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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]

Academic achievement in American high schools is increasingly defined in terms of quantifiable values. Despite being designed to produce favorable data, explicit standardizedtest preparation has an insignificant impact on scores and is counterproductive to the cultivation of attributes necessary for success in higher education and effective civic engagement. Reaffirming trends known since the 1970s, standardized test scores directly correlate to socioeconomic status (SES) across time and space, as this study of six Illinois high schools demonstrates. SES functions to engender test scores independent of curriculum decisions and to a higher degree than racial/ethnic demographics alone. Educational inequality cannot be addressed without broader systemic changes to the American political economy. To implement such changes, it is incumbent upon teachers to transcend classspecific curriculums, foster the imagining of different social realities, and develop students' propensity for collective action through critical pedagogy. [ABSTRACT FROM AUTHOR]

Sociodemographic disparities in terms of access to bariatric surgery are ongoing. This study aimed to examine the trends for bariatric interventions based on patient characteristics from 2011 to 2018 in the state of New York. Administrative statewide database. This study used the New York Statewide Planning and Research Cooperative System database to identify all patients with obesity who underwent Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2011 and 2018. The trends were studied for the types of bariatric procedures performed across different patient characteristics, including median household income as determined based on ZIP code. A multivariable logistic regression analysis was performed to compare the yearly trends. We identified 111,793 patients who underwent bariatric surgery. The number of bariatric procedures increased from 9304 in 2011 to 16,946 in 2018. RYGB was the most performed bariatric operation in 2011, but was replaced by SG from 2013 to 2018. Patients living in the highest decile median household income ZIP code areas had the highest increase in SG (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.46–1.55; P <.0001) and the largest decrease in LAGB (OR,.53; 95% CI,.51–.56; P =.0007). The use of bariatric surgery increased significantly from 2011 to 2018. However, the disproportionately and substantially increased use of SG and the decreased use of LAGB in patients living in wealthier areas suggest that disparity in the use of bariatric interventions still exists. Public health efforts should be made to equalize access to bariatric surgery. • Sociodemographic disparities in terms of access to bariatric surgery were investigated • Patients with the highest decile median household income had the highest increase in LSG and the largest decrease in LAGB • Hispanic patients had the smallest decrease in LAGB and the smallest increase in LSG • Efforts should be made to ensure equality in access to bariatric surgery [ABSTRACT FROM AUTHOR]

Background: Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well.Study Design: Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival.Results: No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028).Conclusions: Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care. [ABSTRACT FROM AUTHOR]

Objectives: The effects of socioeconomic status (SES) on the incidence of well-differentiated thyroid cancer (WDTC) are well researched. However, the association between SES and outcomes is not delineated. Our objective was to determine if SES affected outcomes of WDTC. Study Designs: Retrospective database review. Setting: Tertiary care medical center. Subjects and Methods: The Henry Ford Virtual Data Warehouse Tumor Registry was used to identify cases of WDTC. Socioeconomic data were obtained through the 2010 US Census: median household income, percentage below poverty line, median household size, percentage rent versus own property, and general demographics. Survival was the primary outcome. Disease-specific survival was also calculated. Cox proportional hazards were calculated and a multivariate analysis performed. Results: There were 1317 patients with WDTC. In multivariable analysis, median household income (hazard ratio [HR]: 0.85, 95% confidence interval [95% CI]: 0.79-0.91), household size (HR: 1.49, 95% CI: 1.09-2.14), younger age (HR: 1.97, 95% CI: 1.74-2.23), and female sex (HR: 0.50, 95% CI: 0.37-0.69) were significantly associated with survival. Controlling for stage revealed percentage below poverty line (stage I, HR: 0.51, 95% CI: 1.34-1.78; stage IV, HR: 1.28, 95% CI: 1.04-1.57) and median household income (HR: 0.84, 95% CI: 0.71-0.99) to be significant factors in survival. Median household income was a statistically significant variable for disease-related death (HR: 0.82, 95% CI: 0.69-0.96) CONCLUSIONS: Along with effects on incidence, lower SES correlates with worse survival in WDTC. This suggests that a patient's economic background, with younger age and female sex, influences one's outcomes with regard to both overall and disease-specific death. [ABSTRACT FROM AUTHOR]

Abstract: We examined the prognostic impact of SES, estimated by census median household income, in 312 adult MDS patients. Age, progression to AML, use of recombinant erythropoietin, WHO diagnosis and IPSS risk category were independent predictors of survival but there was no association between SES and survival. Unexpectedly, progression to AML was more prevalent in the highest income quartile (HR 3.96 for highest vs. lowest; p =0.0032). The previously demonstrated association of low SES with poor outcome MDS in the United States may have been driven primarily by reduced access to care rather than other SES-linked factors such as co-morbidity. [Copyright &y& Elsevier]

Demographics of the largest 25 U.S. cities are significantly correlated with either their online sustainability reporting or their sustainability performance. The Leaders-cities with good sustainability reporting and good sustainability performance-such as Seattle, San Diego, Boston, San Jose, Austin, and Phoenix, have the highest median household income and the lowest family poverty rate. The Visionaries-those with superior reporting but poorer performance-such as San Antonio, Columbus, Chicago, Houston, New York, and Los Angeles, have a higher population, higher cost of living index, superior metro transit ridership rank, and the highest earning from the arts, entertainment, and recreation sector. The Pragmatists-having inferior reporting, however, good performance-such as Charlotte, Jacksonville, Milwaukee, San Francisco, and Denver, have the worst metro transit ridership rank, the lowest in population, and the lowest in individual poverty rate. Lastly, the Laggards- cities with both poor reporting and poor performance-such as Memphis, Detroit, Dallas, Indianapolis, El Paso, Philadelphia, Fort Worth, and Baltimore, have the highest individual poverty rate, highest family poverty rate, and highest total property crime. [ABSTRACT FROM AUTHOR]

Childbearing among unmarried women has been the subject of intense public health debate for decades, reflecting concerns about the impact on family structure and the economic security of born children. This report analyzes 2007 data from the OASIS, the website of the Division of Public Health of the Georgia Department of Community Health. Significant inverse correlations were recorded among the counties' median household income on one side and birth rate (r = –.239, p < .01), percentage of all births from unmarried mothers (r = –.679, p < .001), and percentage of all births from mothers with less than a 12th-grade education (r = –.488, p < .001). We believe that creating a network of maternity education and support programs across the state of Georgia that works under centralized supervision from a maternity committee could help alleviate the negative effect of median household income on nonmarital birth and decrease regional disparities related to nonmarital births. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the influence of patient and hospital demographics on cholecystectomy outcomes.Methods: Year 2000 data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was obtained for all patients undergoing inpatient cholecystectomy at 994 nationwide hospitals. Differences (p < 0.05) were determined using standard statistical methods.Results: Of 93,578 cholecystectomies performed, 73.4% were performed laparoscopically. Length of hospital stay (LOS), charges, morbidity, and mortality were significantly less for laparoscopic cholecystectomy (LC). Increasing patient age was associated with increased LOS, charges, morbidity, mortality, and a decreased LC rate. Charges, LOS, morbidity, and mortality were highest for males with a lower LC rate than for females Mortality and LOS were higher, whereas morbidity was lower for African Americans than for whites. Hispanics had the shortest LOS, as well as the lowest morbidity and mortality rates. Laparoscopic cholecystectomy was performed more commonly for Hispanics than for whites or African Americans, with lower charges for whites. Medicare-insured patients incurred longer LOS as well as higher charges, morbidity, and mortality than Medicaid, private, and self-pay patients, and were the least likely to undergo LC. As median income decreases, LOS increases, and morbidity decreases with no mortality effect. Teaching hospitals had a longer LOS, higher charges, and mortality, and a lower LC rate, with no difference in morbidity, than nonteaching centers. As hospital size (number of beds) increased, LOS, and charges increased, with no difference in morbidity. Large hospitals had the highest mortality rates and the lowest incidence of LC. Urban hospitals had higher LOS and charges with a lower LC rate than rural hospitals. After control was used for all other covariates, increased age was a predictor of increased morbidity. Female gender, LC, and intraoperative cholangiogram all predicted decreased morbidity. Increased age, complications, and emergency surgery predicted increased mortality, with laparoscopy and intraoperative cholangiogram having protective effects. Patient income, insurance status, and race did not play a role in morbidity or mortality. Academic or teaching status of the hospital also did not influence patient outcomes.Conclusions: Patient and hospital demographics do affect the outcomes of patients undergoing inpatient cholecystectomy. Although male gender, African American race, Medicare-insured status, and large, urban hospitals are associated with less favorable cholecystectomy outcomes, only increased age predicts increased morbidity, whereas female gender, laparoscopy, and cholangiogram are protective. Increased age, complications, and emergency surgery predict mortality, with laparoscopy and intraoperative cholangiogram having protective effects. [ABSTRACT FROM AUTHOR]