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Sutton AL, He J, Bottinor W, Hong S, Mitchell K, Hines AL. Examining hypertension risk among Black and White breast cancer survivors. Cancer Med 2024; 13:e6929. [PMID: 38214087 PMCID: PMC10905221 DOI: 10.1002/cam4.6929] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Breast cancer survivors are at increased risk of cardiovascular dysfunction following their diagnosis; however, hypertension remains underexplored within this context. This retrospective cohort study examined the incidence of hypertension in breast cancer survivors and the association of race with hypertension risk among them. METHODS Data for this study were abstracted from the electronic health records of women diagnosed with Stages I-III breast cancer. Incident hypertension diagnosis was identified through International Classification of Diseases codes. Bivariate associations were tested using Student's t-test and chi-squared test of independence. Bivariable Cox regression analysis was used to determine demographic and clinical factors that may have been associated with the development of hypertension. RESULTS A total of 664 women were included. Most women were 50 years of age or younger (52.0%), White (33.0% Black), and received a mastectomy (80.6%). Overall, 45.5% of the cohort developed hypertension. The 1-year hypertension-free survival estimates were 47% (95% confidence interval [CI], 41-54) in Black women and 73% (95% CI, 69-77) in White women (p < 0.0001). Besides race, statistically significant predictors of hypertension included: age greater than 50 (vs. ≤50) (adjusted Hazard Ratio [HR]: 1.40; 95% CI, 1.09-1.80) and residing in a non-metropolitan area (vs. metropolitan) (adjusted HR: 1.60; 95% CI, 1.19-2.16). CONCLUSIONS This study suggests that breast cancer survivors who are older, Black, or residing in non-metropolitan areas may benefit from added surveillance and hypertension prevention strategies during treatment. Future studies are needed to identify contributors to the observed racial and geographic disparities.
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Affiliation(s)
- Arnethea L. Sutton
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
- VCU Massey Comprehensive Cancer CenterRichmondVirginiaUSA
| | - Jian He
- VCU Massey Comprehensive Cancer CenterRichmondVirginiaUSA
| | - Wendy Bottinor
- Division of Cardiology, Department of Internal MedicineVCU School of MedicineRichmondVirginiaUSA
| | - Susan Hong
- Division of Hematology/Oncology, Department of Internal MedicineVCU School of MedicineRichmondVirginiaUSA
| | | | - Anika L. Hines
- Department of Health Behavior and PolicyVCU School of MedicineRichmondVirginiaUSA
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Burnside J, Thomas T, Sebastiani G, Saeed S. Geographical disparities in gastroenterologists and transient elastography across Canada. Can Liver J 2023; 6:417-424. [PMID: 38152324 PMCID: PMC10751006 DOI: 10.3138/canlivj-2023-0010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/28/2023] [Indexed: 12/29/2023]
Abstract
Background In the next decade, the incidence and prevalence of advanced liver disease are expected to increase across Canada. However, little is known about the country's resources for monitoring patients requiring specialized care. A resource assessment was conducted to evaluate regional disparities of specialists and transient elastography machines across Canada. Methods Demographic data on licenced gastroenterologists were obtained from Scott's Medical Directory as of October 2022. The primary location of each specialist was linked to 2016 Statistics Canada to obtain the population size and density of provinces/territories and census division (CD). Results were summarized per 100,000 persons. CDs were classified as resource scare or approaching resource scarcity. A list of transient elastography (TE) was provided by KNS Canada Inc. and summarized per 1,000,000 persons by province. Results Eight hundred fifty-three specialists were identified. Rates of gastroenterologists per 100,000 people ranged from 0 in the territories to 2.9 in Quebec. Half the provinces had fewer than 2.0 gastroenterologists per 100,000 persons. Gastroenterologists were concentrated in 24% (71/293) of the CDs across Canada. We identified resource-scarce CDs as areas with no gastroenterologists and in the highest tercile of population density, which accounted for 33% (1 of 3) in Prince Edward Island, 32% in Quebec, 25% in Ontario, 7% in British Columbia, and 4% in Manitoba. Only 94 TEs were identified nationwide. Conclusion We found significant variation in liver-specific resources across Canada. Given the increasing number of people living with liver disease, policies must be implemented to address access to specialized care.
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Affiliation(s)
- Jessica Burnside
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Tyler Thomas
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Sahar Saeed
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Teppo K, Airaksinen KEJ, Halminen O, Jaakkola J, Linna M, Haukka J, Putaala J, Mustonen P, Kinnunen J, Hartikainen J, Lehto M. Rural-urban and geographical differences in prognosis of atrial fibrillation in Finland: a nationwide cohort study. Scand J Public Health 2023:14034948231189918. [PMID: 37571929 DOI: 10.1177/14034948231189918] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
AIMS Rural-urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural-urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland. METHODS The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural-urban categories and into hospital districts (HDs) based on their municipality of residence. RESULTS We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93-1.00) and 0.92 (0.91-0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01-1.08) and 1.06 (1.04-1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28-1.67) and 0.79 (0.62-1.01), and mortality 1.24 (1.16-1.32) and 0.97 (0.93-1.00), respectively. CONCLUSIONS Rural-urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs.
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Affiliation(s)
- Konsta Teppo
- Heart Centre, Turku University Hospital and University of Turku, Finland
| | | | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Jussi Jaakkola
- Heart Centre, Turku University Hospital and University of Turku, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
- University of Eastern Finland, Kuopio, Finland
| | | | - Jukka Putaala
- Neurology, Helsinki University Hospital, and University of Helsinki, Finland
| | - Pirjo Mustonen
- Heart Centre, Turku University Hospital and University of Turku, Finland
| | - Janne Kinnunen
- Neurology, Helsinki University Hospital, and University of Helsinki, Finland
| | - Juha Hartikainen
- University of Eastern Finland, Kuopio, Finland
- Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - Mika Lehto
- Heart and Lung Centre, Helsinki University Hospital and University of Helsinki, Finland
- Jorvi Hospital, Department of Internal Medicine, Helsinki and Uusimaa Hospital District, Espoo, Finland
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Cheung KL, Crews DC, Cushman M, Yuan Y, Wilkinson K, Long DL, Judd SE, Shlipak MG, Ix JH, Bullen AL, Warnock DG, Gutiérrez OM. Risk Factors for Incident CKD in Black and White Americans: The REGARDS Study. Am J Kidney Dis 2023; 82:11-21.e1. [PMID: 36621640 PMCID: PMC10293023 DOI: 10.1053/j.ajkd.2022.11.015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023]
Abstract
RATIONALE & OBJECTIVE Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 4,198 Black and 7,799 White participants aged at least 45 years, recruited from 2003 through 2007 across the continental United States, with baseline estimated glomerular filtration rate (eGFR)>60mL/min/1.73m2 and eGFR assessed again approximately 9 years later. EXPOSURES Age, sex, race (Black or White), region ("stroke belt" or other), education, income, systolic blood pressure, body mass index, diabetes, coronary heart disease, hyperlipidemia, smoking, and albuminuria. OUTCOMES (1) eGFR change and (2) incident CKD defined as eGFR<60mL/min/1.73m2 and≥40% decrease from baseline or kidney failure. ANALYTICAL APPROACH Linear regression and modified Poisson regression were used to determine the association of risk factors with eGFR change and incident CKD overall and stratified by race, sex, and region. RESULTS Mean age of participants was 63±8 (SD) years, 54% were female, and 35% were Black. After 9.4±1.0 years of follow-up, CKD developed in 9%. In an age-, sex-, and race-adjusted model, Black race (β =-0.13; P<0.001) was associated with higher risk of eGFR change, but this was attenuated in the fully adjusted model (β=0.02; P=0.5). Stroke belt residence was independently associated with eGFR change (β =-0.10; P<0.001) and incident CKD (relative risk, 1.14 [95% CI, 1.01-1.30]). Albuminuria was more strongly associated with eGFR change (β of-0.26 vs-0.17; P=0.01 for interaction) in Black compared with White participants. Results were similar for incident CKD. LIMITATIONS Persons of Hispanic ethnicity were excluded; unknown duration and/or severity of risk factors. CONCLUSIONS Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals. Albuminuria was a stronger risk factor for eGFR decrease and incident CKD in Black compared with White individuals. Living in the US stroke belt is a novel risk factor for CKD.
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Affiliation(s)
- Katharine L Cheung
- Divisions of Nephrology, Larner College of Medicine at The University of Vermont, Burlington, Vermont.
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
| | - Mary Cushman
- Hematology/Oncology, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont
| | - Ya Yuan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katherine Wilkinson
- Larner College of Medicine at The University of Vermont, Burlington, Vermont
| | - D Leann Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Division of Nephrology, University of California, San Francisco, San Francisco, California
| | - Joachim H Ix
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - Alexander L Bullen
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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Dasgupta P, Cameron JK, Cramb SM, Trevithick RW, Aitken JF, Mengersen K, Baade PD. Geographical and spatial disparities in the incidence and survival of rare cancers in Australia. Int J Cancer 2023; 152:1601-1612. [PMID: 36495274 PMCID: PMC10952715 DOI: 10.1002/ijc.34395] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Rare cancers collectively account for around a quarter of cancer diagnoses and deaths. However, epidemiological studies are sparse. We describe spatial and geographical patterns in incidence and survival of rare cancers across Australia using a population-based cancer registry cohort of rare cancer cases diagnosed among Australians aged at least 15 years, 2007 to 2016. Rare cancers were defined using site- and histology-based categories from the European RARECARE study, as individual cancer types having crude annual incidence rates of less than 6/100 000. Incidence and survival patterns were modelled with generalised linear and Bayesian spatial Leroux models. Spatial heterogeneity was tested using the maximised excess events test. Rare cancers (n = 268 070) collectively comprised 22% of all invasive cancer diagnoses and accounted for 27% of all cancer-related deaths in Australia, 2007 to 2016 with an overall 5-year relative survival of around 53%. Males and those living in more remote or more disadvantaged areas had higher incidence but lower survival. There was substantial evidence for spatial variation in both incidence and survival for rare cancers between small geographical areas across Australia, with similar patterns so that those areas with higher incidence tended to have lower survival. Rare cancers are a substantial health burden in Australia. Our study has highlighted the need to better understand the higher burden of these cancers in rural and disadvantaged regions where the logistical challenges in their diagnosis, treatment and support are magnified.
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Affiliation(s)
- Paramita Dasgupta
- Viertel Cancer Research CentreCancer Council QueenslandBrisbaneQueenslandAustralia
| | - Jessica K. Cameron
- Viertel Cancer Research CentreCancer Council QueenslandBrisbaneQueenslandAustralia
- School of Mathematical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Susanna M. Cramb
- Australian Centre for Health Services Innovation & Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- School of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Richard W. Trevithick
- Clinical Excellence Division, Department of HealthWestern Australia Cancer RegistryEast PerthWestern AustraliaAustralia
| | - Joanne F. Aitken
- Viertel Cancer Research CentreCancer Council QueenslandBrisbaneQueenslandAustralia
- School of Public Health, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
- Institute for Resilient RegionsUniversity of Southern QueenslandBrisbaneQueenslandAustralia
| | - Kerrie Mengersen
- School of Mathematical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Peter D. Baade
- Viertel Cancer Research CentreCancer Council QueenslandBrisbaneQueenslandAustralia
- Centre for Data ScienceQueensland University of TechnologyBrisbaneQueenslandAustralia
- Menzies Health Institute QueenslandGriffith University, Gold Coast CampusSouthportQueenslandAustralia
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Cameron JK, Fritschi L, Ross DM, Anderson LA, Baade P. Spatial disparities in the reported incidence and survival of myeloproliferative neoplasms in Australia. Pathology 2021; 54:328-335. [PMID: 34535297 DOI: 10.1016/j.pathol.2021.06.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
Myeloproliferative neoplasms (MPNs) are an uncommon group of blood cancers that, if untreated, result in an increased risk of haemorrhagic event or thrombosis. Unlike other cancer types, diagnosis of MPNs requires a combination of microscopic, clinical and genetic evidence, which provide unique challenges given the typical notification processes of cancer registries. This, and the relatively recent advances in diagnosis and revision of the World Health Organization diagnostic criteria, may result in under-diagnosis or under-reporting of MPNs. We used population-based cancer registry data from the Australian Cancer Database and modelled the incidence and survival of MPNs between 2007 and 2016 using generalised linear models and Bayesian spatial Leroux models. Substantial evidence was found of spatial heterogeneity in the incidence of MPNs and significant differences in incidence and survival by state or territory. States with lower incidence tended to have poorer survival, suggesting that some less severe cases may not be diagnosed or notified to the registries in those states. Population rates of genetic testing and percentages of records diagnosed using bone marrow biopsies did not explain the differences in incidence by state and territory. It is important to determine the key drivers of these geographical patterns, including the need to standardise diagnosis and reporting of MPNs.
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Affiliation(s)
- Jessica Katherine Cameron
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Qld, Australia; School of Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.
| | - Lin Fritschi
- School of Population Health, Curtin University, Perth, WA, Australia
| | - David M Ross
- Haematology Directorate, SA Pathology, Adelaide, SA, Australia; Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Leukaemia Laboratory, Centre for Cancer Biology, University of SA, Adelaide, SA, Australia
| | - Lesley Ann Anderson
- Aberdeen Centre for Health Data Science, Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Peter Baade
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Qld, Australia; School of Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
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Dunietz GL, Yu Y, Levine RS, Conceicao AS, Burke JF, Chervin RD, Braley TJ. Obstructive sleep apnea in older adults: geographic disparities in PAP treatment and adherence. J Clin Sleep Med 2021; 17:421-427. [PMID: 33094720 DOI: 10.5664/jcsm.8914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is prevalent among older adults. Although treatment with positive airway pressure (PAP) lowers subsequent morbidity, PAP adherence is inconsistent. Socioeconomic disparities have been observed in OSA treatment, but regional differences in OSA care are unknown. This study examined geographic variations in PAP treatment and adherence among older Americans. METHODS This study utilized a representative 5% sample of all Medicare fee-for-service beneficiaries aged 65+ years. An OSA diagnosis, treatment, and PAP adherence were confirmed with International Classification of Diseases, Ninth Revision, HCPCS (Health Care Common Procedure Coding System) codes, and ≥2 HCPCS claims for PAP supplies respectively. Descriptive statistics were used to examine proportions of Medicare beneficiaries who obtained and adhered to PAP. Maps described the proportion of treated and adherent beneficiaries by state and hospital referral region. RESULTS For state-level data, PAP treatment and adherence proportions among beneficiaries with an OSA diagnosis ranged between 54-87% and 59-81%, respectively. Proportions of treated patients were higher in Midwest states (>80%), in comparison to Northwest, Northeast, and Southern states (<73%). Southern states and California had lowest proportions of PAP adherence (<70%). Within-state variability in treatment patterns were apparent along the East and West coasts. Correlations of PAP treatment and adherence proportions were low in Washington, DC, New York, and New Jersey. Discordant treatment and adherence proportions were observed in Alabama and Mississippi. CONCLUSIONS Significant state-level and regional disparities of PAP treatment and adherence among Medicare beneficiaries with OSA suggest gaps in delivery of OSA care for older Americans.
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Affiliation(s)
- Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Yue Yu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Rivkah S Levine
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Alan S Conceicao
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Ronald D Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Tiffany J Braley
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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Frochen S, Rodnyansky S, Ailshire J. Residential care in California. J Maps 2020; 16:138-143. [PMID: 33093858 PMCID: PMC7577399 DOI: 10.1080/17445647.2020.1768446] [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] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
We examine the distribution of residential care in California, showing geographical disparities in care supply and need. We mapped the ratio of beds to older women in Los Angeles and San Diego County census tracts and concentrations of small and large facilities in the Cities of Los Angeles and San Diego. The largest ratios of residential care beds per older women occur on the border of the City of San Diego and on the periphery of Los Angeles County away from the City of Los Angeles. Clusters of small facilities take place in northern Los Angeles and southeastern San Diego, while clusters of large facilities occur in Downtown Los Angeles and near La Jolla. Understanding geographical disparities in residential care supply and need in California can help residential care developers, service providers, and local and state agencies partner in planning for residential care facility development in underserved areas.
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Affiliation(s)
- Stephen Frochen
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Seva Rodnyansky
- Goldman School of Public Policy, University of California, Berkeley, CA, USA
| | - Jennifer Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Berenson AB, Hirth JM, Chang M. Geographical disparities in human papillomavirus herd protection. Cancer Med 2020; 9:5272-5280. [PMID: 32483924 PMCID: PMC7367635 DOI: 10.1002/cam4.3125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination has occurred unequally across the United States, potentially contributing to uneven vaccine-type HPV prevalence between regions. We examined whether emerging vaccine-related herd protection exhibits regional differences among unvaccinated girls and women. METHODS We evaluated the prevalence of vaginal HPV among women 14-59 years of age from 2003 to 2014 using repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES). Women who provided an adequate vaginal swab sample were included. Vaginal prevalence of vaccine-type HPV (types 6, 11, 16, 18) were examined in four regions of the United States between 2003 and 2014. We examined vaccine-type HPV prevalence in 2007-2014 in each US census region among younger participants (14-34 years old) stratified by vaccination status to determine whether one or both groups contributed to uneven HPV prevalence. RESULTS A total of 12 175 participants 14-59 years of age met inclusion criteria. Vaccine-type HPV prevalence decreased in all regions. Vaccine-type HPV varied by region only among unvaccinated 14-34 year olds, with a higher prevalence in the Midwest (13.8%, 95% confidence interval (CI): 10.7-17.0) and South (12.5%, 95% CI: 10.2-14.8) compared to the Northeast (8.9%, 95% CI: 6.5-11.2). No regional variation in vaccine-type HPV prevalence was observed among vaccinated participants. CONCLUSIONS Higher prevalence of vaccine-type HPV among unvaccinated women in the South and Midwest may contribute to regional disparities in HPV-related cancer incidence, as emerging herd immunity may not be as strong in those regions.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, USA
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Pu J, Hastings KG, Boothroyd D, Jose PO, Chung S, Shah JB, Cullen MR, Palaniappan LP, Rehkopf DH. Geographic Variations in Cardiovascular Disease Mortality Among Asian American Subgroups, 2003-2011. J Am Heart Assoc 2017; 6:JAHA.117.005597. [PMID: 28701306 PMCID: PMC5586288 DOI: 10.1161/jaha.117.005597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are well-documented geographical differences in cardiovascular disease (CVD) mortality for non-Hispanic whites. However, it remains unknown whether similar geographical variation in CVD mortality exists for Asian American subgroups. This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non-Hispanic whites. METHODS AND RESULTS Using US death records from 2003 to 2011 (n=3 897 040 CVD deaths), age-adjusted CVD mortality rates per 100 000 population and age-adjusted mortality rate ratios were calculated for the 6 largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and compared with non-Hispanic whites. There were consistently lower mortality rates for all Asian American subgroups compared with non-Hispanic whites across divisions for CVD mortality and ischemic heart disease mortality. However, cerebrovascular disease mortality demonstrated substantial geographical differences by Asian American subgroup. There were a number of regional divisions where certain Asian American subgroups (Filipino and Japanese men, Korean and Vietnamese men and women) possessed no mortality advantage compared with non-Hispanic whites. The most striking geographical variation was with Filipino men (age-adjusted mortality rate ratio=1.18; 95% CI, 1.14-1.24) and Japanese men (age-adjusted mortality rate ratio=1.05; 95% CI: 1.00-1.11) in the Pacific division who had significantly higher cerebrovascular mortality than non-Hispanic whites. CONCLUSIONS There was substantial geographical variation in Asian American subgroup mortality for cerebrovascular disease when compared with non-Hispanic whites. It deserves increased attention to prioritize prevention and treatment in the Pacific division where approximately 80% of Filipinos CVD deaths and 90% of Japanese CVD deaths occur in the United States.
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Affiliation(s)
- Jia Pu
- Mathematica Policy Research, Oakland, CA
| | | | | | | | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | | | - Mark R Cullen
- School of Medicine, Stanford University, Stanford, CA
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