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Ratnapradipa KL, Li T, Hsieh MC, Tenner L, Peters ES. Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival. Front Oncol 2024; 14:1331049. [PMID: 38380357 PMCID: PMC10878418 DOI: 10.3389/fonc.2024.1331049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Background Liver cancer incidence increased in the US from 1975 through 2015 with heterogeneous rates across subpopulations. Upstream or distal area-level factors impact liver cancer risks. Objective The aim of this study was to examine the association between area-level deprivation and hepatocellular carcinoma (HCC) incidence and survival. We also explored the association between area deprivation and treatment modalities. Methods Louisiana Tumor Registry identified 4,151 adult patients diagnosed with malignant HCC from 2011 to 2020 and linked residential address to census tract (CT)-level Area Deprivation Index (ADI) categorized into quartiles (Q1 = least deprived). ANOVA examined the association between ADI quartile and CT age-adjusted incidence rate (AAIR) per 100,000. Chi-square tested the distribution of demographic and clinical characteristics across ADI quartiles. Kaplan-Meier and proportional hazard models evaluated survival by deprivation quartile. Results Among the 1,084 CTs with incident HCC, the average (SD) AAIR was 8.02 (7.05) HCC cases per 100,000 population. ADI was observed to be associated with incidence, and the mean (SD) AAIR increased from 5.80 (4.75) in Q1 to 9.26 (7.88) in Q4. ADI was also associated with receipt of surgery (p < 0.01) and radiation (p < 0.01) but not chemotherapy (p = 0.15). However, among those who received chemotherapy, people living in the least deprived areas began treatment approximately 10 days sooner than those living in other quartiles. Q4 patients experienced the worst survival with a median of 247 (95% CI 211-290) days vs. Q1 patients with a median of 474 (95% CI 407-547) days (p < 0.0001). Q4 had marginally poorer survival (HR 1.20, 1.05-1.37) than Q1 but the association became non-significant (HR 1.12, 0.96-1.30) when adjusted for rurality, liquor store density, sex, race/ethnicity, age, insurance, BMI, stage, hepatitis diagnosis, and comorbidities. Conclusion Increasing neighborhood (CT) deprivation (ADI) was observed to be associated with increased HCC incidence and poorer HCC survival. However, the association with poorer survival becomes attenuated after adjusting for putative confounders.
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Affiliation(s)
- Kendra L. Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tingting Li
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at Louisiana State University (LSU) Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at Louisiana State University (LSU) Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Laura Tenner
- Department of Internal Medicine, Division of Oncology/Hematology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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Zhuang X, Moshi MA, Quinones O, Trenholm RA, Chang CL, Cordes D, Vanderford BJ, Vo V, Gerrity D, Oh EC. Spatial and Temporal Drug Usage Patterns in Wastewater Correlate with Socioeconomic and Demographic Indicators in Southern Nevada. medRxiv 2024:2024.02.02.24302241. [PMID: 38352613 PMCID: PMC10863018 DOI: 10.1101/2024.02.02.24302241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Evaluating drug use within populations in the United States poses significant challenges due to various social, ethical, and legal constraints, often impeding the collection of accurate and timely data. Here, we aimed to overcome these barriers by conducting a comprehensive analysis of drug consumption trends and measuring their association with socioeconomic and demographic factors. From May 2022 to April 2023, we analyzed 208 wastewater samples from eight sampling locations across six wastewater treatment plants in Southern Nevada, covering a population of 2.4 million residents with 50 million annual tourists. Using bi-weekly influent wastewater samples, we employed mass spectrometry to detect 39 analytes, including pharmaceuticals and personal care products (PPCPs) and high risk substances (HRS). Our results revealed a significant increase over time in the level of stimulants such as cocaine (pFDR=1.40×10-10) and opioids, particularly norfentanyl (pFDR =1.66×10-12), while PPCPs exhibited seasonal variation such as peak usage of DEET, an active ingredient in insect repellents, during the summer (pFDR =0.05). Wastewater from socioeconomically disadvantaged or rural areas, as determined by Area Deprivation Index (ADI) and Rural-Urban Commuting Area Codes (RUCA) scores, demonstrated distinct overall usage patterns, such as higher usage/concentration of HRS, including cocaine (p=0.05) and norfentanyl (p=1.64×10-5). Our approach offers a near real-time, comprehensive tool to assess drug consumption and personal care product usage at a community level, linking wastewater patterns to socioeconomic and demographic factors. This approach has the potential to significantly enhance public health monitoring strategies in the United States.
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Affiliation(s)
- Xiaowei Zhuang
- Laboratory of Neurogenetics and Precision Medicine, College of Sciences, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Neuroscience Interdisciplinary Ph.D. program, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV
| | - Michael A. Moshi
- Laboratory of Neurogenetics and Precision Medicine, College of Sciences, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Neuroscience Interdisciplinary Ph.D. program, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
| | - Oscar Quinones
- Applied Research and Development Center, Southern Nevada Water Authority, P.O. Box 99954, Las Vegas NV, 89193, USA
| | - Rebecca A. Trenholm
- Applied Research and Development Center, Southern Nevada Water Authority, P.O. Box 99954, Las Vegas NV, 89193, USA
| | - Ching-Lan Chang
- Laboratory of Neurogenetics and Precision Medicine, College of Sciences, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Neuroscience Interdisciplinary Ph.D. program, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV
| | - Brett J. Vanderford
- Applied Research and Development Center, Southern Nevada Water Authority, P.O. Box 99954, Las Vegas NV, 89193, USA
| | - Van Vo
- Laboratory of Neurogenetics and Precision Medicine, College of Sciences, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
| | - Daniel Gerrity
- Applied Research and Development Center, Southern Nevada Water Authority, P.O. Box 99954, Las Vegas NV, 89193, USA
| | - Edwin C. Oh
- Laboratory of Neurogenetics and Precision Medicine, College of Sciences, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Neuroscience Interdisciplinary Ph.D. program, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Department of Brain Health, Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89154
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