Oral cancer incidence rate is associated with access to dental care: City and statewide analyses

INTRODUCTION

Access to dental care may affect diagnosis of oral squamous cell carcinoma (OSCC). We tested whether the incidence rate of OSCC is higher in regions with less dental care access in the city of Chicago and state of Illinois.

STUDY DESIGN

Ecological cohort.

SETTING

Population, outpatients, and inpatients.

METHODS

We extracted 5-year averages of the state-wide county-level and city-level OSCC incidence rates from 2015 to 2019 from the Illinois Department of Public Health. Dental care access information was also collected for each county for the same period, as well as the percentage of people that had ≥1 visit to a dentist in the previous year in Chicago. Multivariate Poisson regression was used to investigate the relationship between county-level access to dental care (and city-level dentist visits) and OSCC incidence rate, controlling for confounders, with additional flexible semiparametric models for confirmatory sensitivity analysis.

RESULTS

In Illinois, higher 5-year incidence rate of OSCC was significantly associated with low access to dental care by county (IRR = 0.96, 95% CI 0.91, 0.98). Southern/southwestern counties had higher incidence rates of OSCC (15.5%-28.4%) and the lowest rates of dental care access (47.5%-69.2%) compared to northern counties (10.3%-15% and 55.4%-80.6%, respectively). In Chicago, people with more dentist visits had a reduced chance of being diagnosed with OSCC (IRR = 0.97, 95% CI 0.91, 0.99), consistent with state-wide analyses.

CONCLUSION

OSCC incidence rate is closely associated with poor local dental healthcare access in a major state and urban city. Increasing dental access could improve cancer outcomes via improved oral health and earlier detection.

Using Sudden Unexpected Infant Death-Case Registry Data to Drive Prevention

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ∼10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ∼1 infant dies unexpectedly during sleep every week. Of these SUID, ∼25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep-Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began.

What are the incidence and costs associated with interfacility emergency department transfer patients treated by oral and maxillofacial surgeons?

OBJECTIVE

Interfacility emergency department transfers (IETs) for maxillofacial trauma and infections are prevalent in the United States, with significant implications for health care costs. Limited availability of oral and maxillofacial surgeons (OMS) exacerbates unnecessary transfers and associated expenses. This study aimed to determine the incidence and costs of OMS IET.

STUDY DESIGN

A retrospective cohort study was performed for maxillofacial trauma and infection IET at the University of Illinois Health main hospital via electronic medical record query for terms "infection [or] trauma [and] transfer." Inclusion criteria required presentation from January 1, 2022 to June 30, 2022; emergency department (ED)-ED transfer; and or consultation by OMS. Distance transferred, insurance type, location of treatment, weekend presentation, and associated costs were collected.

RESULTS

One thousand ninety-nine records were identified, including 46 trauma IET and 122 infection IET. Costs ranged from $2,683,918.90 to $7,984,912.89, indicating ∼$1.5 billion annual expenditure across US OMS programs. Three trauma IET required urgent treatment; no infection IETs were "emergent." Trauma IET averaged 20.7 + 17.1 miles and infection IET 22.0 + 17.4 miles for transfer distance. Among trauma IET, 28 were treated in the operating room (OR), 10 had outpatient follow-up, and 8 had ED treatment. Among infection IETs, 57 received ED treatment, 56 received OR treatment, and 9 received antibiotics/no treatment.

CONCLUSIONS

Maxillofacial trauma and infection IET impose significant health care costs. Increased funding for OMS training may mitigate the shortage and improve patient care. Further research is needed for better triaging and reimbursement strategies.

Work-related injuries and illnesses (WRII) presenting to Illinois hospitals, 2017-2021: The importance of emergency department (ED) data

OBJECTIVES

Research characterizing work-related injuries and illnesses (WRII) has predominantly focused on inpatients and deaths, despite evidence that 4% of WRII are admitted as inpatients and deaths are less than 0.2% of acute WRII. Our aim is to determine the usefulness of incorporating emergency department (ED) hospital data into current occupational health surveillance systems.

METHODS

Data on ED and admitted WRII treated in Illinois hospitals from 2017 to 2021 were analyzed. Demographic characteristics, primary diagnosis, procedures undertaken, and unique patient estimates are described. Multivariable logistic regression models were developed to evaluate predictors of treatment in the ED and multivariable median regression models determined associations of total hospital charges.

RESULTS

Between 2017 and 2021 there were 488,033 hospital presentations (95.9% nonadmissions) for WRII in Illinois, equating to a crude annual population rate of 1502.1/100,000. Non-Hispanic Whites (NHW) were disproportionately treated for illnesses, while Hispanic or Latino workers were disproportionately treated for injuries. African-Americans had the highest rate of ED emergent presentations (incident rate ratio [IRR] = 1.3, ref = NHW) and were less likely to be admitted for emergent presentations (IRR = 0.7, ref = NHW). ED presentations were more likely to be female, present with an injury, and at a rural, versus urban, hospital. Radiological investigations compromised the majority of procedures for nonadmitted patients (n = 403,317), and 94.8% were coded for a body region CONCLUSION: Between 2017 and 2021 in Illinois, there were nearly 500,000 hospital visits charged to workers' compensation totaling over US$ four billion. ED data provide additional insights into work-related chronic conditions, health disparities, and the usage of diagnostic and therapeutic procedures for WRII.

Validation of Prognostic Scales for Functional Outcome in Ischemic Stroke Patients Treated with Intravenous Thrombolysis in a Rural Setting

INTRODUCTION

Early prediction of functional outcome after rtPA helps clinicians in prognostic conversations with stroke patients and their families. Three prognostic tools have been developed in this regard: DRAGON, MRI-DRAGON, and S-TPI scales. These tools, all performing with comparable accuracy, have been internally and externally validated in tertiary care centers. However, their performance in rural areas remains uncertain. This study addresses this gap in the literature by evaluating the effectiveness of those prognostic tools in stroke patients treated in a rural area of the Midwest.

METHODS

We conducted a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare Stroke Network from July 2017 to June 2024. Data on demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. Modified Rankin Scale (mRS) at 1 month, classified into good (mRS ≤2) and poor (mRS ≥5) outcomes were noted. DRAGON and MRI-DRAGON scores were calculated. S-TPI model was built. Area under the receiver operating characteristic curve (AUC) with its 95% confidence interval was calculated for each prognostic model.

RESULTS

A total of 279 patients were included in this study. Of those, 43% (n = 119) were male. Median age (interquartile range [IQR]) was 69 (57-80) years. NIHSS at presentation (IQR) was 7 (4-13). 12% of the cohort (n = 34) had posterior circulation stroke. At 1 month, 66% of patients (n = 185) had mRS ≤2, whereas 14% of patients (n = 39) had mRS ≥5. MRI-DRAGON showed the highest accuracy in predicting both good (AUC = 0.86, 95% CI: 0.81-0.90) and poor outcomes (AUC = 0.84, 95% CI: 0.76-0.91). DRAGON also demonstrated high accuracy for good (AUC = 0.85, 95% CI: 0.80-0.89) and poor (AUC = 0.82, 95% CI: 0.75-0.90) outcomes. Conversely, in our population, the S-TPI model had the lowest accuracy for good (AUC = 0.56, 95% CI: 0.49-0.63) and poor (AUC = 0.68, 95% CI: 0.61-0.76) outcomes.

CONCLUSION

Among the available grading scores, MRI-DRAGON score can be considered the more accurate short-term prognostic tool for stroke patients treated with rtPA in the rural setting.

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study

BACKGROUND

During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths.

OBJECTIVE

To determine whether hospital differences in pre-pandemic and during pandemic nursing resources-average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition-explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic.

METHODS

This is a cross-sectional study of 87,936 Medicare beneficiaries (65-99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models.

RESULTS

The mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12-1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09-1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided.

CONCLUSIONS

Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

Association of early statin initiation during COVID-19 admission with inpatient mortality at an academic health system in Illinois, March 2020 to September 2022: a target trial emulation using observational data

OBJECTIVE

We assessed the association of early statin initiation with inpatient mortality among hospitalised COVID-19 patients.

DESIGN, SETTING AND PARTICIPANTS

This observational study emulated a hypothetical target trial using electronic health records data from Northwestern Medicine Health System, Illinois, 2020-2022. We included patients who were ≥40 years, admitted ≥48 hours for COVID-19 from March 2020 to August 2022 and had no evidence of statin use before admission.

INTERVENTIONS

Individuals who initiated any statins within 48 hours of admission were compared with individuals who did not initiate statins during this period.

PRIMARY OUTCOME MEASURES

Inpatient mortality at hospital days 7, 14, 21 and 28 were determined using hospital records. Risk differences between exposure groups were calculated using augmented inverse propensity weighting (AIPW) with SuperLearner.

RESULTS

A total of 8893 individuals (24.5% early statin initiators) were included. Early initiators tended to be older, male and have higher comorbidity burdens. Unadjusted day 28 mortality was higher in early initiators (6.0% vs 3.6%). Adjusted analysis showed slightly higher inpatient mortality risk at days 7 (RD: 0.5%, 95% CI: 0.2 to 0.8) and 21 (RD: 0.6%, 95% CI: 0.04 to 1.1), but not days 14 (RD: 0.4%, 95% CI: -0.03 to 0.9) and 28 (RD: 0.4%, 95% CI: -0.2 to 1.1). Sensitivity analyses using alternative modelling approaches showed no difference between groups.

CONCLUSIONS

Early statin initiation was not associated with lower mortality contrasting with findings of previous observational studies. Trial emulation helped in identifying and addressing sources of bias incompletely addressed by previous work. Statin use may be indicated for other conditions but not COVID-19.

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.

Emydomyces testavorans Surveillance in Multiple Free-Ranging Terrestrial and Aquatic Chelonian Species in Illinois, USA

The order Onygenales contains multiple fungal pathogens that affect free-ranging and zoo-housed reptilian species. Emydomyces testavorans, an onygenalean fungus associated with skin and shell disease, has been sporadically detected in aquatic chelonians. Because of the recent discovery of this organism, little is known about its prevalence in free-ranging chelonians. The objective of this study was to perform surveillance for E. testavorans in six free-ranging aquatic and terrestrial chelonian species in Illinois, USA: Blanding's turtles (n=437; Emydoidea blandingii), painted turtles (n=199; Chrysemys picta), common snapping turtles (n=35; Chelydra serpentina), red-eared sliders (n=62; RES; Trachemys scripta elegans), eastern box turtles (n=73; Terrapene carolina carolina) and ornate box turtles (n=29; Terrapene ornata). Combined cloacal-oral swabs (COSs) or shell (carapace and plastron surfaces) swabs were collected from 2019 to 2021 and tested for E. testavorans using quantitative PCR. The PCR detected E. testavorans in COSs of an adult male, subadult female, and juvenile male Blanding's turtle (0.6%; 95% confidence interval [CI], 0.2-1.9%) and a shell swab from an adult female RES (1.6%; 95% CI, 0-8.7%). Shell lesions consistent with E. testavorans infection were present in two of the positive Blanding's turtles. These results document the rarity of this pathogen on the landscape in Illinois. Additional studies should determine this pathogen's impact on individuals and clarify its significance for conservation efforts of Blanding's turtle, in which E. testavorans has not been reported previously.

Substance Use Among Illinois Farmers

BACKGROUND

 People in agriculture face unique stressors and occupational hazards, and relatively little is known about substance use in this population. The purpose of this study was to describe substance use among farmers in Illinois.

METHODS

 We conducted a mail survey of Illinois farmers that included the Brief ASSIST to assess substance use for lifetime and past three-month use of ten different substances. The survey also included questions about farming characteristics, mental health, stress, coping, social support, and demographic characteristics. We used chi-square and non-parametric tests to assess group differences.

RESULTS

 Alcohol, tobacco, cannabis, and sedatives were most reported as used for a lifetime and in the past three months. About three-quarters of the sample had recently used alcohol. Recent tobacco use was associated with not being married, less education, and less concern about climate-related farm stress. Recent sedative use was associated with greater concern about isolation-related farm stress. People who reported multiple substance use were at a greater risk for suicide and were more likely to meet the criteria for generalized anxiety disorder. None of the participants reported recent use of cocaine, heroin, inhalants, or hallucinogens.

CONCLUSION

 Specific social and cultural aspects of farming and farm communities may contribute to substance use among people working in agriculture. Future research can help to better understand this intersection and make recommendations for programs and resources to promote adaptive coping strategies.

The Association of Medical Cannabis Use with Pain Levels and Opioid Use in Illinois' Opioid Alternative Pilot Program

OBJECTIVE

The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019.

METHODS

A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used.

RESULTS

A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users.

CONCLUSIONS

Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes.

Change in Nutrition and Physical Activity Practices in Early Childcare and Education Settings in Illinois During the COVID-19 Pandemic

CONTEXT

For many young children, early childcare and education (ECE) programs are the only source of nutritious meals and physical activity (PA); however, the COVID-19 pandemic led to program closures, restrictions, and changed practices.

OBJECTIVE

To examine changes in nutrition and PA-related best practices in ECE settings in Illinois from 2019, just prior to the pandemic, as compared to 2022. We also examined how changes over time varied by program type (ie, centers vs homes), Child and Adult Care Food Program (CACFP) status, and/or Head Start/Early Head Start status.

DESIGN

The study design is a repeated cross-sectional survey administered in December 2019 and October 2022.

SETTING

State of Illinois.

PARTICIPANTS

A total of 888 and 1162 ECE providers completed initial and follow-up surveys, respectively.

INTERVENTION

NA.

MAIN OUTCOME MEASURE

Provider report of meeting 14 nutrition and 9 PA-related best practices.

RESULTS

Overall, 9 nutrition-related best practices were maintained and 5 declined over time. Centers, CACFP, and Head Start providers reported significant declines in meeting nutrition-related practices over time. A total of 8 PA-related best practices were maintained and 1 declined over time. Centers reported a significant decline in 5 of the PA-related best practices over time, and these declines were significantly different than in homes over time. Similarly, Head Start programs reported a decline in 4 PA-related best practices over time, and the change was significantly different from non-Head Start programs in 3 of the 4 practices.

CONCLUSION

The findings of this study should be considered a new baseline for ECE nutrition and PA-related best practices in Illinois and should serve as a wake-up call for advocates nationwide with regard to the provision of nutrition and PA-related best practices in centers and by CACFP and Head Start providers postpandemic.

Asthma policy in Illinois: A survey of school nursing and staff knowledge and implementation patterns

OBJECTIVE

Our goal is to examine gaps in self-carry, asthma emergency protocol, and stock inhaler policy knowledge in Illinois schools.

DESIGN

A 30-item REDCap cross-sectional survey developed by a team of stakeholders was disseminated. Questions assessed policy knowledge, awareness, and practices regarding asthma emergency protocols, self-carry, and stock inhalers.

SAMPLE

Participants were Illinois school nurses belonging to a governmental organization listserv.

MEASUREMENTS

Analysis utilized Chi-square tests, descriptive statistics, and t-tests.

RESULTS

Nurses reported 36% of students on average self-carried asthma medication. Thirty percent of nurses were not aware of their emergency asthma policy and only 60% reported having an emergency asthma protocol in their school(s). Fifty-four percent of nurses were aware of stock inhaler programming. Of the 10.3% who reported a stock inhaler program, a lower frequency reported calling 911 for asthma emergencies. Perceived school asthma prevalence varied from 0%-87%.

CONCLUSIONS

Our survey demonstrates large variation in knowledge and implementation of school-based asthma health policy. This is likely due to variations in health policy education dissemination. Future efforts should focus on the dissemination and implementation of school-based asthma health policies to improve their more universal adoption and better support school-based asthma management.

Serosurvey for Canine Influenza in Coyotes (Canis latrans) in Illinois, USA, 2000-23

Coyotes (Canis latrans) share urban habitats with domestic dogs (Canis lupus familiaris), providing opportunities for pathogen transmission. In Chicago, Illinois, USA, canine influenza virus (CIV) is prevalent in dogs. Serologic investigation for exposure in 101 coyote samples collected 2000-23 did not detect any antibodies against CIV H3N2 and H3N8.

Treatment Referrals Post-prohibition of Alcohol Exclusion Laws: Evidence from Colorado and Illinois

BACKGROUND

Individuals with alcohol-related disorders often encounter barriers to accessing treatment. One potential barrier is the state alcohol exclusion laws (AELs) that allow insurers to deny coverage for injuries or illnesses caused by alcohol intoxication. Several states have repealed AELs by prohibiting them completely, including banning exclusions in health and accident insurance policies, limiting their scope, or creating exemptions.

OBJECTIVES

To examine whether prohibiting alcohol exclusions in health and accident insurance policies is associated with alcohol-related treatment admissions.

DESIGN

We used the 2002 to 2017 Treatment Episode Data Set and obtained data from several sources to control for state-level factors. We employed a heterogeneous difference-in-differences method and an event study to compare the treatment admissions in Colorado and Illinois, two states that uniquely repealed AELs, with control states that allowed or had no AELs.

MAIN MEASURES

We used aggregated alcohol treatment admission for adults by healthcare referral: (i) with alcohol as the primary substance and (ii) with alcohol as the primary, secondary, or tertiary substance.

KEY RESULTS

We found a significant relationship between AEL repeal and increased referrals. AEL repeal in Colorado and Illinois was associated with higher treatment admissions from 2008 to 2011 (average treatment effect on the treated: 2008 = 653, 2009 = 1161, 2010 = 1388, and 2011 = 2020). We also found that a longer duration of exposure to AEL repeal was associated with higher treatment admissions, but this effect faded after the fourth year post-treatment.

CONCLUSIONS

Our study reveals a potential positive association between the repeal and prohibition of AELs and increased alcohol-related treatment admissions. These findings suggest that states could enhance treatment opportunities for alcohol-related disorders by reconsidering their stance on AELs. While our study highlights the possible public health benefits of repealing AELs, it also paves the way for additional studies in this domain.

Relationship between Civilian Injuries Caused during Contact with Law Enforcement and Community-Level Sociodemographic Characteristics

Civilian injuries caused during contact with law enforcement personnel erode community trust in policing, impact individual well-being, and exacerbate existing health inequities. We assessed the relationship between ZIP code-level rates of civilian injuries caused during legal interventions and community-level sociodemographic characteristics using Illinois hospital data from 2016 to 2022. We developed multivariable Poisson regression models to examine whether legal intervention injury rates differed by race-ethnicity and community economic disadvantage across three geographic regions of Illinois representing different levels of urbanization. Over the study period, 4976 civilian injuries were treated in Illinois hospitals (rate of 5.6 per 100,000 residents). Compared to non-Hispanic white residents, non-Hispanic Black residents demonstrated 5.5-10.5 times higher injury rates across the three geographic regions, and Hispanic-Latino residents demonstrated higher rates in Chicago and suburban Cook County, but lower rates in the rest of the state. In most regions, models showed that as the percent of minority residents in a ZIP code increased, injury rates among non-Hispanic Black and Hispanic-Latino residents decreased. As community economic disadvantage increased at the ZIP code level, civilian injury rates increased. Communities with the highest injury rates involving non-Hispanic white residents were significantly more economically unequal and disadvantaged. While the injury rates were consistently and substantially higher among non-Hispanic Black residents throughout the state, the findings illustrate that the association between overall civilian injuries caused during contact with law enforcement and community sociodemographic characteristics varied across regions. Data on local law enforcement agency policies and procedures are needed to better identify appropriate interventions.

Lifetime Upward Economic Mobility and US-Born Latina Women's Preterm Birth Rates

OBJECTIVES

To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB) .

METHODS

Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989-1991) and their mothers (born 1956-1976).

RESULTS

In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively.

CONCLUSIONS FOR PRACTICE

Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas.

Checkup Visits in Adult Federally Qualified Health Center Patients: a Retrospective Cohort Study

BACKGROUND

Checkup visits (i.e., general health checks) can increase preventive service completion and lead to improved treatment of new chronic illnesses. After the onset of the COVID-19 pandemic, preventive service completion decreased in many groups that receive care in safety net settings.

OBJECTIVE

To examine potential benefits associated with checkups in federally qualified health center (FQHC) patients.

DESIGN

Retrospective cohort study, from March 2018 to February 2022.

PATIENTS

Adults at seven FQHCs in Illinois.

INTERVENTIONS

Checkups during a two-year Baseline (i.e., pre-COVID-19) period and two-year COVID-19 period.

MAIN MEASURES

The primary outcome was COVID-19 period checkup completion. Secondary outcomes were: mammography completion; new diagnoses of four common chronic illnesses (hypertension, diabetes, depression, or high cholesterol), and; initiation of chronic illness medications.

KEY RESULTS

Among 106,114 included patients, race/ethnicity was most commonly Latino/Hispanic (42.1%) or non-Hispanic Black (30.2%). Most patients had Medicaid coverage (40.4%) or were uninsured (33.9%). While 21.0% of patients completed a checkup during Baseline, only 15.3% did so during the COVID-19 period. In multivariable regression analysis, private insurance (versus Medicaid) was positively associated with COVID-19 period checkup completion (adjusted relative risk [aRR], 1.15; 95% confidence interval, [CI], 1.10-1.19), while non-Hispanic Black race/ethnicity (versus Latino/Hispanic) was inversely associated with checkup completion (aRR, 0.89; 95% CI, 0.85-0.93). In secondary outcome analysis, COVID-19 period checkup completion was associated with 61% greater probability of mammography (aRR, 1.61; 95% CI, 1.52-1.71), and significantly higher probability of diagnosis, and treatment initiation, for all four chronic illnesses. In exploratory interaction analysis, checkup completion was more modestly associated with diagnosis and treatment of hypertension and high cholesterol in some younger age groups (versus age ≥ 65).

CONCLUSIONS

In this large FQHC cohort, checkup completion markedly decreased during the pandemic. Checkup completion was associated with preventive service completion, chronic illness detection, and initiation of chronic illness treatment.

Epidemiology of Craniomaxillofacial Fractures Over a 5-year Period at a Midwestern Level 1 Trauma Center Serving a Large Rural Population

BACKGROUND

Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals have not been well studied.

PURPOSE

The purpose of this study is to report on the epidemiology of CMF fractures at a regional Level 1 trauma center serving a large rural population in central Illinois.

STUDY DESIGN, SETTING, SAMPLE

This is a retrospective cohort study at a community-based regional tertiary referral center that serves a predominantly rural population. Inclusion criteria comprised patients with radiologically confirmed CMF fractures between 2015 and 2019. Patients with incomplete medical records were excluded.

PREDICTOR VARIABLE

Predictor variables included demographics (age, admission source, race, and sex) and etiology of CMF fracture (assault/domestic violence, all-terrain vehicle/off-road, falls, farm-related, motor vehicle collisions, gunshot wound, and others).

MAIN OUTCOME VARIABLE

The primary outcome variable was the CMF anatomic location including nasal bone, orbit, mandible, malar/maxillary, and other CMF fractures.

COVARIATES

The covariates are not applicable.

ANALYSES

Descriptive statistics were used to summarize a sample of the population characteristics. Wilcoxon ranked sign tests and χ2 tests of independence were used to assess for statistically significant associations between select variables of interest. Statistical significance was defined as P < .05.

RESULTS

Between 2015 and 2019, a total of 2,334 patients presented to the emergency department with a CMF fracture. After applying the inclusion/exclusion criteria, the final sample was composed of 1,844 patients for the management of 2,405 CMF fractures. The majority of patients were male(62.0%) and young adults (aged 18-39) had the highest number of CMF fractures (819) relative to all other age groups. The most common fracture etiology was fall(37.3%), and nasal bone fractures represented the most common fracture location(41.6%). χ2 analyses revealed statistically significant associations between the anatomic location of CMF fracture incurred, and differing categories of age, admission source, race, sex, and etiology.

CONCLUSION AND RELEVANCE

Our study shows that patients seen at our Midwestern Level 1 trauma center are more likely to present with nasal bone and malar/maxillary fractures due to falls. In studies based in urban centers, patients are likely to present with orbital and mandibular fractures due to falls and assault.

Spatial and temporal clustering of anti-SARS-CoV-2 antibodies in Illinois household cats, 2021-2023

This study aimed to evaluate the seroprevalence and spatial and temporal clustering of SARS-CoV-2 antibodies in household cats within 63 counties in Illinois from October 2021 to May 2023. The analysis followed a stepwise approach. First, in a choropleth point map, we illustrated the distribution of county-level seroprevalence of SARS-CoV-2 antibodies. Next, spatial interpolation was used to predict the seroprevalence in counties without recorded data. Global and local clustering methods were used to identify the extent of clustering and the counties with high or low seroprevalence, respectively. Next, temporal, spatial, and space-time scan statistic was used to identify periods and counties with higher-than-expected seroprevalence. In the last step, to identify more distinct areas in counties with high seroprevalence, city-level analysis was conducted to identify temporal and space-time clusters. Among 1,715 samples tested by serological assays, 244 samples (14%) tested positive. Young cats had higher seropositivity than older cats, and the third quarter of the year had the highest odds of seropositivity. Three county-level space-time clusters with higher-than-expected seroprevalence were identified in the northeastern, central-east, and southwest regions of Illinois, occurring between June and October 2022. In the city-level analysis, 2 space-time clusters were identified in Chicago's downtown and the southwestern suburbs of Chicago between June and September 2022. Our results suggest that the high density of humans and cats in large cities such as Chicago, might play a role in the transmission and clustering of SARS-CoV-2. Our study provides an in-depth analysis of SARS-CoV-2 epidemiology in Illinois household cats, which will aid in COVID-19 control and prevention.

Parasitism and branchitis in various fish species from 4 Cook County, Illinois inland freshwater lakes, 5-year survey, 2017-2021

We investigated disease trends of concern for fish or public health in a 5-y (2017-2021) prospective survey of fish in Cook County, IL, inland lakes. Lesions were assessed in relation to fish species, lake type and location, season and collection year, and lake water chemistry parameters. Fish included bullheads (n = 98), common carp (n = 99), bluegill (n = 114), and largemouth bass (n = 118). Annually, fish collection and point-source water sampling were conducted in spring, summer, and fall from both seepage and impoundment lakes. Examinations included autopsy, wet-mount cytologic assessment for ectoparasites, and histopathology. No lesions of public health concern were detected. The most common abnormalities were branchitis (261 of 429; 60.8%) and endoparasitism (312 of 429; 72.7%). Branchitis was mild in most cases (189 of 261; 72.4%) and concurrent with branchial parasitism in 175 of 261 (67%) cases. Monogeneans were the most common gill parasites but did not influence branchitis severity (Kruskal-Wallis, p = 0.484). Using generalized ordered logistic regression, predictors of branchitis severity included fish species (p < 0.001), the interaction of lake or location and alkalinity (p < 0.001), and water temperature or season (p < 0.001). Endoparasites included tissue larval trematodes (metacercaria), nematodes, and cestodes (plerocercoids), enteric acanthocephalans, gastric trematodes, renal myxosporidia, biliary and gall bladder myxosporidia, enteric cestodes, and tissue microsporidia. Using generalized ordered logistic regression, variables influencing endoparasitism severity included species (p < 0.001), year (p < 0.001), chloride level (p = 0.009), and the interaction of year and chloride level (p < 0.001). Our results suggested overall good health of fish in sampled Cook County inland lakes and provide a foundation for continued monitoring of ecosystem and public health in the urban environment.

Estimated public health impact of concurrent mask mandate and vaccinate-or-test requirement in Illinois, October to December 2021

BACKGROUND

Facing a surge of COVID-19 cases in late August 2021, the U.S. state of Illinois re-enacted its COVID-19 mask mandate for the general public and issued a requirement for workers in certain professions to be vaccinated against COVID-19 or undergo weekly testing. The mask mandate required any individual, regardless of their vaccination status, to wear a well-fitting mask in an indoor setting.

METHODS

We used Illinois Department of Public Health's COVID-19 confirmed case and vaccination data and investigated scenarios where masking and vaccination would have been reduced to mimic what would have happened had the mask mandate or vaccine requirement not been put in place. The study examined a range of potential reductions in masking and vaccination mimicking potential scenarios had the mask mandate or vaccine requirement not been enacted. We estimated COVID-19 cases and hospitalizations averted by changes in masking and vaccination during the period covering October 20 to December 20, 2021.

RESULTS

We find that the announcement and implementation of a mask mandate are likely to correlate with a strong protective effect at reducing COVID-19 burden and the announcement of a vaccinate-or-test requirement among frontline professionals is likely to correlate with a more modest protective effect at reducing COVID-19 burden. In our most conservative scenario, we estimated that from the period of October 20 to December 20, 2021, the mask mandate likely prevented approximately 58,000 cases and 1,175 hospitalizations, while the vaccinate-or-test requirement may have prevented at most approximately 24,000 cases and 475 hospitalizations.

CONCLUSION

Our results indicate that mask mandates and vaccine-or-test requirements are vital in mitigating the burden of COVID-19 during surges of the virus.

Characteristics of Cannabis and Opioid Users Among Older U.S. Veterans and Their Health Outcomes: A Longitudinal Perspective

Medical cannabis use among U.S. Veterans has continued to rise. However, data on cannabis use by older Veterans is generally less available. This study aims to understand the characteristics of older Veterans who enrolled in the Medical Cannabis Patient Program in Illinois and analyze their health outcomes and co-use of cannabis and opioids using longitudinal survey data. Overall, participants reported positive outcomes for pain, sleep, and emotional problems because of cannabis use in two survey periods. Approximately, 62% and 85% respondents reported no change in memory and falls, respectively, with only 3% and 1% reporting a negative outcome for the conditions in both surveys. About 20.4% of those who indicated cannabis use only in the initial survey started to co-use opioids in the follow-up survey, while 44.1% of those who indicated the use of both substances in the initial survey reported no longer using opioids in the follow-up survey. However, these changes were not statistically significant (α = 0.05 ) . The logistic regression showed that both clinical and contextual factors affected co-use. In conclusion, older U.S. Veterans may be using cannabis to alleviate their pain and other chronic conditions. More research is needed to understand the effect of cannabis use on reducing or substituting opioids.

Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals

OBJECTIVE

Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs.

METHODS

Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care.

RESULTS

We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons.

CONCLUSION

The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.