Changing demographics in Hamilton may leave the kids behind

This paper addresses the stark geographic disparity that youth in Hamilton face when trying to access services. There is a high number of youth services concentrated in the inner and lower city, but this does not seem poised to meet the changing demographics and needs of the city of Hamilton. Gentrification and community uplift have started in the lower city, and as such, having a majority of youth services located in the downtown presents a major form of disconnection. This is especially shown as youths living in poverty begin to be pushed out of the lower city and into the inner suburbs on top of the Niagara Escarpment—a place that is geographically cut off from the rest of the city. This paper examines these issues and presents recommendations, to help youth and the City of Hamilton address this disconnection as Hamilton experiences unprecedented growth and development, which may leave the youth behind. Key words: An article on social planning and youth programing in Hamilton, Ontario, used the key words: Hamilton; youth services; gentrification; access.

Changing demographics in Hamilton may leave the kids behind

This paper addresses the stark geographic disparity that youth in Hamilton face when trying to access services. There is a high number of youth services concentrated in the inner and lower city, but this does not seem poised to meet the changing demographics and needs of the city of Hamilton. Gentrification and community uplift have started in the lower city, and as such, having a majority of youth services located in the downtown presents a major form of disconnection. This is especially shown as youths living in poverty begin to be pushed out of the lower city and into the inner suburbs on top of the Niagara Escarpment—a place that is geographically cut off from the rest of the city. This paper examines these issues and presents recommendations, to help youth and the City of Hamilton address this disconnection as Hamilton experiences unprecedented growth and development, which may leave the youth behind. Key words: An article on social planning and youth programing in Hamilton, Ontario, used the key words: Hamilton; youth services; gentrification; access.

Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania—A Geo-Additive Approach

Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007–2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.

Location Matters: Geographic Disparities and Impact of Coronavirus Disease 2019

The coronavirus disease 2019 (COVID-19) pandemic in the United States has revealed major disparities in the access to testing and messaging about the pandemic based on the geographic location of individuals, particularly in communities of color, rural areas, and areas of low income. This geographic disparity, in addition to deeply rooted structural inequities, have posed additional challenges to adequately diagnose and provide care for individuals of all ages living in these settings. We describe the impact that COVID-19 has had on geographically disparate populations in the United States and share our recommendations on what might be done to ameliorate the current situation.

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

Unwarranted variation in the quality of care challenges the sustainability of healthcare systems. Especially in decentralised healthcare systems, it is crucial to understand the drivers behind regional differences in hospital qualities such as unplanned readmissions. This paper examines the factors that influence the risk of unplanned hospital readmission and the geographic disparity of readmission rate in Italy. We use hospital discharge data from 2010 to 2015 for patients above 65 years old admitted with Acute Myocardial Infarction. Employing hierarchical models, we identified the patient and hospital-level determinants for unplanned readmission. In line with the literature, the risk of readmission increases with age and being male, while hospitals with higher patient volume and capacity tend to have lower unplanned readmission. In particular, we find that after patient risk-adjustments, there are differential effects of hospitalisation length-of-stay on the probability of readmission across the hospitals that are governed by different payment systems. For hospitals under a prospective payment system, the effect of length-of-stay in reducing the probability of readmission is weaker than hospitals under an ex-post global budget, but the overall readmission rates are the lowest. Moreover, there are substantial geographic variations in readmission rate across Local Health Authority and regions, and these variations of unplanned readmission are explained by differences in hospital length-of-stay and surgical procedures used. Our results demonstrate that differential hospital behaviours can be one of the potential mechanisms that drive geographic quality disparities.