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Road environment characteristics and fatal crash injury during the rush and non-rush hour periods in the U.S: Model testing and cluster analysis

Adeyemi, Oluwaseun; Paul, Rajib; Delmelle, Eric; DiMaggio, Charles; Arif, Ahmed
This study aims to assess the relationship between county-level fatal crash injuries and road environmental characteristics at all times of the day and during the rush and non-rush hour periods. We merged eleven-year (2010 - 2020) data from the Fatality Analysis Reporting System. The outcome variable was the county-level fatal crash injury counts. The predictor variables were measures of road types, junction types and work zone, and weather types. We tested the predictiveness of two nested negative binomial models and adjudged that a nested spatial negative binomial regression model outperformed the non-spatial negative binomial model. The median county crash mortality rates at all times of the day and during the rush and non-rush hour periods were 18.4, 7.7, and 10.4 per 100,000 population, respectively. Fatal crash injury rate ratios were significantly elevated on interstates and highways at all times of the day - rush and non-rush hour periods inclusive. Intersections, driveways, and ramps on highways were associated with elevated fatal crash injury rate ratios. Clusters of high fatal crash injury rates were observed in counties located in Montana, Nevada, Colorado, Kansas, New Mexico, Oklahoma, Texas, Arkansas, Mississippi, Alabama, Georgia, and Nevada. The built and natural road environment factors are associated with county-level fatal crash injuries during the rush and non-rush hour periods. Understanding the association of road environment characteristics and the cluster distribution of fatal crash injuries may inform areas in need of focused intervention.
PMID: 36707195
ISSN: 1877-5853
CID: 5467972

Changes in Breast Cancer Presentation during COVID-19: Experience in an Urban Academic Center

Diskin, Brian; Pourkey, Nakisa; Schnabel, Freya; Miah, Pabel; DiMaggio, Charles; Axelrod, Deborah; Shapiro, Richard; Guth, Amber A
The COVID-19 pandemic strained healthcare systems worldwide, delaying breast cancer screening and surgery. In 2019, approximately 80% of breast cancers in the U.S. were diagnosed on screening examinations, with 76.4% of eligible Medicare patients undergoing screening at least every two years. Since the start of the pandemic, many women have been reluctant to seek elective screening mammography, even with the lifting of pandemic-related restrictions in access to routine healthcare. We describe the effect of the COVID-19 pandemic on breast cancer presentation at a tertiary academic medical center greatly impacted by the pandemic.
PMCID:10275681
PMID: 37334101
ISSN: 2090-3170
CID: 5542532

Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional study

Adeyemi, Oluwaseun; Bukur, Marko; Berry, Cherisse; DiMaggio, Charles; Grudzen, Corita R; Konda, Sanjit; Adenikinju, Abidemi; Cuthel, Allison; Bouillon-Minois, Jean-Baptiste; Akinsola, Omotola; Moore, Alison; McCormack, Ryan; Chodosh, Joshua
BACKGROUND:Alcohol and drug use (substance use) is a risk factor for crash involvement. OBJECTIVES:To assess the association between substance use and crash injury severity among older adults and how the relationship differs by rurality/urbanicity. METHODS:We pooled 2017-2021 cross-sectional data from the United States National Emergency Medical Service (EMS) Information System. We measured injury severity (low acuity, emergent, critical, and fatal) predicted by substance use, defined as self-reported or officer-reported alcohol and/or drug use. We controlled for age, sex, race/ethnicity, road user type, anatomical injured region, roadway crash, rurality/urbanicity, time of the day, and EMS response time. We performed a partial proportional ordinal logistic regression and reported the odds of worse injury outcomes (emergent, critical, and fatal injuries) compared to low acuity injuries, and the predicted probabilities by rurality/urbanicity. RESULTS:Our sample consisted of 252,790 older adults (65 years and older) road users. Approximately 67%, 25%, 6%, and 1% sustained low acuity, emergent, critical, and fatal injuries, respectively. Substance use was reported in approximately 3% of the population, and this proportion did not significantly differ by rurality/urbanicity. After controlling for patient, crash, and injury characteristics, substance use was associated with 36% increased odds of worse injury severity. Compared to urban areas, the predicted probabilities of emergent, critical, and fatal injuries were higher in rural and suburban areas. CONCLUSION:Substance use is associated with worse older adult crash injury severity and the injury severity is higher in rural and suburban areas compared to urban areas.
PMCID:10599556
PMID: 37878571
ISSN: 1932-6203
CID: 5606472

ASO Visual Abstract: An Analysis of COVID-19 on Surgical Delays in Breast Cancer Patients in NYC Public Hospitals-A Multicenter Study

Escobar, Natalie; DiMaggio, Charles; Pocock, Benjamin; Pescovitz, Allison; McCalla, Sydney; Joseph, Kathie-Ann
PMCID:9513008
PMID: 36161378
ISSN: 1534-4681
CID: 5334012

Effects of COVID-19 on Surgical Delays in Patients with Breast Cancer in NYC Public Hospitals: A Multicenter Study

Escobar, Natalie; DiMaggio, Charles; Pocock, Benjamin; Pescovitz, Allison; McCalla, Sydney; Joseph, Kathie-Ann
BACKGROUND:Increased time to surgery (TTS) is associated with decreased survival in patients with breast cancer. In early 2020, elective surgeries were canceled to preserve resources for patients with coronavirus disease 2019 (COVID-19). This study attempts to measure the effect of mandated operating room shutdowns on TTS in patients with breast cancer. PATIENTS AND METHODS/METHODS:This multicenter retrospective study compares 51 patients diagnosed with breast cancer at four public hospitals from January to June 2020 with 353 patients diagnosed from January 2017 to June 2018. Demographics, tumor characteristics, treatment regimens, and TTS for patients were statistically compared using parametric, nonparametric, and Cox proportional hazards regression modeling. RESULTS:Across all centers, there was a non-statistically significant increase in median TTS from 59 days in the pre-COVID period to 65 days during COVID (p = 0.9). There was, however, meaningful variation across centers. At center A, the median TTS decreased from 57 to 51 days, center C's TTS decreased from 83 to 64 days, and in center D, TTS increased from 42 to 129 days. In a multivariable Cox proportional hazards model for the pre-COVID versus COVID period effect on TTS, center was an important confounding variable, with notable differences for centers C and D compared with the referent category of center A (p = 0.04, p = 0.006). CONCLUSION/CONCLUSIONS:Data suggest that, while mandated operating room shutdowns did not result in an overall statistically significant delay in TTS, there were important differences between centers, indicating that, even in a unified multicenter public hospital system, COVID-19 may have resulted in delayed and potentially disparate care.
PMCID:9483518
PMID: 36109414
ISSN: 1534-4681
CID: 5332922

The association of crash response times and deaths at the crash scene: A cross-sectional analysis using the 2019 National Emergency Medical Service Information System

Adeyemi, Oluwaseun J; Paul, Rajib; DiMaggio, Charles; Delmelle, Eric; Arif, Ahmed
BACKGROUND:Deaths at the crash scene (DAS) are crash deaths that occur within minutes after a crash. Rapid crash responses may reduce the occurrence of DAS. OBJECTIVES/OBJECTIVE:This study aims to assess the association of crash response time and DAS during the rush and nonrush hour periods by rurality/urbanicity. METHOD/METHODS:This single-year cross-sectional study used the 2019 National Emergency Medical Services (EMS) Information System. The outcome variable was DAS. The predictor variables were crash response measures: EMS Chute Initiation Time (ECIT) and EMS Travel Time (ETT). Age, gender, substance use, region of the body injured, and the revised trauma score were used as potential confounders. Logistic regression was used to assess the unadjusted and adjusted odds of DAS. RESULTS:A total of 654,675 persons were involved in EMS-activated road crash events, with 49.6% of the population exposed to crash events during the rush hour period. A total of 2,051 persons died at the crash scene. Compared to the baseline of less than 1 minute, ECIT ranging from 1 to 5 minutes was significantly associated with 58% (95% CI: 1.45-1.73) increased odds of DAS. Also, when compared to the baseline of less than 9 minutes, ETT ranging between 9 and 18 minutes was associated with 34% (95% CI: 1.22-1.47) increased odds of DAS. These patterns were consistent during the rush and nonrush hour periods and across rural and urban regions. CONCLUSION/CONCLUSIONS:Reducing crash response times may reduce the occurrence of DAS.
PMID: 35452139
ISSN: 1748-0361
CID: 5218622

A disturbing trend: An analysis of the decline in surgical critical care (SCC) fellowship training of Black and Hispanic surgeons

Hambrecht, Amanda; Berry, Cherisse; DiMaggio, Charles; Chiu, William; Inaba, Kenji; Frangos, Spiros; Krowsoski, Leandra; Greene, Wendy Ricketts; Issa, Nabil; Pugh, Carla; Bukur, Marko
BACKGROUND:Underrepresented minorities in medicine (URiM) are disproportionally represented in surgery training programs. Rates of URiM applying to and completing General Surgery residency remain low. We hypothesized that the patterns of URiM disparities would persist into Surgical Critical Care (SCC) fellowship applicants, matriculants and graduates. METHODS:We performed a retrospective analysis of SCC applicants, matriculants and graduates from 2005-2020 using the Graduate Medical Education (GME) resident survey and analyzed applicant characteristics using the Surgical critical care and Acute care surgery Fellowship Application Service (SAFAS) from 2018-2020. The data were stratified by race/ethnicity and gender. Indicator variables were created for Asian, Hispanic, White and Black trainees. Yearly proportions for each race/ethnicity and gender categories completing or enrolling in a program were calculated and plotted over time with Loess smoothing lines and overlying 95% confidence bands. The yearly rate and statistical significance of change over time were tested with linear regression models with race/ethnicity and gender proportion as the dependent variables and year as the explanatory variable. RESULTS:From 2005-2020, there were a total of 2,481 graduates. Black men accounted for 4.7% of male graduates with a significant decline of 0.3% per year for the study period of those completing the fellowship (p = 0.02). Black women comprised 6.4% of female graduates and had a 0.6% decline each year (p < 0.01). A similar trend was seen with Hispanic men, who comprised 3.2% of male graduates and had a 0.3% annual decline (p = 0.02). White men had a significant increase in both matriculation to and graduation from SCC fellowships during the same interval. Similarly, Black and Hispanic applicants declined from 2019 to 2020, while the percentage of White applicants increased. CONCLUSIONS:Disparities in URiM representation remain omnipresent in surgery and extend from residency training to SCC fellowship. Efforts to enhance the recruitment and retention of URiM in SCC training are warranted. LEVEL OF EVIDENCE/METHODS:Level IV - Therapeutic/Care Management.
PMID: 35343928
ISSN: 2163-0763
CID: 5185002

Disparity in Transport of Critically Injured Patients to Trauma Centers: Analysis of the National Emergency Medical Services Information System (NEMSIS)

Escobar, Natalie; DiMaggio, Charles; Frangos, Spiros G; Winchell, Robert J; Bukur, Marko; Klein, Michael J; Krowsoski, Leandra; Tandon, Manish; Berry, Cherisse
BACKGROUND:Patient morbidity and mortality decrease when injured patients meeting CDC Field Triage Criteria (FTC) are transported by emergency medical services (EMS) directly to designated trauma centers (TCs). This study aimed to identify potential disparities in the transport of critically injured patients to TCs by EMS. STUDY DESIGN/METHODS:We identified all patients in the National EMS Information System (NEMSIS) database in the National Association of EMS State Officials East region from January 1, 2018, to December 31, 2019, with a final prehospital acuity of critical or emergent by EMS. The cohort was stratified into patients transported to TCs or non-TCs. Analyses consisted of descriptive epidemiology, comparisons, and multivariable logistic regression analysis to measure the association of demographic features, vital signs, and CDC FTC designation by EMS with transport to a TC. RESULTS:A total of 670,264 patients were identified as sustaining an injury, of which 94,250 (14%) were critically injured. Of those 94,250 critically injured, 56.0% (52,747) were transported to TCs. Among all critically injured women (n = 41,522), 50.4% were transported to TCs compared with 60.4% of critically injured men (n = 52,728, p < 0.001). In a multivariable logistic regression model, critically injured women were 19% less likely to be taken to a TC compared with critically injured men (OR 0.81, 95% CI 0.71-0.93, p = 0.003). CONCLUSIONS:Critically injured female patients are less likely to be transported to TCs when compared with their male counterparts. Performance improvement processes that assess EMS compliance with field triage guidelines should explicitly evaluate for sex-based disparities. Further studies are warranted.
PMID: 35703965
ISSN: 1879-1190
CID: 5236672

Occupational Conditions Associated With Negative Mental Health Outcomes in New York State Health Professionals During the COVID-19 Pandemic

Cheslack-Postava, Keely; Bresnahan, Michaeline; Ryan, Megan; Musa, George J; Amsel, Lawrence; DiMaggio, Charles; Andrews, Howard F; Susser, Ezra; Li, Guohua; Abramson, David M; Lang, Barbara H; Hoven, Christina W
OBJECTIVE:The aim of this study was to assess occupational circumstances associated with adverse mental health among health care workers during the COVID-19 pandemic. METHODS:A cross-sectional study examined responses to an on-line survey conducted among 2076 licensed health care workers during the first pandemic peak. Mental health (depression, anxiety, stress, and anger) was examined as a multivariate outcome for association with COVID-related occupational experiences. RESULTS:Odds of negative mental health were increased among those who worked directly with patients while sick themselves (adjusted odds ratio, 2.29; 95% confidence interval, 1.71-3.08) and were independently associated with working more hours than usual in the past 2 weeks, having family/friends who died due to COVID-19, having COVID-19 symptoms, and facing insufficiencies in personal protective equipment/other shortages. CONCLUSIONS:Occupational circumstances were associated with adverse mental health outcomes among health care workers during the COVID-19 pandemic, and some are potentially modifiable.
PMID: 35732029
ISSN: 1536-5948
CID: 5268782

Examination of Intersectionality and the Pipeline for Black Academic Surgeons

Keshinro, Ajaratu; Butler, Paris; Fayanju, Oluwadamilola; Khabele, Dineo; Newman, Erika; Greene, Wendy; Ude Welcome, Akuezunkpa; Joseph, Kathie-Ann; Stallion, Anthony; Backhus, Leah; Frangos, Spiros; DiMaggio, Charles; Berman, Russell; Hasson, Rian; Rodriguez, Luz Maria; Stain, Steven; Bukur, Marko; Klein, Michael J; Henry-Tillman, Ronda; Barry, Linda; Oseni, Tawakalitu; Martin, Colin; Johnson-Mann, Crystal; Smith, Randi; Karpeh, Martin; White, Cassandra; Turner, Patricia; Pugh, Carla; Hayes-Jordan, Andrea; Berry, Cherisse
Importance/UNASSIGNED:The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. Objective/UNASSIGNED:To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. Design, Setting, and Participants/UNASSIGNED:In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex. Analyses consisted of descriptive statistics, time series plots, and simple linear regression for the rate of change over time. Medical students and general surgery residency trainees of Asian, Black, Hispanic or Latino of Spanish origin, White, and other races were included. Data for non-US citizens or nonpermanent residents were excluded. Data were collected from 2005 to 2018, and data were analyzed in March 2021. Main Outcomes and Measures/UNASSIGNED:Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs. Results/UNASSIGNED:Over the study period, there were 71 687 applicants, 26 237 first-year matriculants, and 24 893 graduates. Of 71 687 applicants, 24 618 (34.3%) were women, 16 602 (23.2%) were Asian, 5968 (8.3%) were Black, 2455 (3.4%) were Latino, and 31 197 (43.5%) were White. Women applicants and graduates increased from 29.4% (1178 of 4003) to 37.1% (2293 of 6181) and 23.5% (463 of 1967) to 33.5% (719 of 2147), respectively. When stratified by race and ethnicity, applications from Black women increased from 2.2% (87 of 4003) to 3.5% (215 of 6181) (P < .001) while applications from Black men remained unchanged (3.7% [150 of 4003] to 4.6% [284 of 6181]). While the matriculation rate for Black women remained unchanged (2.4% [46 of 1919] to 2.3% [52 of 2264]), the matriculation rate for Black men significantly decreased (3.0% [57 of 1919] to 2.4% [54 of 2264]; P = .04). Among Black graduates, there was a significant decline in graduation for men (4.3% [85 of 1967] to 2.7% [57 of 2147]; P = .03) with the rate among women remaining unchanged (1.7% [33 of 1967] to 2.2% [47 of 2147]). Conclusions and Relevance/UNASSIGNED:Findings of this study show that the underrepresentation of Black physicians at every stage in surgical training pipeline persists. Black men are especially affected. Identifying factors that address intersectionality and contribute to the successful recruitment and retention of Black trainees in general surgery residency is critical for achieving racial and ethnic as well as gender equity.
PMCID:8829744
PMID: 35138327
ISSN: 2168-6262
CID: 5171692