Inclusive Soundscapes: How Race, Socioeconomic Status and Maternal Age Influence the Pediatric Cochlear Implant Journey.

OBJECTIVE: This study aimed to assess how race, social vulnerability, and maternal age influence pediatric cochlear implant access and usage. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary Pediatric University Hospital. METHODS: This study included individuals aged 0 to 18 who received a cochlear implant at our center between the years 2000 and 2022. Social vulnerability data from 2020 was obtained from the Centers for Disease Control and Prevention. RESULTS: Of the 302 patients included in our study, 43% were black and 50% were white. Patients from the highest to lowest social vulnerability quintiles comprised 31%, 25%, 18%, 10%, and 14% of our sample, respectively. Race was associated with social vulnerability index (SVI) (P < .001), with a mean score of 0.70 (±0.26) and 0.49 (±0.27) for black and white patients, respectively. Later age at hearing loss (HL) diagnosis and cochlear implantation (CI) were associated with more and most vulnerable SVI (P < .05). Delayed diagnosis was also associated with black and other racial groups (P = .041), and adolescent maternal age (P = .03). Greater SVI was associated with less daily cochlear implant usage (P = .004). The most vulnerable patients were more likely to be lost to follow-up (P = .03) despite no difference based on maternal age (P = .59) and insurance status (P = .47). CONCLUSION: This study underscores the significance of mitigating disparities in timely diagnosis of HL, consistent CI usage, and appropriate follow-up care. This is a first step toward the formulation of novel strategies aimed at overcoming barriers and developing appropriate intervention programs.

Livelihood vulnerability to climate change health impacts among Amhara Sayint district community, northeastern Ethiopia: A composite index approach.

Climate change significantly impacts public health, affecting nearly everyone across the globe and contributing to approximately 10% of global mortality. Ethiopia is particularly vulnerable to the changing climate attributed impacts due to economic, and social determinants. While research on climate change is expanding, it often prioritizes its effects on agriculture. The impacts from public health perspective are frequently overlooked. We address this shortcoming by evaluating the vulnerability of the community in the district of Amhara Sayint, Amhara, northeastern Ethiopia, to the health impacts of climate change, and identifying factors involved. Data was collected using a community-based cross-sectional approach, involving 605 randomly selected households between July Twenty and September Five, 2022. The data collection process utilized a validated and pilot-tested questionnaire, which was administered through face-to-face interview with the aid of Kobo Collect toolbox. The community's vulnerability was assessed using the IPCC's framework of vulnerability. Household's Vulnerability status was then classified into three levels according to their Livelihood Vulnerability Index (LVI) score. A partial proportional oddsapproach of ordinal logistic regression model was used to identify factors associated with vulnerability to climate change attributed health impacts. Among the 605 respondents, 48% (95% CI: 44.1, 52.1) were identified as vulnerable, and about 4.6 % (95% CI: 3, 6.6) were classified as highly vulnerable. Wealth status (AOR1 = 1.8; 95 % CI: 1.2, 2.8), educational status (AOR1 = 2.8; 95% CI: 1.1, 7.3), marital status (AOR2 = 4.7, 95% CI: 1.6, 13.4), and home crowdedness (AOR2 = 2.9, 95% CI: 1.1, 8.1) significantly associated with vulnerability. Over half of the residents in the district wereeither being vulnerable or highly vulnerable to climate change attributed health impacts. Therefore, prioritizing prevention and preparedness along with conducting spatial analysis to identify high-risk areas for timely intervention, is essential.

Comparison of Neighborhood Disadvantage Indices on Emergency Medical Services Interventions and Outcomes for Pediatric Out-of-Hospital Emergencies.

OBJECTIVE: Measures of neighborhood disadvantage demonstrate correlations to health outcomes in children. We compared differing indices of neighborhood disadvantage with emergency medical services (EMS) interventions in children. METHODS: We performed a retrospective study of EMS encounters for children (<18 years) from approximately 2000 US EMS agencies between 2021 and 2022. Our exposures were the Child Opportunity Index (COI; v2.0), 2021 Area Deprivation Index (ADI), and 2018 Social Vulnerability Index (SVI). We evaluated the agreement in how children were classified with each index using the intraclass correlation coefficient. We used logistic regression to evaluate the association of each index with transport status, presence of cardiac arrest, and condition-specific interventions and assessments. RESULTS: We included 738,892 encounters. The correlation between the indices indicated good agreement (intraclass correlation coefficient=0.75). There was overlap in relationships between the COI, ADI, and SVI for each of the study outcomes, both when visualized as a splined predictor and when using representative odds ratios (OR) comparing the third quartile of each index to the lower quartile (most disadvantaged). For example, the OR of non-transport was 1.12 (95% confidence interval [CI]: 1.10-1.14) for COI, 1.18 (95% CI: 1.16-1.20) for ADI, and 1.22 (95% CI: 1.20-1.23) for SVI. CONCLUSION: The COI, ADI, and SVI had good correlation and demonstrated similar effect size estimates for a variety of clinical outcomes. While investigators should consider potential causal pathways for outcomes when selecting an index for neighborhood disadvantage, the relative strength of association between each index and all outcomes was similar.

Evaluating the Association Between Social Vulnerability and Outcomes of Heart Transplantation in the United States.

INTRODUCTION: The Social Vulnerability Index (SVI) is a tool that was developed by the Centers for Disease Control and Prevention to help identify communities that are at risk of harm from social, economic, or environmental factors. This study evaluates the association between SVI and outcomes of adult heart transplantation (HT) in the United States. METHODS: The United Network for Organ Sharing registry was used to identify all isolated adult (≥18 y) HT recipients and their home address zip codes between 2010 and 2021. Recipients were classified into three SVI risk groups: low risk (SVI: <0.33), intermediate risk (SVI: 0.33-0.65), and high risk (SVI: ≥0.66). Kaplan-Meier analysis was used to estimate recipient survival probability based on SVI risk. Multivariable Cox proportional hazard models were built to evaluate the association of SVI with 1- and 5-y mortality. RESULTS: A total of 22,400 recipients distributed over 9753 zip codes were included. Unadjusted 1-y survival rates in the three risk groups were as follows: low risk: 90.5%, intermediate risk: 91.1%, high risk 90.9%, and Log-rank P = 0.550 and 5-y survival rates were as follows: low risk: 80.8%, intermediate risk: 78.6%, high risk: 76.1%, and Log-rank P < 0.001. Compared to low-risk recipients, risk-adjusted 1-y mortality hazard ratio was 1.02 (0.92-1.14, P = 0.657) for intermediate risk and 1.09 (0.95-1.24, P = 0.222) for high-risk recipients. Risk-adjusted 5-y mortality hazard ratio was 1.07 (0.99-1.16, P = 0.095) for intermediate-risk recipients and 1.17 (1.06-1.28, P = 0.002) for high-risk recipients. CONCLUSIONS: Social vulnerability is associated with HT outcomes. The Centers for Disease Control and Prevention SVI may be a useful tool in identifying at-risk geographic areas where targeted efforts may be prudent for reducing disparities in HT outcomes.

Analyzing the Social Vulnerability Index With Metabolic Surgery.

INTRODUCTION: The social vulnerability index (SVI) is a census tract-level population-based measure generated from 16 socioeconomic and demographic variables on a scale from 1 (least) to 100 (most) vulnerable. This study has three objectives as follows: 1) to analyze multiple ways of utilizing SVI, 2) compare SVI as a group measure of marginalization to individual markers, and 3) to understand how SVI is associated with choice of surgery in metabolic surgery. METHODS: We retrospectively identified adults undergoing Roux-en-Y gastric bypass and gastric sleeve in 2013-2018 National Surgical Quality Improvement Program data from a single academic center. High SVI was defined as >75th percentile. Low SVI was coded as <75th percentile in measure 1 and < 25th percentile in measure 2. Chi-square and Mann-Whitney U tests were utilized for categorical and continuous variables, respectively. Multivariable regression models were performed comparing SVI to marginalized status as a predictor for type of metabolic surgery. RESULTS: We identified 436 patients undergoing metabolic surgery, with a low overall morbidity (6.1%). Complication and readmission rates were similar across comparator groups. The logistic regression models had similar area under the curve, supporting SVI as a proxy for individual measures of marginalization. CONCLUSIONS: SVI performed as well as marginalized status in predicting preoperative risk. This suggests the validity of using SVI to identify high risk patients. By providing a single, quantitative score encompassing many social determinants of health, SVI is a useful tool in identifying patients facing the greatest health disparities.

Is naloxone where it needs to be? Using spatial analytics to examine equitable distribution of community-based naloxone sites.

BACKGROUND: One of the most effective harm reduction services for preventing opioid overdose deaths is naloxone. Given the ongoing opioid crisis, which has led to a surge in overdose deaths across the country, expanding access to naloxone is critical. Community-based naloxone distributions sites in Palm Beach County can increase access to naloxone. However, several rural and disadvantaged regions rarely have any type of access to naloxone. The purpose of this descriptive paper is to examine the spatial distribution of and evaluate equitable accessibility to community-based naloxone sites in Palm Beach County. METHODS: We examined health equity in the distribution of community-based naloxone sites using a mixed-methods approach with ArcGIS Pro version 3.0, which is a geographic information system (GIS) software used for mapping, spatial analysis, and data visualization. RESULTS: The Belle Glade region was identified as the location most adversely affected with health inequities and limited accessibility to naloxone distribution sites, as it ranked in the 100 % percentile for all social vulnerability index (SVI) themes. The 30-minute drive-time area calculated a county service area of 1885.3 km2 (km2), which covers about 34 % of the 478.0 km2 land area of census tracts. Drive-time areas did not account for periods of heavier traffic such as during rush hour. Maximum distances during heavier traffic may be smaller, thus decreasing accessibility to naloxone distribution sites. CONCLUSION: There is a need for effective policy-led strategies tailored to expanding our understanding of the challenges that are experienced by the individuals in need of naloxone and encountered by the distribution sites themselves, as accessible naloxone is crucial for preventing nonfatal and fatal overdoses and ensuring timely emergency responses in vulnerable communities.

Microplastic dynamics and risk projections in West African coastal areas: Developing a vulnerability index, adverse ecological pathways, and mitigation framework using remote-sensed oceanographic profiles.

Microplastic pollution presents a serious risk to marine ecosystems worldwide, with West Africa being especially susceptible. This study sought to identify the key factors driving microplastic dynamics in the region. Using NASA's Giovanni system, we analyzed environmental data from 2019 to 2024. Results showed uniform offshore air temperatures due to turbulence (25.22-45.62 K) with significant variations nearshore. Salinity levels remained largely stable (4 PSU) but slightly decreased in southern Nigeria. Surface wind speeds rose from 4.206-5.026 m/s in Nigeria to over 5.848 m/s off Mauritania, while eastward stress hotspots were prominent in Nigeria and from Sierra Leone to Senegal. Photosynthetically available radiation (PAR) beam values peaked off Mauritania and dipped from Nigeria to Sierra Leone, with the inverse pattern observed for diffuse PAR. Hotspots of high absorption, particulate backscattering, elevated aerosol optical depth, and remote sensing reflectance all pointed to substantial particulate matter concentrations. The Microplastic Vulnerability Index (MVI) identifies the coastal stretch from Nigeria to Guinea-Bissau as highly vulnerable to microplastic accumulation due to conditions that favor buildup. In contrast, moderate vulnerability was observed from Guinea-Bissau to Senegal and in Mauritania, where conditions were less extreme, such as higher offshore temperatures that could promote widespread microplastic suspension and cooler nearshore temperatures that favor sedimentation. Increased turbulence and temperatures in coastal areas of Senegal and Mauritania may enhance microplastic transport and impact marine life. In Nigeria, stable coastal conditions-characterized by consistent temperatures, low turbulence, and uniform salinity-may lead to increased persistence and accumulation of microplastics in sensitive habitats like mangroves and coral reefs. These findings highlight the need for region-specific management strategies to address microplastic pollution and effectively protect marine ecosystems.

Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020-2023.

Background: Inequities in stroke outcomes have existed for decades, and the COVID-19 pandemic amplified these inequities. Objectives: This study examined the association between social vulnerability and all-cause mortality among Medicare beneficiaries hospitalized with acute ischemic stroke (AIS) during COVID-19 pandemic periods. Methods: We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS between April 1, 2020, and December 31, 2021 (followed until December 31, 2023) merged with county-level data from the 2020 Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's Social Vulnerability Index (SVI). We used a Cox proportional hazard model to examine the association between SVI quartile and all-cause mortality. Results: Among 176,123 Medicare fee-for-service beneficiaries with AIS, 29.9% resided in the most vulnerable counties (SVI quartile 4), while 14.9% resided in counties with least social vulnerability (SVI quartile 1). AIS Medicare beneficiaries living in the most vulnerable counties had the highest proportions of adults aged 65 to 74 years, non-Hispanic Black or Hispanic, severe stroke at admission, a history of COVID-19, and more prevalent comorbidities. Compared to those living in least vulnerable counties, AIS Medicare beneficiaries living in most vulnerable counties had significantly higher all-cause mortality (adjusted HR: 1.11, 95% CI: 1.08-1.14). The pattern of association was largely consistent in subgroup analyses by age group, sex, and race and ethnicity. Conclusions: Higher social vulnerability levels were associated with increased all-cause mortality among AIS Medicare beneficiaries. To improve outcomes and address disparities, it may be important to focus efforts toward addressing social vulnerability.

Evaluating the Influence of Social Determinants of Health on Blood Phenylalanine Levels in Phenylketonuria Patients.

Phenylketonuria (PKU) is a genetic metabolic disorder that causes the accumulation of phenylalanine (Phe) in tissues, leading to intellectual disability, seizures, and socioemotional challenges. The role of social determinants of health (SDOH) in PKU management has not been formally studied, and this investigation evaluates the association between in-home and in-office factors on blood Phe levels in PKU patients. We conducted a retrospective chart review on over 200 patients attending the well-resourced PKU Clinic at Lurie Children's Hospital of Chicago. Data included patients' average Phe level, various demographic information, and CDC/ATSDR social vulnerability index (SVI) score. The analysis revealed no significant association between social vulnerability status and average Phe level. However, a significant correlation was found between sapropterin dihydrochloride use and average Phe level. Age interacted separately with sex assigned at birth, pegvaliase use, total Phe samples submitted, and the presence of genetic testing to significantly influence the average Phe level. This study highlights the multifactorial influences on PKU management and underscores the importance of social resources, such as clinic social workers and state-provided formula, in modulating the effects of SDOH on PKU control. Further research in different healthcare settings is needed to understand the social determinants affecting PKU patients comprehensively, which will strengthen advocacy efforts for this population.

Changes of ecological vulnerability in areas with different urban expansion patterns- A case study in the Yanhe river basin, China.

Urban expansion has the potentiality to disrupt ecosystems and form highly fragile urban landscapes. However, studies investigating the impact of different urban expansion patterns on the ecological environments are relatively limited. Taking the Yanhe river basin, a typical basin in a loess region, as a case study, we developed an ecological vulnerability assessment system as well as assessed the main drivers of ecological vulnerability for different time periods (1990, 2000, 2010 and 2018). Additionally, we classified each urban expansion region into three different patterns according to the landscape expansion index, and analyzed changes in the ecological vulnerability under these three diverse patterns. Finally, the Kruskal-Wallis rank sum test was applied to compare the factors for the different changes in ecological vulnerability across different urban expansion patterns. Our investigation also aimed to elucidate the impacts of different urban expansion patterns on ecological vulnerability and identify key physical-social-economic-climatic drivers. The results indicate that the ecological vulnerability index (EVI) of the study area is decreasing gradually from the peak value of 0.459 in 2000 to 0.383 in 2018. Habitat quality index is found to be the most influencing factor, followed by aridity index and building density (mean q of 0.53, 0.46, and 0.42, respectively). Our study also reveals that the outlying expansion areas have the greatest increase in EVI at 0.38, with edge and infill expansions at 0.31 and 0.27, respectively. It is also found that when the overall environment is improving, the outlying expansion areas have the smallest decrease in EVI. Initial ecological vulnerability and key drivers may explain this difference. Therefore, results of this study indicate that the ecological impacts of diverse urban expansion patterns are significantly different, among which outlying expansions should receive prioritized attention.

Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States.

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

The role of agroforestry systems for addressing climate change livelihood vulnerability of farmers of Northwestern Ethiopia.

Farmers in Ethiopia have been vulnerable to climate change in recent decades. In the face of this change, farmers have managed agroforestry systems to maintain their livelihoods. However, studies exploring the role of agroforestry in reducing household vulnerability are lacking in Northwestern Ethiopia. The objectives of the study were to (i) investigate households' livelihoods vulnerability to climate change in Northwestern Ethiopia; (iii) assess the role of agroforestry in mitigating the negative impacts of climate change on farmers livelihoods. Key informant interviews, in-depth interviews, household surveys (387), and focus group discussions were used to collect the data. Descriptive statistics, principal component analysis, the X2-test, and the t-test were run to analyze the data. The findings revealed that households are vulnerable to rising temperatures, rainfall variability, frost, disease and pests, erosion, hailstorms, price hikes, wildlife damage to crops, and health stress. Agroforestry non-practitioners had a higher livelihood vulnerability index (LVI) (0.42 ± 0.081) than practitioners (0.46 ± 0.079). The Livelihood Vulnerability-Intergovernmental Panel for Climate Change Index (LVI-IPCC) showed that AF non-practitioners had a higher exposure (0.58), sensitivity (0.54) index, and a lower adaptive capacity index (0.44) than the exposure (0.34), sensitivity (0.38), and adaptive capacity index (0.51) of practitioners. Plant diversity, income level and diversity, livelihood activities, social network, and food security status of farmers were improved by agroforestry. Farmers were therefore less susceptible to adverse climate shocks. Thus, the AF system could be part of future adaptation and resilience programs that provide dependable tools to minimize households' vulnerability to climate shocks. However, management guidelines, such as understanding local ecosystems, setting clear objectives, choosing suitable species, planning for diversity, considering the market, and regular maintenance and monitoring, are needed for agroforestry to improve its contribution.

Impact of social vulnerability index on patients with alcohol-related liver disease.

INTRODUCTION: Alcohol related liver disease (ALD) affects diverse communities with individual and social characteristics that can impact outcomes. The social vulnerability index (SVI) assigns a score between 0 and 1, where higher scores represent an increased risk of social vulnerability. We sought to assess the impact of SVI on outcomes of patients hospitalized with ALD with access to social support services. METHODS AND MATERIALS: Hospitalizations for ALD at our institution between March and August 2019 were reviewed. All patients were assigned an SVI score based on their residential census tract. Per our standard practice, patients were screened by care coordinators to identify needs for rehabilitation counseling, and care coordination after discharge. Demographics, hepatic decompensation, critical care needs, readmission, and mortality were compared. RESULTS: Among 73 patients admitted for alcoholic hepatitis, 32 had a low SVI and 42 had a high SVI. African American patients were more likely to have a higher SVI (35% vs 0%, p=<0.001). No significant difference in outcomes based on SVI was noted. There were 393 patients admitted for alcoholic cirrhosis including 166 with a low SVI and 227 with a high SVI. Patients that were African American (23.6% vs 5.5%, p=<0.001) or disabled (41.4% vs 29.5%, p = 0.008) had a higher SVI. No significant difference in outcomes based on SVI was noted. CONCLUSION: Most patients admitted for ALD had a high SVI; however, SVI did not impact hospitalization outcomes.

A health equity science approach to assessing drivers of COVID-19 vaccination coverage disparities over the course of the COVID-19 pandemic, United States, December 2020-December 2022.

INTRODUCTION: Health equity science examines underlying social determinants, or drivers, of health inequities by building an evidence base to guide action across programs, public health surveillance, policy, and communications efforts. A Social Vulnerability Index (SVI) was utilized during the COVID-19 response to identify areas where inequities exist and support communities with vaccination. We set out to assess COVID-19 vaccination coverage by two SVI themes, Racial and Ethnicity Minority Status and Housing Type and Transportation to examine disparities. METHODS: US county-level COVID-19 vaccine administration data among persons aged 5 years and older reported to the Centers for Disease Control and Prevention from December 14, 2020 to December 14, 2022, were analyzed. Counties were categorized 1) into tertiles (low, moderate, high) according to each SVI theme's level of vulnerability or 2) dichotomized by urban or rural classification. Primary series vaccination coverage per age group were assessed for SVI social factors by SVI theme tertiles or urbanicity. RESULTS: Older adults aged 65 years and older had the highest vaccination coverage across all vulnerability factors compared with children aged 5-17 years and adults aged 18-64 years. Overall, children and adults had higher vaccination coverage in counties of high vulnerability. Greater vaccination coverage differences were observed by urbanicity as rural counties had some of the lowest vaccination coverage for children and adults. CONCLUSION: COVID-19 vaccination efforts narrowed gaps in coverage for adults aged 65 years and older but larger vaccination coverage differences remained among younger populations. Moreover, greater disparities in coverage existed in rural counties. Health equity science approaches to analyses should extend beyond identifying differences by basic demographics such as race and ethnicity and include factors that provide context (housing, transportation, age, and geography) to assist with prioritization of vaccination efforts where true disparities in vaccination coverage exist.

Climate change and resilience of the Senegalese health system in the face of the floods in Keur Massar.

This article is based on the observation that the affected populations perceive existing community-based adaptation strategies to the health effects of floods differently. We explore the resilience of the local health system to climate change (CC) in Keur Massar (Senegal) using a monographic approach based on a qualitative survey of flooded households, health professionals, hygiene agents, community health actors, administrative and local authorities, agents from the Ministries of Health and Environment, and experts from the ecological and meteorological monitoring centre (n = 72). The effects of CC on health are modulated by financial, organisational, social and cultural factors. The effects of CC on health are modulated by traditionally praised by self-centred health governance, which is often based on standardisation of problems and thus not sufficiently attuned to local contexts, especially the climate vulnerability index (CVI) of households and health structures. Despite the existence of programs to combat the consequences of CC, the notorious lack of exhaustive mapping of areas with a high CVI hinders the effective management of the health of the affected populations. A typology of forms of mobility in the context of flooding-ground floor to the upper floor, borrowing a room, renting a flat, seasonal residence-reveals inequalities in access to care as well as specific health needs management of vector-borne diseases, discontinuity of maternal, newborn and child health care, and psychosocial assistance. The article outlines how a health territorialisation based on surveillance and response mechanisms can be co-constructed and made sustainable in areas with a high CVI. Integrating this approach into national health policies allows for equity in health systems efficiently and sustainably.

Association of US county-level social vulnerability index with breast, colorectal, and lung cancer screening, incidence, and mortality rates across US counties.

Background: Despite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Materials and methods: Using county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median. Results: Our study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates. Conclusion: In conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.

Gestational exposure to wildfire PM2.5 and its specific components and the risk of gestational hypertension and eclampsia in the southwestern United States.

In the southwestern United States, the frequency of summer wildfires has elevated ambient PM2.5 concentrations and rates of adverse birth outcomes. Notably, hypertensive disorders in pregnancy (HDP) constitute a significant determinant associated with maternal mortality and adverse birth outcomes. Despite the accumulating body of evidence, scant research has delved into the correlation between chemical components of wildfire PM2.5 and the risk of HDP. Derived from data provided by the National Center for Health Statistics, singleton births from >2.68 million pregnant women were selected across 8 states (Arizona, AZ; California, CA, Idaho, ID, Montana, MT; Nevada, NV; Oregon, OR; Utah, UT, and Wyoming, WY) in the southwestern US from 2001 to 2004. A spatiotemporal model and a Goddard Earth Observing System chemical transport model were employed to forecast daily concentrations of total and wildfire PM2.5-derived exposure. Various modeling techniques including unadjusted analyses, covariate-adjusted models, propensity-score matching, and double robust typical logit models were applied to assess the relationship between wildfire PM2.5 exposure and gestational hypertension and eclampsia. Exposure to fire PM2.5, fire-sourced black carbon (BC) and organic carbon (OC) were associated with an augmented risk of gestational hypertension (ORPM2.5 = 1.125, 95 % CI: 1.109,1.141; ORBC = 1.247, 95 % CI: 1.214,1.281; OROC = 1.153, 95 % CI: 1.132, 1.174) and eclampsia (ORPM2.5 = 1.217, 95 % CI: 1.145,1.293; ORBC = 1.458, 95 % CI: 1.291,1.646; OROC = 1.309, 95 % CI: 1.208,1.418) during the pregnancy exposure window with the strongest effect. The associations were stronger that the observed effects of ambient PM2.5 in which the sources primarily came from urban emissions. Social vulnerability index (SVI), education years, pre-pregnancy diabetes, and hypertension acted as effect modifiers. Gestational exposure to wildfire PM2.5 and specific chemical components (BC and OC) increased gestational hypertension and eclampsia risk in the southwestern United States.

Trends in youth acute care hospital visits for anxiety and depression in Illinois.

PURPOSE: This study analyzes the trajectory of youth emergency department or inpatient hospital visits for depression or anxiety in Illinois before and during the COVID-19 pandemic. METHODS: We analyze emergency department (ED) outpatient visits, direct admissions, and ED admissions by patients ages 5-19 years coded for depression or anxiety disorders from 2016 through June 2023 with data from the Illinois Hospital Association COMPdata database. We analyze changes in visit rates by patient sociodemographic and clinical characteristics, hospital volume and type, and census zip code measures of poverty and social vulnerability. Interrupted times series analysis was used to test the significance of differences in level and trends between 51 pre-pandemic months and 39 during-pandemic months. RESULTS: There were 250,648 visits to 232 Illinois hospitals. After large immediate pandemic decreases there was an estimated -12.0 per-month (p = 0.003, 95% CI -19.8-4.1) decrease in male visits and a - 13.1 (p = 0.07, 95% CI -27 -1) per-month decrease in female visits in the during-pandemic relative to the pre-pandemic period. The reduction was greatest for outpatient ED visits, for males, for age 5-9 and 15-19 years patients, for smaller community hospitals, and for patients from the poorest and most vulnerable zip code areas. CONCLUSIONS: llinois youth depression and anxiety hospital visit rates declined significantly after the pandemic shutdown and remained stable into 2023 at levels below 2016-2019 rates. Further progress will require both clinical innovations and effective prevention grounded in a better understanding of the cultural roots of youth mental health.

Workplace Exposures Vary Across Neighborhoods in the US: Implications on Social Vulnerability and Racial/Ethnic Health Disparities.

Ignoring workplace exposures that occur beyond the local residential context in place-based risk indices like the CDC's Social Vulnerability Index (SVI) likely misclassifies community exposure by under-counting risks and obscuring true drivers of racial/ethnic health disparities. To investigate this hypothesis, we developed several place-based indicators of occupational exposure and examined their relationships with race/ethnicity, SVI, and health inequities. We used publicly available job exposure matrices and employment estimates from the United States (US) Census to create and map six indicators of occupational hazards for every census tract in the US. We characterized census tracts with high workplace-low SVI scores. We used natural cubic splines to examine tract level associations between the percentage of racial/ethnic minorities (individuals who are not non-Hispanic White) and the occupational indicators. Lastly, we stratified each census tract into high/low occupational noise, chemical pollutant, and disease/infection exposure to examine racial/ethnic health disparities to diabetes, asthma, and high blood pressure, respectively, as a consequence of occupational exposure inequities. Our results show that racial/ethnic minority communities, particularly those that are also low-income, experience a disproportionate burden of workplace exposures that may be contributing to racial/ethnic health disparities. When composite risk measures, such as SVI, are calculated using only information from the local residential neighborhood, they may systematically under-count occupational risks experienced by the most vulnerable communities. There is a need to consider the role of occupational justice on nationwide, racial/ethnic health disparities.

Social vulnerability and prenatal diagnosis.

OBJECTIVES: There are limited data on how neighborhood-level risk factors affect the likelihood of having prenatal diagnosis. Neighborhood social vulnerability can be quantified and ranked using the social vulnerability index (SVI), a tool that measures the cumulative effect of external stressors in the local environment that may affect health outcomes. The objective of the study was to determine the relationship between SVI and prenatal diagnosis among pregnant patients who received genetic counseling. METHODS: Retrospective cohort study of all pregnant patients who had genetic counseling at two hospitals in New York between January 2019 and December 2022. For each patient, the address of residence was linked to an SVI score (primary exposure) based on census tract. SVI scores were subdivided into fifths and analyzed categorically. The primary outcome was prenatal diagnosis (yes/no). Multivariable logistic regression was performed. RESULTS: A total of 5,935 patients were included for analysis and 231 (3.9 %) had prenatal diagnosis. On regression analysis, no association between SVI and prenatal diagnosis was observed. Patients who had a diagnostic procedure were more likely to be English speaking (aOR 1.80; 95 % CI 1.13-2.87), carriers of a genetic disorder (aOR 1.94; 95 % CI 1.32-2.86), had increased NT (aOR 6.89; 95 % CI 3.65-13.00), abnormal NIPS (aOR 9.58; 95 % CI 5.81-15.80), or had fetal structural anomalies (aOR 10.60; 95 % CI 6.62-16.96). No differences were seen based on race and ethnicity group, insurance type, or marital status. CONCLUSIONS: SVI score does not affect rate of prenatal diagnosis. Findings may differ in other geographic regions and populations.