽

American Hospital Association ◽

Hospital Bed ◽

Ed Visits

Study objectives To describe nationwide hospital-based emergency department (ED) closures and mergers, as well as the utilization of emergency departments and inpatient beds, over time and across varying geographic areas in the United States. Methods Observational analysis of the American Hospital Association (AHA) Annual Survey from 2005 to 2015. Primary outcomes were hospital-based ED closure and merger. Secondary outcomes were yearly ED visits per hospital-based ED and yearly hospital admissions per hospital bed. Results The total number of hospital-based EDs decreased from 4,500 in 2005 to 4,460 in 2015, with 200 closures, 138 mergers, and 160 new hospital-based EDs. While yearly ED visits per hospital-based ED exhibited a 28.6% relative increase (from 25,083 to 32,248), yearly hospital admissions per hospital bed had a 3.3% relative increase (from 45.4 to 43.9) from 2005 to 2015. The number of hospital admissions and hospital beds did not change significantly in urban areas and declined in rural areas. ED visits grew more uniformly across urban and rural areas. Conclusions The number of hospital-based ED closures is small when accounting for mergers, but occurs as many more patients are presenting to a stable number of EDs in larger health systems, though rural areas may differentially affected. EDs were managing accelerating patient volumes alongside stagnant inpatient bed capacity.

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LO51: Emergency department use by pregnant women: a population-based study within a universal healthcare system

CJEM ◽

10.1017/cem.2020.106 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S25-S26

Author(s):

C. Varner ◽

A. Park ◽

D. Little ◽

J. Ray

Keyword(s):

Emergency Department ◽

Rural Areas ◽

Urban Areas ◽

First Trimester ◽

Population Based ◽

Maternal Characteristics ◽

Universal Healthcare ◽

Relative Risks ◽

Ed Visits ◽

Dose Response Effect

Introduction: Emergency Department (ED) utilization during pregnancy may be common, but data specific to universal healthcare systems like Canada are lacking, where pregnancy care is supposed to be standardized. The objective of this study was to quantify and characterize ED utilization among all Ontarian women who had a recognized pregnancy, including by trimester and within 42 days after pregnancy, and further stratified by pregnancy outcome. Methods: Utilizing provincial administrative health databases, this retrospective population-based cohort study included all recognized pregnancies in Ontario conceived between April 1, 2002 and March 31, 2017. Peri-pregnancy ED utilization was defined as any ED visit from 0-42 weeks’ gestation, or within 42 days after the end of pregnancy. Modified Poisson regression was used to generate relative risks (RR) and 95% confidence intervals (CI) for the outcome of any peri-pregnancy ED utilization in association with maternal characteristics. Results: Peri-pregnancy ED utilization occurred among 1,075,991 of 2,728,236 recognized pregnancies (39.4%), including among 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages, and 84.8% of threatened abortions. There were 22,802 (0.84%) ectopic pregnancies among all pregnancies in the cohort. ED utilization peaked in the first trimester and in the first week postpartum. A dose-response effect was seen in the number of peri-pregnancy ED visits in relation to certain maternal characteristics. Women residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39 to 3.49) for ≥ 3 ED visits, compared to those in urban areas. Women with 3-5 (OR 1.99 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49 to 3.61), or ≥ 7 (OR 7.59, 95% CI 7.39 to 7.78) pre-pregnancy comorbidities were more likely to have ≥ 3 peri-pregnancy ED visits than those with 0-2 comorbidities. Of all recognized pregnancies in the cohort, only 106,989 (3.9%) had an injury-related ED visit. Conclusion: Peri-pregnancy ED utilization occurs in nearly 40% of pregnancies, notably in the first trimester and immediately postpartum. Efforts are needed to streamline rapid access to ambulatory obstetrical care during these peak periods, when women are vulnerable to either a miscarriage, or a complication after a livebirth.

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4269 Frequent emergency department use among homeless individuals seen in emergent care: High risks of opioid-related diagnoses and adverse health services utilization outcomes

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.394 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 133-133

Author(s):

Ayae Yamamoto ◽

Lillian Gelberg ◽

Yusuke Tsugawa ◽

Gerald Kominski ◽

Jack Needleman

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Alcohol Abuse ◽

Health Services ◽

Hospital Mortality ◽

Health Services Utilization ◽

The State ◽

Opioid Overdose ◽

Services Utilization ◽

Ed Visits

OBJECTIVES/GOALS: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes. METHODS/STUDY POPULATION: Based on the State Emergency Department Database and the State Inpatient Database, homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons). RESULTS/ANTICIPATED RESULTS: Higher rates of ED use were associated with Medicare coverage <65; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit (2.8% vs. 2.8% vs. 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.

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Urban–Rural Dichotomy in Planning: Review of Legal Framework in Four States of India

Indian Journal of Public Administration ◽

10.1177/00195561211001610 ◽

2021 ◽

pp. 001955612110016

Author(s):

Anurima Mukherjee Basu ◽

Rutool Sharma

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Planning Process ◽

Legal Framework ◽

Quantum Jump ◽

Class 1 ◽

Urban Settlements ◽

Urban Rural ◽

Territorial Approach ◽

Sizeable Number

Current urbanisation trends in India show a quantum jump in number of ‘census towns’, which are not statutorily declared as urban areas, but have acquired all characteristics of urban settlements. Sizeable number of such census towns are not located near any Class 1 city. Lack of proper and timely planning has led to unplanned growth of these settlements. This article is based on a review of planning legislations, institutional framework and planning process of four states in India. The present article analyses the scope and limitations of the planning process adopted in the rapidly urbanising rural areas of these states. The findings reveal that states are still following a conventional approach to planning that treats ‘urban’ and ‘rural’ as separate categories and highlights the need for adopting an integrated territorial approach to planning of settlements.

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Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽

10.1136/bmjopen-2020-042762 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042762

Author(s):

Shuai Yuan ◽

Shao-Hua Xie

Keyword(s):

Cancer Incidence ◽

Rural Areas ◽

Urban Areas ◽

Incidence Rates ◽

Cancer Type ◽

Anatomic Site ◽

Cross Sectional ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

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RURAL–URBAN MIGRATION AND CHILD SURVIVAL IN URBAN BANGLADESH: ARE THE URBAN MIGRANTS AND POOR DISADVANTAGED?

Journal of Biosocial Science ◽

10.1017/s0021932007002271 ◽

2008 ◽

Vol 40 (1) ◽

pp. 83-96 ◽

Cited By ~ 39

Author(s):

M. MAZHARUL ISLAM ◽

KAZI MD ABUL KALAM AZAD

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Urban Poor ◽

Child Survival ◽

Childhood Mortality ◽

Policy Implications ◽

Urban Migration ◽

Under Five ◽

Urban Migrants ◽

Urban Rural

SummaryThis paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children’s survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999–2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban–rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural–urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant–native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural–urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor–non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant’s children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban–rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.

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Seasonal variation and spatial distribution of carbonaceous aerosols in Taiwan

Atmospheric Chemistry and Physics ◽

10.5194/acp-10-9563-2010 ◽

2010 ◽

Vol 10 (19) ◽

pp. 9563-9578 ◽

Cited By ~ 42

Author(s):

C. C.-K. Chou ◽

C. T. Lee ◽

M. T. Cheng ◽

C. S. Yuan ◽

S. J. Chen ◽

...

Keyword(s):

Spatial Distribution ◽

Rural Areas ◽

Urban Areas ◽

Air Pollutants ◽

Chemical Properties ◽

Anthropogenic Sources ◽

Carbonaceous Aerosols ◽

Urban Rural ◽

Southern Taiwan ◽

Northern Taiwan

Abstract. To investigate the physico-chemical properties of aerosols in Taiwan, an observation network was initiated in 2003. In this work, the measurements of the mass concentration and carbonaceous composition of PM10 and PM2.5 are presented. Analysis on the data collected in the first 5-years, from 2003 to 2007, showed that there was a very strong contrast in the aerosol concentration and composition between the rural and the urban/suburban stations. The five-year means of EC at the respective stations ranged from 0.9±0.04 to 4.2±0.1 μgC m−3. In rural areas, EC accounted for 2–3% of PM10 and 3–5% of PM2.5 mass loadings, comparing to 4–6% of PM10 and 4–8% of PM2.5 in the urban areas. It was found that the spatial distribution of EC was consistent with CO and NOx across the network stations, suggesting that the levels of EC over Taiwan were dominated by local sources. The measured OC was split into POC and SOC counterparts following the EC tracer method. Five-year means of POC ranged from 1.8±0.1 to 9.7±0.2 μgC m−3 among the stations. It was estimated that the POM contributed 5–17% of PM10 and 7–18% of PM2.5 in Taiwan. On the other hand, the five-year means of SOC ranged from 1.5±0.1 to 3.8±.3 μgC m−3. The mass fractions of SOM were estimated to be 9–19% in PM10 and 14–22% in PM2.5. The results showed that the SOC did not exhibit significant urban-rural contrast as did the POC and EC. A significant cross-station correlation between SOC and total oxidant was observed, which means the spatial distribution of SOC in Taiwan was dominated by the oxidant mixing ratio. Besides, correlation was also found between SOC and particulate nitrate, implying that the precursors of SOA were mainly from local anthropogenic sources. In addition to the spatial distribution, the carbonaceous aerosols also exhibited distinct seasonality. In northern Taiwan, the concentrations of all the three carbonaceous components (EC, POC, and SOC) reached their respective minima in the fall season. POC and EC increased drastically in winter and peaked in spring, whereas the SOC was characterized by a bimodal pattern with the maximal concentration in winter and a second mode in summertime. In southern Taiwan, minimal levels of POC and EC occurred consistently in summer and the maxima were observed in winter, whereas the SOC peaked in summer and declined in wintertime. The discrepancies in the seasonality of carbonaceous aerosols between northern and southern Taiwan were most likely caused by the seasonal meteorological settings that dominated the dispersion of air pollutants. Moreover, it was inferred that the Asian pollution outbreaks could have shifted the seasonal maxima of air pollutants from winter to spring in the northern Taiwan, and that the increases in biogenic SOA precursors and the enhancement in SOA yield were responsible for the elevated SOC concentrations in summer.

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Agriculture Biomaterial Industry in Romania

International Journal of Sustainable Economies Management ◽

10.4018/ijsem.2021010103 ◽

2021 ◽

Vol 10 (1) ◽

pp. 32-44

Author(s):

Irina Bancescu

Keyword(s):

Rural Development ◽

Rural Areas ◽

Urban Areas ◽

Rural Poverty ◽

Value Added ◽

Poverty Rate ◽

Economic Implications ◽

Income Gap ◽

Rural Income ◽

Urban Rural

Rural areas in Romania are underdeveloped, with the main economic activity being agriculture. Urban-rural income gap and poverty levels are indicative of an underdeveloped rural area. Urban-rural absolute income gap for average monthly income increased from 352 RON in 2007 to 663 RON in 2017. Moreover, the work poverty rate is higher in rural areas than in urban areas. Economic rural development can be achieved by improvements of the labour market and introduction of new value-added products. Agricultural and non-agricultural activities are dependent on each other for a successful rural development leading to poverty alleviation. An industry that combines the two types of economic activities is agriculture biomaterial industry. In this paper, the authos investigates the factors influencing rural poverty and analyses the current stage of the bioplastics market in Romania and its economic implications. Bioplastics industry can reduce urban-rural income gaps and poverty in rural areas.

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Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education

Mental Health Clinician ◽

10.9740/mhc.2019.07.294 ◽

2019 ◽

Vol 9 (4) ◽

pp. 294-297

Author(s):

Aimee N. Jensen ◽

Candace M. Beam ◽

Amber R. Douglass ◽

Jennifer E. Brabson ◽

Michelle Colvard ◽

...

Keyword(s):

At Risk ◽

High Risk ◽

Rural Areas ◽

Urban Areas ◽

Patient Specific ◽

Opioid Overdose ◽

Overdose Prevention ◽

Innovative Practice ◽

Risk Patients ◽

Urban And Rural Areas

Abstract To achieve the nationwide goal of reducing opioid-related deaths, a clinical pharmacy specialist–led clinical video telehealth (CVT) clinic was created at a Veterans Affairs medical center (VAMC) to deliver opioid overdose prevention and naloxone education to at-risk patients. The purpose of this innovative practice was to improve access to this potentially life-saving intervention to patients across urban and rural areas. This study is a single-center, descriptive analysis of adult patients across 2 VAMC campuses and 4 community-based outpatient clinics from July 11, 2016, through December 31, 2016. The purpose of this innovative practice was to increase access to overdose education and naloxone distribution (OEND) to at-risk patients across urban and rural areas. Patient-specific factors were also examined among those receiving naloxone through the CVT clinic compared to other prescribers. During the first 6 months from the initiation of the clinic, 1 pharmacist prescribed 21% of the health care system's naloxone. These patients identified by the pharmacist-led CVT clinic were more likely to be considered high-risk due to concomitant use of opioids and benzodiazepines. In conclusion, the pharmacist-led CVT group clinic has been an efficient strategy to extend OEND services to high-risk patients beyond central, urban areas.

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Seasonal patterns of dengue incidence in Thailand across the urban-rural gradient

10.1101/2020.11.25.20186056 ◽

2020 ◽

Author(s):

Qifang Bi ◽

Derek AT Cummings ◽

Nicholas G. Reich ◽

Lindsay T. Keegan ◽

Joshua Kaminsky ◽

...

Keyword(s):

Wavelet Analysis ◽

Temporal Variation ◽

Rural Areas ◽

Urban Areas ◽

Dynamic Models ◽

Seasonal Patterns ◽

Disease Dynamics ◽

Urban Rural ◽

Spatio Temporal ◽

Dengue Epidemics

AbstractIn Southeast Asia, endemic dengue follows strong spatio-temporal patterns with major epidemics occurring every 2-5 years. However, important spatio-temporal variation in seasonal dengue epidemics remains poorly understood. Using 13 years (2003-2015) of dengue surveillance data from 926 districts in Thailand and wavelet analysis, we show that rural epidemics lead urban epidemics within a dengue season, both nationally and within health regions. However, local dengue fade-outs are more likely in rural areas than in urban areas during the off season, suggesting rural areas are not the source of viral dispersion. Simple dynamic models show that stronger seasonal forcing in rural areas could explain the inconsistency between earlier rural epidemics and dengue “over wintering” in urban areas. These results add important nuance to earlier work showing the importance of urban areas in driving multi-annual patterns of dengue incidence in Thailand. Feedback between geographically linked locations with markedly different ecology is key to explaining full disease dynamics across urban-rural gradient.

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