Spatial and Temporal Patterns of Chronic Disease Burden in the U.S., 2018-2021.

INTRODUCTION: Chronic diseases are primary causes of mortality and disability in the U.S. Although individual-level indices to assess the burden of multiple chronic diseases exist, there is a lack of quantitative tools at the population level. This gap hinders the understanding of the geographical distribution and impact of chronic diseases, crucial for effective public health strategies. This study aimed to construct a Chronic Disease Burden Index (CDBI) for evaluating county-level disease burden, to identify geographic and temporal patterns, and investigate the association between CDBI and social vulnerability. METHODS: 20 health measures from CDC's PLACES database (2018-2021) were used to construct annual county-level CDBIs through principal component analysis. Geographic hotspots of chronic disease burden were identified using Getis-Ord Gi*. Multinomial logistic regression models and bivariate maps were used to assess the association between CDBI and CDC's social vulnerability index (SVI). Analyses were conducted in 2023-2024. RESULTS: Counties with high chronic disease burden were predominantly clustered in the southern U.S. High persistent chronic disease burden was prevalent in Kentucky and West Virginia, while increased burden was observed in Ohio and Texas. Chronic disease burden was highly associated with SVI (ORQ5 vs Q1= 7.6, 95% CI: [6.6, 8.8]), with non-metro urban counties experiencing elevated CDBI (OR = 14.6 95% CI: [9.7, 21.9]). CONCLUSIONS: The CDBI offers an effective tool for assessing chronic disease burden at the population-level. Identifying high burden and vulnerable communities is a crucial first step towards facilitating resource allocation to enhance equitable healthcare access and advancing understanding of health disparities.

Geospatial Analysis for Prehospital Extracorporeal Cardiopulmonary Resuscitation in Houston, Texas.

OBJECTIVES: Extracorporeal cardiopulmonary resuscitation (eCPR) is a promising treatment that could improve survival for refractory out-of-hospital (OHCA) patients. Healthcare systems may choose to start eCPR in the prehospital setting to optimize time to eCPR initiation and decrease low-flow time. We used geospatial modeling to evaluate different eCPR catchment strategies for a forthcoming prehospital eCPR program in Houston, Texas. METHODS: We studied OHCAs treated by the Houston Fire Department from 2013 to 2021. We included OHCA patients aged 18-65 years old with an initial shockable rhythm that did not have prehospital return of spontaneous circulation (ROSC). Based on the geolocation that each OHCA occurred, we used geospatial modeling to identify eCPR candidates using four mapping strategies based on distance/drive time from the eCPR center: 1) 15-minute drive time, 20-minute drive time, 10-mile drive distance, and 15-mile drive distance. RESULTS: Of 18,501 OHCAs during the study period, 881 met the eCPR inclusion criteria. Compared to non-eCPR candidates, eCPR candidates were younger (median age 52.3 years vs 62.7 years, p < 0.01) and had a higher proportion of males (76.6% v 59.8%, p < 0.01). Of eCPR candidate OHCAs, OHCAs occurred more frequently during the weekdays and the daytime, with 5:00 PM being the most common time. Using geospatial modeling and based on drive time, 219 OHCAs (24.9% of 881) were within a 15-minute drive, and 454 (51.5%) were within a 20-minute drive. Using drive distance, 383 eCPR candidates (43.5%) were within 10 miles, and 703 (79.8%) were within 15 miles. CONCLUSIONS: Using geospatial modeling, we demonstrated a process to estimate potential eCPR patient volumes for a geographic region. Geospatial modeling represents a viable strategy for healthcare systems to delineate eCPR catchment areas.

Morphology, performance and fluid dynamics of the crayfish escape response.

Sexual selection can result in an exaggerated morphology that constrains locomotor performance. We studied the relationship between morphology and the tail-flip escape response in male and female rusty crayfish (Faxonius rusticus), a species in which males have enlarged claws (chelae). We found that females had wider abdomens and longer uropods (terminal appendage of the tail fan) than males, while males possessed deeper abdomens and larger chelae, relative to total length. Chelae size was negatively associated with escape velocity, whereas longer abdomens and uropods were positively associated with escape velocity. We found no sex-specific differences in maximum force generated during the tail flip, but uropod length was strongly, positively correlated with tail-flip force in males. Particle image velocimetry (PIV) revealed that the formation of a vortex, rather than the expulsion of fluid between two closing body surfaces, generates propulsion in rusty crayfish. PIV also revealed that the pleopods (ventral abdominal appendages) contribute to the momentum generated by the tail. To our knowledge, this is the first confirmation of vortex formation in a decapod crustacean.