Search

Wastewater affordability is a pressing concern in the US as the cost of collecting and treating wastewater continues to rise rapidly, and reports have revealed that millions of residents are experiencing a lack of equitable access to affordable wastewater management. The USEPA has established an affordability metric based on 2.5% of median household income (MHI) and affordability is typically interpreted as the monthly utility bill. However, this approach is not applicable to the 25% of US households that are not connected to networked sewer. This study developed the first statewide methodology for mapping wastewater affordability for users of both networked and onsite wastewater treatment systems (OWTS) based on USEPA guidelines. The methodology used local data from the Alabama Department of Environmental Management (ADEM), utilities, and the US Census Bureau. This article presents a novel methodology for quantifying water and wastewater affordability challenges for large geographical areas while maintaining the accuracy of small-spatial scale analysis. This study also incorporated income inequalities by using census tract-level household income data to estimate the number of households in Alabama with unaffordable wastewater access. This study revealed that wastewater access affordability challenges are more widespread than indicated by traditional MHI-based analysis and are likely affecting approximately 445,000 households in Alabama (23.7%). This study also showed that expansions in the available funding and types of eligible applicants for grant programs that subsidize OWTS capital costs could reduce OWTS affordability challenges eightfold. We propose using this methodology to quantify affordability challenges alongside a suite of approaches to address wastewater affordability in the US at the utility and household levels to preserve the human right to affordable sanitation. Practical Applications: Wastewater affordability is a key aspect of providing sustainable wastewater collection and treatment for US residents. The ongoing discussions about wastewater access affordability are often centered around customers of sewer utilities and neglect to consider the affordability challenges of residents with OWTS (commonly known as septic tank systems). This study develops a methodology for analyzing statewide wastewater access affordability for both residents with sewer bills and users of OWTS based on annual household incomes at the census tract level. This study reveals that wastewater affordability challenges affect both users of centralized sewer networks and OWTS including approximately 445,000 households in Alabama (23.7%). [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of this study was to identify survival rates and potential prognostic factors of ovarian squamous cell carcinoma (OSCC), offering valuable insights for clinical decision making.Leveraging the Surveillance, Epidemiology, and End Results (SEER) database, we selected 11 078 serous carcinoma (SC) patients and 198 OSCC patients based on predetermined criteria diagnosed from 2000 to 2020. We compared the overall survival (OS) and cancer‐specific survival (CSS) before and after propensity score matching (PSM) in two groups. Prognostic differences were also compared between OSCC and SC groups at different stages. Univariate and multivariate Cox regression analyses were performed to investigate the impact of clinical and pathologic variables on the survival of patients with OSCC. Finally, we developed and validated a nomogram predictive model.OSCC tumors exhibited distinct characteristics, being relatively larger, more frequently unilateral, and better differentiated than SC tumors. After PSM, Kaplan–Meier analysis revealed significantly lower survival rates for OSCC patients in Stages IIB–IV, while Stages IA–IC displayed comparable survival. Independent risk factors for OSCC patients included advanced age, single marital status, higher tumor stage, and increased tumor size. Conversely, higher median household income and chemotherapy emerged as independent protective factors. Our predictive model and nomogram accurately forecasted patient survival rates in both SEER and internal validation datasets.OSCC patients face significantly poorer prognosis than their SC counterparts, except in the very early stages. Higher median household income was associated with better OSCC survival. [ABSTRACT FROM AUTHOR]

A growing number of studies have reported mental health problems in men with prostate cancer. Relationships of median household income and ethnicity to suicide in prostate cancer are poorly characterized. A retrospective study from database data answered this question. Median household income and ethnicity are important factors strongly related to suicide risk in prostate cancer patients, and the lower median household income individuals and non-Spanish-Hispanic-Latino individuals were associated with higher suicide risk. Purpose: To determine whether socioeconomic disparities have an impact on the likelihood of suicide among prostate cancer patients. Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with malignant prostate cancer between 2005 and 2020. The socioeconomic disparities of the patients were evaluated by median household income (MHI) and ethnicit y. Ethnicit y included Spanish-Hispanic-Latino and non-Spanish-Hispanic-Latino. A Cox proportional risk model was utilized. Using the Kaplan-Meier approach, the cumulative incidence of suicide mortality was measured. Results: A total of 857,418 US population with prostate cancer were included. In the multivariate analysis, individuals with MHI over $75,000 had a lower risk of suicide mortality than those with MHI between $54,999 and $74,999 in all patients (aHRs: 0.693, 95 CI%: 0.603-0.797). Spanish-Hispanic-Latino displayed lower overall suicide mortality in all patients (aHRs: 0.426, 95% CI: 0.323-0.561). In the subgroup analysis of different ages, individuals with MHI over $75,000 had a lower risk of suicide than those with MHI between $54,999 and $74,999 in patients 60 to 79 years (aHRs: 0.668, 95% CI: 0.562-0.794) and individuals with MHI below $54,999 had higher suicide risk than those with MHI between $54,999 and $74,999 in patients 80 + years (aHRs: 1.786, 95% CI: 1.100-2.902). Hispanic-Latino individuals had lower overall suicide mortality in 00 to 59 years (aHRs: 0.420, 95% CI: 0.240-0.734), 60 to 79 years (aHRs: 0.445, 95% CI: 0.319-0.621), 80 + years (aHRs: 0.363, 95% CI: 0.133-0.988). Conclusion: Socioeconomic disparities, including MHI and ethnicity, are important factors strongly related to suicide risk in prostate cancer patients. The lower MHI individuals and non-Spanish-Hispanic-Latino individuals were associated with higher suicide risk. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is widely acknowledged as a prevalent malignancy and the second most common cause of cancer-related mortality worldwide. The aim of this study was to examine the independent impact of Median Household Income (MHI) on prognosis and survival outcomes in patients with CRC. Methods: Data from 17 cancer registries of the United States Surveillance, Epidemiology, and End Results program, with follow-up extended until November 2022 was analyzed. A Cox proportional hazards regression analysis was conducted to evaluate the influence of different levels of MHI on survival outcomes among patients with CRC. A total of 761,697 CRC patient records were retrieved from the SEER database. Results: The Cox regression analysis results indicated that patients with higher MHI exhibited improved overall survival outcomes when compared to those with lower MHI (MMHI: P < 0.001; HMHI: P < 0.001). Regardless of the specific tumor location, gender, stage of CRC, or treatment method, higher MHI is consistently linked to improved survival outcomes. However, this association was not found to be statistically significant among American Indian/Alaska Native (MMHI: P = 0.017; HMHI: P = 0.081), Asian or Pacific Islander (MMHI: P = 0.223; HMHI: P = 0.002) and unmarried or domestic partner patients (MMHI: P = 0.311; HMHI: P = 0.011). Conclusion: These results emphasize the importance of considering socioeconomic factors, such as income level, in understanding and addressing disparities in survival outcomes of CRC patients. [ABSTRACT FROM AUTHOR]

Background: There is limited data on how demographics, tumor characteristics, and treatment methods affect overall survival in patients with dermatofibrosarcoma protuberans (DFSP). Objective: To summarize characteristics of patients with DFSP, assess prognostic factors, and evaluate the impact of treatment modality on their overall survival. Methods: We investigated DFSP using data for 4451 patients with histologically confirmed cases of DFSP diagnosed between 2000 and 2018 from the 18 US regional registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Results: Older age (P <.001) and large tumor size (P =.006) were significantly associated with worse overall survival in controlled analysis. Older age (P <.050), males (P <.001), non-white race (P <.001), and lower median household income (P <.010) were more likely to present with larger tumor size. Different treatments were associated with patient characteristics. Older age (P <.001), non-white race (P <.032), larger tumor size (P <.001), and head/neck location (P <.001) were associated with patients receiving surgery and radiation instead of surgery only. Additionally, men (P <.021), non-whites (P <.001), lower median household income (P <.001), and larger tumor size (P =.003) were less likely to have Mohs micrographic surgery performed over excision. Conclusions: Age at presentation and tumor size appeared to be notable prognostic factors. Although treatment modality did not significantly influence patient survival, certain patient characteristics are associated with different treatment modalities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer. Study Design: Retrospective review (2000-2019). Setting: Single-institution tertiary medical center. Methods: MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation. Results: The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P =.022; β = −0.092, P =.045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]). Conclusion: MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Penile cancer, while relatively rare in developed nations, presents substantial disparities in outcomes among different demographic groups. Previous research has shown race/ethnicity and socioeconomic status, often proxied by household median income, to be critical determinants of health outcomes across various diseases., Objective: This study examines the association of race/ethnicity and household median income with survival among penile cancer patients in the United States., Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) Registry to identify patients with a primary diagnosis of penile malignancies from 2000 to 2019. Our primary outcome of interest was the hazard of death following a diagnosis of penile cancer. We utilized the Cox regression model to explore the association between race/ethnicity and median household income and how this influences survival among these patients. We adjusted for patients' characteristics, disease stage at presentation, and treatment modalities., Result: Of the 6,520 penile cancer patients identified, 5,242 (80.4%) had primary malignancies. The distribution of patients was as follows: 64.1% non-Hispanic Whites, 8.9% non-Hispanic Blacks, 20.8% Hispanics, and 6.2% from other racial/ethnic groups. The median diagnosis age was 66 years (interquartile range: 56-74). Survival rates at 5, 10, and 15 years showed racial disparities: 76.4%, 72.5%, and 69.7% for non-Hispanic Whites; 70.6%, 64.1%, and 61.1% for non-Hispanic Blacks; and 70.5%, 67.4%, and 65.6% for Hispanics. Multivariate Cox regression revealed worst survival for Black (HR=1.40; 95% CI=1.08-1.81, p=0.01) and Hispanic patients (HR=1.24; 95% CI=1.01-1.52, p=0.04). No association was found between median household income and survival. Interaction analysis indicated that the poorest Black men had worse outcomes than the poorest Whites did (HR=2.08; 95% CI=1.27-3.41, p=0.003)., Conclusion: Survival rates for non-Hispanic Black and Hispanic patients are significantly lower than those for non-Hispanic Whites. Furthermore, survival is worse for low-income Black patients than their White counterparts in the same income bracket., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Akinyemi et al.)