Browsing by keyword "geography"
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Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study CohortAdverse socioeconomic conditions, at both the individual and the neighborhood level, increase the risk of colorectal cancer (CRC) death, but little is known regarding whether CRC survival varies geographically and the extent to which area-level socioeconomic deprivation affects this geographic variation. Using data from the National Institutes of Health (NIH)-AARP Diet and Health Study, the authors examined geographic variation and the role of area-level socioeconomic deprivation in CRC survival. CRC cases (n = 7,024), identified during 1995-2003, were followed for their CRC-specific vital status through 2005 and overall vital status through 2006. Bayesian multilevel survival models showed that there was significant geographic variation in overall (variance = 0.2, 95% confidence interval (CI): 0.1, 0.2) and CRC-specific (variance = 0.3, 95% CI: 0.1, 0.4) risk of death. More socioeconomically deprived neighborhoods had a higher overall risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.4) and a higher CRC-specific risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.5). However, neighborhood socioeconomic deprivation did not account for the geographic variation in overall and CRC-specific risks of death. In future studies, investigators should evaluate other neighborhood characteristics to help explain geographic heterogeneity in CRC survival. Such research could facilitate interventions for reducing geographic disparity in CRC survival.
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Geographic Variation in Hospital Costs Associated with Isolated Coronary Artery Bypass GraftingBackground: In the past decades, studies have shown geographic variation (GV) in patient risk factors, outcomes, and practice patterns associated with coronary artery bypass grafting (CABG). However, contemporary data related to GV in hospital costs associated with isolated CABG are lacking. Methods: We used the latest (2014) National Inpatient Sample (NIS) to identify patients aged 18+ who underwent primary isolated CABG. ICD-9 codes were used to derive comorbidities and procedure types. Geographic stratification was based on the Census Division of each hospital. The NIS cost-to-charge ratio based on all-payer inpatient costs and census-region-based medical care consumer price index were used to adjust for hospital costs. Data were analyzed by using weighted analyses of variance for continuous data and the Rao-Scott likelihood ratio Chi-square test for categorical variables. Weighted multivariable regression analysis was used to examine the association between geographic divisions and adjusted costs (log-transformed) by adjusting for patient/procedure characteristics, and comorbidities. Results: In 2014, 132,270 patients from 1,106 hospitals underwent a primary isolated CABG. The median (Inter Quartile Range [IQR]) of age was 65 (57-72) years (GV: 63-66), and 25% was female (GV: 22%-28%). Overall, 47% were admitted electively (GV: 38%-54%), 28% had a primary diagnosis of acute myocardial infarction (GV: 26%-32%), 84% had hypertension (GV: 80%-86%), 27% had atrial fibrillation (GV: 24%-29%), 12% (GV: 8%-15%) had 4+ coronary arteries bypassed and 1.4% died in-hospital (GV: 0.9%-2.1%). The median (IQR) hospital length of stay was 6.9 (5.0-9.8) days (GV: 6.3-7.2). The median (IQR) adjusted cost was $34,949 ($26,879-$44,725), which was lowest in the East South Central ($28,854 [$23,268-$36,193]) and highest in the East North Central ($41,852 [$32,965-$54,223]) (p Conclusions: We observed statistically, but not clinically, significant differences in patient baseline characteristics. Geographic variations exist in outcomes and the hospital costs among patients who underwent isolated CABG.
