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Economic damage due to hurricane activities has been shown to impact income inequality in the coastal states of the United States. We consider 17 other natural hazards, in addition to hurricanes, that affected the entire United States for the period 1970-2013. Two fixed effects models were developed to quantify the relationship between income inequality and economic and demographic variables, including crop and property losses from natural hazard-induced disasters. These models include state-by-year and region-by-year fixed effects models. Our findings show that the damages from all natural hazards impact income distribution across the United States, not only in hurricane-affected areas, but also in non-hurricane states. The results of our study have important implications for the insurance industry and government policymakers. [ABSTRACT FROM AUTHOR]

Urban stream condition is often degraded by human activities in the surrounding watershed. Given the complexity of urban areas, relationships among variables that cause stream degradation can be difficult to isolate. We examined factors affecting stream condition by evaluating social, terrestrial, stream hydrology and water quality variables from 20 urban stream watersheds in central Iowa, U.S.A. We used path analysis to examine and quantify social and ecological factors related to variation in stream conditions. Path models supported hypotheses that stream water quality was influenced by variables in each category. Specifically, one path model indicated that increased stream water conductivity was linked to high road density, which itself was associated with high human population density. A second path model revealed nitrogen concentration in stream water was positively related to watershed area covered by cropland, and that cropland increased as human population density declined. A third path model indicated phosphorus concentration in stream water declined as percent of watershed residents with college education increased, although the mechanism underlying this relationship was unclear and could have been an artifact of lower soil-derived nutrient input from watersheds dominated by paved surfaces. To improve environmental conditions in urban streams, land use planning strategies should include limiting or reducing road density near streams, installing treatment trains for surface water runoff associated with roads, and establishing vegetated buffer zones to reduce inputs of road salt and other pollutants. Additionally, education/outreach should be conducted with residents to increase understanding of how their own behaviors influence stream water quality. [ABSTRACT FROM AUTHOR]

Highlights: [•] Impervious surface area increased and became more connected over time. [•] Building and parking lot surfaces became more important in the last 20 years. [•] Spatial heterogeneity of surfaces was quantified in different percent IS zones. [•] Dominant impervious surfaces include roads (low IS zones), buildings (medium), and parking lots (high). [•] Policy and practice implementation to mitigate against IS impacts can be targeted in different percent IS zones. [ABSTRACT FROM AUTHOR]

• The urban growth pattern and change in the three urban agglomerations in China and the USA were compared. • Diffusional sprawl in the three Chinese Urban Agglomerations is more obvious than those in the USA. • Urban sprawl process in China manifests itself as "engulfing" whereas it becomes "breeding" in the USA. Urban sprawl is a worldwide significant challenge for a sustainable urban development. This study compared China, with its unprecedented urbanisation process, and the USA, with its long-standing campaign urban sprawl, as case study areas. The urban growth pattern was quantitatively identified in three noted urban agglomerations (the Yangtze River Delta, the Pearl River Delta, and the Beijing-Tianjin-Hebei urban agglomerations) in China and in three megalopolises (the Great Lakes Megalopolis, the Northeast Megalopolis, and the Californian Megaregion) in the USA at the patch level. The periods from 1995 to 2005 and from 2005 to 2015 were investigated, and the sprawl characteristic in infilling, edge, and outlying expansion patches were compared. The main findings include: 1) more than half of the outlying urban sprawl occurs within a distance of 4 km from the current primary construction centre in the USA. In China, the range of outlying urban sprawl is more extensive with a radius of 4–10 km; 2) the edge urban sprawl is the primary sprawl type in both countries; however, the proportion of edge-expansion land in China's metropolises is higher than in the USA, and edge expansion mainly occurs in the core cities of China's metropolitan areas; 3) with respect to infilling compact growth, more than a 20% increase of area and a more balanced pattern were observed in the three megalopolises in the USA during both periods, which is considerably higher than in China. The exploration on the differences and similarities between both countries provides an important reference toward optimised urban spatial planning in other countries. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth., Methods: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts., Results: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084)., Conclusions: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)