Sociodemographic and Geographic Factors Associated With Non-Obstetrical Ultrasound Imaging Utilization: A Population-Based Study

Objective: Ultrasound is one of the most commonly used imaging modalities, though some populations face barriers in accessing ultrasound services, potentially resulting in disparities in utilization. The objective of this study was to assess the association between sociodemographic and geographic factors and non-obstetrical ultrasound utilization in the province of Saskatchewan, Canada. Methods: All non-obstetrical ultrasound exams performed from 2014 to 2018 in Saskatchewan, Canada were retrospectively identified from province-wide databases. Univariate and multivariate Poisson regression analyses were performed to assess the association between ultrasound utilization and sex, age, First Nations status, Charlson Comorbidity Index, urban vs. rural residence, geographic remoteness, and neighborhood income. Results: A total of 1,324,846 individuals (5,857,044 person-years) were included in the analysis. Female sex (adjusted incidence rate ratio [aIRR], 2.20; 95% confidence interval [CI], 2.19-2.22), age (aIRR, 4.97; 95% CI, 4.90-5.05 for ≥57 years vs. <11 years), comorbidities (aIRR, 4.36 for Charlson Comorbidity Index >10 vs. 0; 95% CI, 3.78-5.03), and higher neighborhood income (aIRR, 1.04; 95% CI, 1.02-1.05 for highest vs. lowest quintile) were associated with higher rates of ultrasound utilization. Individuals who were status First Nations (aIRR, 0.91; 95% CI, 0.90-0.92) or resided in geographically remote areas (aIRR, 0.87 for most vs. least remote; 95% CI, 0.83-0.91) had lower rates of ultrasound utilization. Individuals who lived in a rural area also had lower rates of ultrasound utilization (aIRR, 0.93; 95% CI, 0.92-0.94). Conclusion: Substantial disparities exist in non-obstetrical ultrasound utilization among individuals in low-income neighborhoods, status First Nations individuals, and individuals in rural and remote communities.

Using Ecological Diversity Analyses to Characterize the Availability of Healthy Food and Socio-Economic Food Deserts

“Food deserts” are usually defined as geographic areas without local access to fresh, healthy food. We used community ecology statistics in supermarkets to quantify the availability of healthy food and to potentially identify food deserts as areas without a diverse selection of food, rather than a binary as to whether fresh food is present or not. We test whether produce diversity is correlated with neighborhood income or demographics. Abundance and diversity of fresh produce was quantified in supermarkets in Broward County, Florida, USA. Neighborhood income level and racial/ethnic makeup were retrieved from the U.S. Census and American Community Survey. Although diversity varied, there were no communities that had consistently less available fresh food, although the percent of a neighborhood identifying as “white” was positively correlated with produce diversity. There may be fewer choices in neighborhoods with a higher proportion of minorities, but there were no consistent patterns of produce diversity in Broward County. This method demonstrates an easy, inexpensive way to characterize food deserts beyond simple distance, and results in precise enough information to identify gaps in the availability of healthy foods.

Neighborhood Income Inequality and Alcohol Use among Adolescents in Boston, Massachusetts

Objectives: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol consumption among adolescents. Methods: We analyzed cross-sectional data from a sample of 1878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. Results: In comparison to the first tertile of income inequality, or the most equal neighborhood, adolescent participants living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. Conclusions: Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor.

Geographic footprints of life expectancy inequalities in the state of Geneva, Switzerland

Introduction Although Switzerland has one of the highest life expectancy in the world, this global indicator may mask significant disparities at a local level. The present study used a spatial cluster detection approach on individual mortality data to investigate the geographic footprint of life expectancy inequalities in the state of Geneva, Switzerland. Methods Individual-level mortality data (n=30,592) were obtained from the Geneva’s mortuary announcements (2003-2017). We measured life expectancy inequalities through Life Expectancy Difference (LED), defined as the difference between the individual’s age at death and their Life Expectancy at Birth. We assessed the spatial dependence of LED across the state of Geneva using spatial autocorrelation statistics (Local Moran’s I). To ensure the robustness of the discovered patterns, we ran the analysis for ten random subsets of 10,000 individuals drawn from the 30,592 deceased. We also repeated the spatial analysis for LED before and after controlling for nationality and neighborhood income.Results LED was not randomly distributed across the state of Geneva. The ten random subsets revealed no significant difference in the geographic footprint of LED and the population characteristics within Local Moran cluster types, suggesting the robustness of the spatial structure obtained. The proportion of women, the proportion of Swiss, and the median neighborhood income were significantly lower for populations within low LED clusters than for populations within high LED clusters. After controlling for nationality and neighborhood income, we observed a slight reduction in the low LED cluster footprints, but we found similar differences in population characteristics between cluster types.Conclusion To the best of our knowledge, this is the first study in Switzerland using spatial cluster detection methods to investigate small area inequalities in life expectancy. We identified a clear geographic footprint of LED, which may support further investigations and guide future public health interventions at the local level.

Telehealth to increase access to transplant survivorship care for allogeneic stem cell transplant recipients regardless of distance to transplant center or neighborhood income.

e13615 Background: Transplant Survivorship Clinic at our institution serves to improve outcomes and overall health of allogeneic transplant survivors. The COVID19 pandemic allowed for growth of telemedicine in our program. We examine the patterns of use of telehealth and hypothesize that the use of telemedicine allowed continued access to care compared to the era prior to availability. We compared our transplant survivorship clinic data from July- December 2020, when telehealth was well established and compared to July-December 2019. Methods: All patients seen by the survivorship team for end of treatment visits, graft versus host disease assessments and survivorship visits annually between July-December 2019 and July-December 2020 were included. Their zip codes were used to get direct distance to survivorship clinic, average drive time, driving distance and average household income as in zip-codes.com database. Results: Total number of office visits in July-Dec 2019 was 163 visits (0% via telehealth) and in July-Dec 2020 was 228 (66.2% via telehealth). All encounters (telehealth and office visits) were lower in July and August 2020 compared to July and August 2019 but higher in months of September -December 2020 compared to 2019. Comparing all encounters during 7/2019-12/2019 to 7/2020-12/2020, there was no statistically significant difference in median age (58yr vs 60 yr), gender (males: 58% vs 59%), race (non-white: 11% vs 8.7%), median years from transplant (4yr vs 3 yrs), median income of patient neighborhood ($63,735 vs $60,465) and average drive time to center from zip code (40 min vs 51min). Comparison of patients who chose telehealth vs. office visit is summarized in table. While there was no statistically significant difference in age when comparing all encounters in 2019 and 2020, those who chose telehealth were younger (55yrs vs 60yrs, p=0.003). Conclusions: There were higher patient encounters in the 2020 period compared to 2019. Most of these 2020 encounters were via were telehealth, demonstrating the role of telehealth in increasing access. Younger patients appeared to choose telehealth, but telehealth served patients up to the age of 77 yrs. Utilization of telehealth appeared to be irrespective of demographics such as gender, neighborhood income and driving distance to the center. Comparison of telehealth vs office visit for July-December 2019 and 2020.[Table: see text]

Food Environment in and around Primary School Children’s Schools and Neighborhoods in Two Urban Settings in Kenya

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Neighborhood income inequality and alcohol use among adolescents in Boston, Massachusetts

Background Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area-units, such as neighborhoods. Methods We analyzed cross-sectional data from a sample of 1,878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. Results In comparison to the first tertile of income inequality, or the most equal neighborhood, those living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. Conclusions Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor.

Abstract P631: The Relationship of Neighborhood Greenness to Stroke/ Transient Ischemic Attack in 249,405 US Medicare Beneficiaries

Introduction: Nature exposures represent a novel environmental protective factor for chronic disease, which is understudied with respect to stroke and transient ischemic attack. The purpose of the present study is to investigate the relationship between objectively measured neighborhood greenness (vegetative presence) and Stroke/Transient Ischemic Attack (Stroke/TIA), in a population-based sample of Medicare beneficiaries. Methods: The sample was comprised of 249,405 U.S. Medicare beneficiaries ages > 65 years with the same location (ZIP+4) in Miami-Dade County, Florida, from 2010-2011. Analyses examined the relationship of greenness, measured by mean block-level Normalized Difference Vegetation Index (NDVI) from satellite imagery, to a diagnosis of Stroke/TIA. Hierarchical regression analyses, in a multi-level framework, assessed the relationship of greenness to Stroke/TIA, adjusting successively for individual age, gender, race/ethnicity, neighborhood income, and biological risk factors (diabetes, hypertension, hyperlipidemia). Secondary analyses then examined the relationship of greenness separately for specific diagnoses of Transient Ischemic Attack (TIA), Ischemic Stroke, and Hemorrhagic Stroke, respectively. Results: Higher greenness was associated with reduced risk for Stroke/TIA, adjusting for individual sociodemographics and neighborhood income: When compared to individuals residing in the lowest tertile of greenness, those individuals residing in the highest tertile of greenness had a 20% lower odds of Stroke/TIA (OR=0.80; 95% CI: 0.74, 0.86, p<0.0001), as well as a 26% lower odds of TIA (OR=0.74; 95% CI: 0.66, 0.82; p<0.0001) and a 16% lower odds of Ischemic Stroke (OR=0.84; 95% CI: 0.75, 0.95; p=0.0050), but did not have a statistically significantly reduced odds of Hemorrhagic Stroke (OR=0.84; 95% CI: 0.61, 1.16; p=0.2990). Associations were attenuated after adjusting for biological risk factors, suggesting that cardiometabolic risk factors may partly mediate greenness’ relationship to stroke and TIA. Conclusions: Neighborhood greenness may be associated with reduced risk of Stroke/TIA. Policies and strategies to increase greenness may be a future means of reducing Stroke/TIA at the population level.