Examining the Associations of and Interactions Between Intrapersonal and Perceived Environmental Factors With Objectively Assessed Physical Activity Among Rural Midwestern Adults, USA.

PURPOSE: We investigated associations of intrapersonal and environmental factors with objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes, and their interactions in rural adults. DESIGN: Cross-sectional. SETTING: 14 rural towns participating in a multilevel intervention to promote physical activity. SAMPLE: Baseline data from 241 rural community members (19% losses due to missing data). MEASURES: Self-reported demographics, behavioral factors, and neighborhood environment perceptions. Weekly MVPA minutes were assessed using accelerometry data. ANALYSIS: Generalized linear models using a negative binomial distribution examined associations of and interactions between intrapersonal and environmental correlates with weekly MVPA. RESULTS: Older age (ß = -1.37; P= .025) and identifying as a woman (ß = -.71; p= <.001) were inversely associated with MVPA. Self-efficacy (ß = .34; p = <.001) and trail use (ß = .44; P-value = .003) were directly associated with MVPA. Further, among women, perceived safety from traffic was inversely associated with MVPA (ß = -.37; P = .003), while indoor recreational facility access was directly associated with MVPA (ß = .24; P = .045). CONCLUSIONS: Rural residents, especially women, face disproportionately lower MVPA levels. Improving recreational access and self-efficacy may be effective strategies for increasing MVPA.

Understanding contributors to racial and ethnic inequities in COVID-19 incidence and mortality rates.

BACKGROUND: Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts. METHODS: We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors. RESULTS: As of September 10, 2020 there were 73,635 confirmed COVID-19 cases in the State of Missouri. Among the 64,526 case records (87.7% of all cases) that merged with prior demographic and health care utilization data, 12,946 (20.1%) were Non-Hispanic (NH) Black, 44,550 (69.0%) were NH White, 3,822 (5.9%) were NH Other/Unknown race, and 3,208 (5.0%) were Hispanic. Raw cumulative case rates for NH Black individuals were 1,713 per 100,000 population, compared with 2,095 for NH Other/Unknown, 903 for NH White, and 1,218 for Hispanic. Cumulative COVID-19-related death rates for NH Black individuals were 58.3 per 100,000 population, compared with 38.9 for NH Other/Unknown, 19.4 for NH White, and 14.8 for Hispanic. In a model that included insurance source, history of a social determinant billing code in the patient's claims, census block travel change, population density, Area Deprivation Index, and clinical comorbidities, NH Black race (OR 1.75, 1.51-2.04, p<0.001) and NH Other/Unknown race (OR 1.83, 1.36-2.46, p<0.001) remained strongly associated with mortality. CONCLUSIONS: In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19.

Helpline Calls Associated With Preventable Emergency Department Utilization.

INTRODUCTION: Unmet social needs are linked with greater healthcare utilization, but most studies lack timely and granular data on these needs. The 2-1-1 helpline is a telephone helpline focused on social needs. The objective of the study is to determine whether the number of 2-1-1 requests per 1,000 people is associated with preventable emergency department visits and compare the strength of the association with another commonly used predictor, Area Deprivation Index. METHODS: This cross-sectional study linked 2-1-1 requests to emergency department visits from uninsured and Medicaid-insured patients by ZIP code for a large urban hospital system from January 1, 2016 to August 31, 2019. Negative binomial regression analysis was used to estimate the association of 2-1-1 service requests and Area Deprivation Index with preventable emergency department visits. RESULTS: A total of 233,146 preventable emergency department visits and 520,308 2-1-1 requests were analyzed. For every 1-SD increase in 2-1-1 requests per 1,000 population, preventable emergency department visits increased by a factor of 3.05, even after controlling for local area deprivation and other population characteristics (p<0.001). CONCLUSIONS: Requests to 2-1-1 helplines are strongly associated with preventable emergency department visits. This information may help hospital leaders and policymakers target social needs interventions to the neighborhoods with the greatest need.

Characteristics of The Cancer Genome Atlas cases relative to U.S. general population cancer cases.

BACKGROUND: Despite anecdotal reports of differences in clinical and demographic characteristics of The Cancer Genome Atlas (TCGA) relative to general population cancer cases, differences have not been systematically evaluated. METHODS: Data from 11,160 cases with 33 cancer types were ascertained from TCGA data portal. Corresponding data from the Surveillance, Epidemiology, and End Results (SEER) 18 and North American Association of Central Cancer Registries databases were obtained. Differences in characteristics were compared using Student's t, Chi-square, and Fisher's exact tests. Differences in mean survival months were assessed using restricted mean survival time analysis and generalised linear model. RESULTS: TCGA cases were 3.9 years (95% CI 1.7-6.2) younger on average than SEER cases, with a significantly younger mean age for 20/33 cancer types. Although most cancer types had a similar sex distribution, race and stage at diagnosis distributions were disproportional for 13/18 and 25/26 assessed cancer types, respectively. Using 12 months as an end point, the observed mean survival months were longer for 27 of 33 TCGA cancer types. CONCLUSIONS: Differences exist in the characteristics of TCGA vs. general population cancer cases. Our study highlights population subgroups where increased sample collection is warranted to increase the applicability of cancer genomic research results to all individuals.