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Background Adherence to cancer screening is important for cancer survivors because they are at high risk of subsequent cancer diagnoses or recurrence. We assessed adherence to breast, cervical, and colorectal cancer‐(CRC)‐screening guidelines and evaluated demographic disparities among a population‐based sample of survivors. Methods A representative sample of Utah survivors diagnosed from 2012–2018 with any reportable invasive cancer was selected from central cancer registry records for a survey about survivorship needs. We estimated the proportion of eligible survivors adhering to U.S. Preventive Services Task Force screening guidelines and calculated risk ratios and 95% confidence intervals. Analyses were age‐adjusted and weighted to account for sample design and nonresponse. Results And 1421 survivors completed the survey (57.2% response rate). Screening adherence was 74.4% for breast, 69.4% for cervical, and 79.7% for CRC. Rural residents were more likely to adhere to breast cancer screening than urban residents (86.1% vs. 72.7%; adjusted RR = 1.19, CI = 1.05, 1.36). Higher educational attainment was associated with increased adherence to cervical and colorectal cancer screening. Younger age was associated with greater adherence to cervical cancer screening (p = 0.006) but lower adherence to CRC screening (p = 0.003). CRC screening adherence was lower among the uninsured and those without a primary care provider (45.6%) compared to those with a regular provider (83.0%; adjusted RR = 0.57, CI = 0.42, 0.79). Conclusions Surveys based on samples from central cancer registries can provide population estimates to inform cancer control. Findings demonstrate work is needed to ensure all Utah cancer survivors obtain recommended cancer screenings. Efforts should focus particularly on increasing uptake of breast and cervical cancer screening and reducing demographic disparities in CRC screening. Precis Despite high risk for subsequent cancer diagnosis, Utah cancer survivors are not all obtaining recommended breast, cervical, and colorectal cancer screenings. This presents a significant healthcare gap. In this paper, we examine adherence to breast, cervical, and colorectal cancer screening guidelines using a population‐based sample survey of cancer survivors in Utah. Our findings indicate additional work is needed to ensure all Utah cancer survivors obtain recommended cancer screenings and reduce demographic disparities in screening.

Transgender and gender-diverse (TGD) individuals are at risk for discrimination and inequities across legal, social, and medical contexts. Population-level resources have rarely been used for TGD health research and, therefore, data is lacking about prevalences of a wide range of clinical conditions among TGD populations. To leverage the Utah Population Database's demographic, vital, and health records and examine population-level diagnostic prevalences in TGD individuals and an age-matched general cohort. 6,664 TGD individuals were identified using ICD codes for gender incongruence between 1995 and 2021; 64,124 age-matched individuals comprised the control cohort. Using Phecodes to collapse ICD codes, this study examined differences in the prevalence of medical, mental health, and neurodevelopmental clinical phenotypes in TGD and control cohorts using modified Poisson regression models. Affiliated healthcare systems within the state of Utah. We evaluated adjusted prevalence ratios of identified Phecodes. The TGD cohort showed broadly higher documented prevalences of medical, mental health, and neurodevelopmental conditions compared to controls. Medical diagnoses more common in the TGD cohort included sleep disorders and chronic pain. Disparities in diagnoses such as \"other endocrine disorders\" and \"need for hormone replacement therapy\" likely reflect gender-affirming treatments. Mental health conditions including mood, depression, anxiety, and personality disorders were significantly more prevalent in the TGD cohort. This study highlights diagnostic disparities for TGD individuals across multiple clinical categories. Our findings may be driven by: 1) discrimination and over-medicalization of TGD individuals, 2) differences in accessing and interacting with the healthcare system, and 3) variation in the true incidence of medical and mental health outcomes in the TGD vs control cohorts.

Background: Increasing attention is being paid to the costs associated with various orthopaedic surgeries. Here, we studied the factors that influence costs associated with surgically treated acute Achilles tendon tears. Methods: We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture detailed cost data—costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% CIs. Results: Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of 4 fellowship-trained orthopaedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on surgical positioning (prone n = 156, supine n = 68). Open repairs (n = 215), compared with percutaneous techniques (n = 9) that used commercially available instrumentation, had 37% less total direct costs (P < .001, 95% CI 0.55-0.72). Compared with surgery at a main academic hospital (n = 15), procedures at an ambulatory care center (n = 207) had 19% lower total direct costs (P = .040, 95% CI 0.66-0.99) and 41% lower facility costs (P < .001, 95% CI 0.5-0.7). Conclusion: Improving cost-effective orthopaedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful impacts on cost. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs. Level of Evidence: Level III, retrospective comparative study.

Introduction/Purpose: Increasing attention is being paid to the costs associated with various orthopedic surgeries. Here, we studied the factors that influence costs associated with surgically treated acute Achilles tendon tears. Methods: We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture granular-level cost data – costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% confidence intervals (CIs). Results: Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on positioning (prone N =156, supine N =68). Total direct costs were 9% higher in males (N =182) compared to females (N =42) (p=0.023, 95% CI: 1.01-1.17) in an unadjusted analysis. Mini-open repairs (N =215), compared to percutaneous techniques (N =9), had 32% less total direct costs (p < 0.001; 95% CI: 0.60-0.78). Compared to surgery at a main academic hospital (N =15), procedures at an ambulatory care center (N =207) had 25% lower total direct costs (p < 0.001; 95% CI: 0.67-0.83) and 44% lower reduced facility costs (p < 0.001; 95% CI: 0.51-0.61). Significance was maintained in multivariable analysis except for sex. Conclusion: Improving cost-effective orthopedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful effects on cost. Surgery at an ambulatory center was significantly less costly than repairs performed at an academic hospital. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs.

PurposeRace and Hispanic ethnicity data can be challenging for central cancer registries to collect. We evaluated the accuracy of the race and Hispanic ethnicity variables collected by the Utah Cancer Registry compared to self-report.MethodsParticipants were 3,162 cancer survivors who completed questionnaires administered in 2015–2022 by the Utah Cancer Registry. Each survey included separate questions collecting race and Hispanic ethnicity, respectively. Registry-collected race and Hispanic ethnicity were compared to self-reported values for the same individuals. We calculated sensitivity and specificity for each race category and Hispanic ethnicity separately.ResultsSurvey participants included 323 (10.2%) survivors identifying as Hispanic, a lower proportion Hispanic than the 12.1% in the registry Hispanic variable (sensitivity 88.2%, specificity 96.5%). For race, 43 participants (1.4%) self-identified as American Indian or Alaska Native (AIAN), 32 (1.0%) as Asian, 23 (0.7%) as Black or African American, 16 (0.5%) Pacific Islander (PI), and 2994 (94.7%) as White. The registry race variable classified a smaller proportion of survivors as members of each of these race groups except White. Sensitivity for classification of race as AIAN was 9.3%, Asian 40.6%, Black 60.9%, PI 25.0%, and specificity for each of these groups was > 99%. Sensitivity and specificity for White were 98.8% and 47.4%.ConclusionCancer registry race and Hispanic ethnicity data often did not match the individual’s self-identification. Of particular concern is the high proportion of AIAN individuals whose race is misclassified. Continued attention should be directed to the accurate capture of race and ethnicity data by hospitals.

The STREAMLINE Surgical System performs microinvasive glaucoma surgery (MIGS) by creating micro-goniotomy incisions in the trabecular meshwork with focal ab-interno canaloplasty of Schlemm's canal. This retrospective review examines the procedure's effect on intraocular pressure (IOP) and number of glaucoma medications throughout one post-operative year. All cases at the John A. Moran Eye Center with Current Procedural Terminology codes 65820 and 66174 were searched for STREAMLINE cases from October 2021 to May 2024. Eyes were excluded if the case was combined with another procedure other than phacoemulsification, did not include both goniotomy and ab-interno canaloplasty, or was a standalone STREAMLINE procedure without phacoemulsification. Demographic data and baseline number of medications and IOP were recorded. IOP measurements were recorded on post-operative day 0, week 1, month 1, month 3, month 6, month 9, and month 12. Number of medications was recorded post-operatively at 6 months and 12 months. Linear mixed effects models were fit to estimate IOP at each follow-up time while accounting for within-eye correlation. Thirty-nine eyes that underwent the procedure were included from 29 patients of ages 18-86. The average IOP decrease from baseline IOP was 0.68 mmHg on post-operative day 0 (p=0.52), 1.49 mmHg at post-operative month 1 (p=0.16), 1.67 mmHg at post-operative month 3 (p=0.17), 1.62 mmHg at post-operative month 6 (p=0.18), 1.05 mmHg at post-operative month 9 (p=0.36), and 1.87 mmHg at post-operative month 12 (p=0.13). There was a post-operative IOP increase of 0.18 mmHg at post-operative week 1 (p=0.88). The average number of glaucoma medications was reduced by 47% at 6 months post-operatively (p<0.001) and 48% at 12 months (p=0.003). In a retrospective review of 39 eyes at one institution, STREAMLINE goniotomy and ab-interno canaloplasty significantly decreased the number of glaucoma medications one year after surgery.

Background: The impact of social health on patient-reported outcomes (PROs) is gaining increasing attention within the orthopaedic community. Few studies have explored any relationship between social deprivation levels and PROs in orthopaedic foot and ankle patients. Methods: We retrospectively identified patients who presented to an orthopaedic foot and ankle clinic for new evaluation. Patients completed PROs including PROMIS physical function (PF), PROMIS pain interference (PI), and the Foot and Ankle Ability Measure (FAAM). Social deprivation was measured using the Area Deprivation Index (ADI), a metric that incorporates various domains of poverty, education, housing, and employment. The ADI score quantifies the degree of social deprivation based on the 9-digit home zip code but is not a specific measure to an individual patient. Briefly, a lower ADI indicates less deprivation whereas a higher score denotes greater deprivation. Patient characteristics and outcomes were summarized and stratified by the nationally defined median ADI. Multivariable linear regression models assessed the relationships between PROs and continuous ADI controlling for demographics (age, sex, race/ethnicity, marital status, and employment status). Results: Our cohort consisted of 1565 patients with PRO and appropriate zip code data. Patients in the most-deprived median ADI split had more pain (median PROMIS-PI 62.7 vs 61.2, P = .001) and less function (median PROMIS-PF 37.1 vs 38.6, P = .021) compared with the least-deprived median ADI split. The clinical significance of these findings is unclear, though, given the minimal differences between groups for PROMIS measures. There was no relationship between ADI and FAAM scores. Conclusion: More socially deprived patients presented to the clinic with marginally less function and greater pain. Although statistically significant, the clinical significance of these relationships is unclear and merits further exploration. We plan to continue to study the connection between social deprivation and patient outcomes in specific clinical conditions as well as before/after surgical interventions. Level of Evidence: Level IV, retrospective cases series.

We introduce a new system of stochastic differential equations which models dependence of market beta and unsystematic risk upon size, measured by market capitalization. We fit our model using size deciles data from Kenneth French’s data library. This model is somewhat similar to generalized volatility-stabilized models. The novelty of our work is twofold. First, we take into account the difference between price and total returns (in other words, between market size and wealth processes). Second, we work with actual market data. We study the long-term properties of this system of equations, and reproduce observed linearity of the capital distribution curve. In the “Appendix”, we analyze size-based real-world index funds.

PurposeThe 2016–2020 Utah Comprehensive Cancer Prevention and Control Plan prioritized strategies to address cancer survivorship experiences. In this paper we present estimates for nine indicators evaluating these priorities, trends over time, and assess disparities in survivorship experiences across demographic subgroups.MethodsWe surveyed a representative sample of Utah cancer survivors diagnosed between 2012 and 2019 with any reportable cancer diagnosis. We calculated weighted percentages and 95% confidence intervals (CI) for each indicator. We assessed change over time using a test for trend across survey years in a logistic regression model and used Rao-Scott F-adjusted chi-square tests to test the association between demographic characteristics and each survivorship indicator.ResultsMost of the 1,793 respondents (93.5%) reported their pain was under control, 85.7% rated their overall health as good, very good, or excellent, but 46.5% experienced physical, mental, or emotional limitations. Only 1.7% of survivors aged 75 or older were current smokers, compared to 5.8% of 65–74-year-olds and 7.9% of survivors aged 55–74 (p < 0.006). No regular physical activity was reported by 20.6% and varied by survivor age and education level. The proportion who received a survivorship care plan increased from 34.6% in 2018 to 43.0% in 2021 (p = 0.025). However, survivors under age 55 were significantly less likely to receive a care plan than older survivors.ConclusionThis representative survey of cancer survivors fills a gap in understanding of the cancer survivorship experience in Utah. Results can be used to evaluate and plan additional interventions to improve survivorship quality of life.