Environmental and socioeconomic factors affect bladder cancer mortality and effects appear to vary by gender and race. Additionally there were temporal trends of bladder cancer hot spots which, when persistent, should be the focus of individual level studies of occupational and environmental factors.

Background For patients receiving hemodialysis, distance to their dialysis facility may be particularly important due to the need for thrice weekly dialysis. We sought to determine whether African-Americans and Whites differ in proximity and access to high quality dialysis facilities. Methods We analyzed urban, Whites and African-Americans aged 18-65 receiving in-center hemodialysis linked to data on neighborhood and dialysis facility quality measures. In multivariable analyses, we examined the association between individual and neighborhood characteristics, and our outcomes: distance from home zip code to nearest dialysis facility, their current facility and the nearest high quality facility, as well as likelihood of receiving dialysis in a high quality facility. Results African-Americans lived a half mile closer to a dialysis facility (B=-0.52) but traveled the same distance to their own dialysis facility compared to Whites. In initial analysis, African-Americans are 14% less likely than their White counterparts to attend a high quality dialysis facility (OR 0.86); and those disparities persist, though are reduced, even after adjusting for region, neighborhood poverty and percent African-American. In predominately African-American neighborhoods, individuals lived closer to high quality facilities (B=--5.92), but were 53% less likely to receive dialysis there (OR 0.47, highest group versus lowest, p<0.05). Living in a predominately African-American neighborhood explains 24% of racial disparity in attending a high quality facility. Conclusions African-Americans' proximity to high quality facilities does not lead to receiving care there. Institutional and social barriers may also play an important role in where people receive dialysis.

BACKGROUND: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening. METHODS: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated. RESULTS: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215. CONCLUSIONS: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center.

Asian Americans have experienced compounding stressors during the pandemic as a result of racial discrimination. We aim of to investigate the prevalence of depression symptoms among Asian Americans before and during the COVID-19 pandemic and examine differences based on socio-demographic factors. Data are from a cross-sectional study (N = 636) among Chinese and South Asian adults in Chicago collected between February and May 2020. One cohort of participants were surveyed from each ethnic group before the pandemic and a second cohort of participants were surveyed during the pandemic. Depression symptoms increased more than two-fold, from 9% pre-pandemic to 21% during the COVID-19 pandemic. We found an increase in depression symptoms during the pandemic for South Asians, men and adults older than 30 years. These findings call for public health education that effectively addresses anti-Asian harassment and violence and ensure that culturally competent mental health services are provided to Asian Americans from diverse ethnic backgrounds.

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