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Background Risk adjustment for reimbursement and quality measures omits social risk factors despite adversely affecting health outcomes. Social risk factors are not usually available in electronic health records (EHR) or administrative data. Socioeconomic status can be assessed by using US Census data. Distressed Communities Index (DCI) is based upon zip codes, and the Area Deprivation Index (ADI) provides more granular estimates at the block group level. We examined the association of neighborhood disadvantage using the ADI, DCI, and patient-level insurance status on 30-day readmission risk after colorectal surgery. Methods Our 677 patient cohort was derived from the 2013–2017 National Surgical Quality Improvement Program at a safety net hospital augmented with EHR data to determine insurance status and 30-day readmissions. Patients’ home addresses were linked to the ADI and DCI. Results Our cohort consisted of 53.9% males and 63.8% Hispanics with a 22.9% 30-day readmission rate from the date of discharge; > 50% lived in highly deprived neighborhoods. Controlling for medical comorbidities and complications, ADI was associated with increased risk of 30 days from the date of discharge readmissions among patients living in medium (OR = 2.15, p  = .02) or high (OR = 1.88, p  = .03) deprived areas compared to less-deprived neighborhoods, but not insurance status or DCI. Conclusions The ADI identified patients living in deprived communities with increased readmission risk. Our results show that block-group level ADI can potentially be used in risk adjustment, to identify high-risk patients and to design better care pathways that improve health outcomes.

We evaluated the impact of socioeconomic status on presentation, management, and outcomes of ventral hernias. The Abdominal Core Health Quality Collaborative was queried for adult patients undergoing ventral hernia repair. Socioeconomic quintiles were assigned using the Distressed Community Index (DCI): prosperous (0–20), comfortable (21–40), mid-tier (41–60), at-risk (61–80), and distressed (81–100). Outcomes included presenting symptoms, urgency, operative details, 30-day outcomes, and one-year hernia recurrence rates. Multivariable regression evaluated 30-day wound complications. 39,494 subjects were identified; 32,471 had zip codes (82.2%).Urgent presentation (3.6% vs. 2.3%) and contaminated cases (0.83% vs. 2.06%) were more common in the distressed group compared to the prosperous group (p < 0.001). Higher DCI correlated with readmission (distressed: 4.7% vs prosperous: 2.9%,p < 0.001) and reoperation (distressed 1.8% vs prosperous: 0.92%,p < 0.001). Wound complications were independently associated with increasing DCI (p < 0.05). Clinical recurrence rates were similar at one-year (distressed: 10.4% vs prosperous: 8.6%, p = 0.54). Inequity exists in presentation and perioperative outcomes for ventral hernia repair and efforts should be focused on increasing access to elective surgery and improving postoperative wound care. •Distressed Community Index (DCI) is a measure of socioeconomic distress based on zip code.•DCI is associated with more urgent hernia presentation and higher perioperative complication rates.•There was no difference in hernia recurrence up to one-year based on DCI.•Hernia-specific quality of life improved for all groups regardless of DCI.

Purpose: This research aims to test and analyze whether the central role of SOE compare with the phenomenon of financial distress will result in dysfunctional behavior. This motivates researchers to investigate SOE financial performance and behavior. Thus, this study aims to prove that the influence of financial distress on SOE and POE behavior is different. Design/methodology/approach: The researcher employs a quantitative approach to test the hypotheses. The data collected using documentation of financial data of 55 SOE and 135 POE listed in Indonesia Stock Exchange year 2014-2018. Distress status determines using Altman Z-score and earnings management measured using the Modified Jones Model. This study examines two groups of samples originating to test hypotheses using two independent sample t-tests. Findings: The research results succeeded in proving that SOE and POE react to a distressing condition in different ways. While SOE responds in the increasing pattern, means income maximization, the POE were in the opposite direction. Research limitations/implications: Scoring bankrupt prediction use only one equation, that is Altman Z-score, thus there are bias potential due to “no one-size-fits-all” view point. Practical implications: This result suggests that the government and other shareholders should be careful in making decisions concerning distressed SOE. Originality/value: Most earnings study was conducted in good financial performance in order to get a general conclusion. Since other scholars focus on how SOE performance in a “normal” situation, this research tries to investigate their behavior in the “abnormal situation.

Purpose: This research aims to test and analyze whether the central role of SOE compare with the phenomenon of financial distress will result in dysfunctional behavior. This motivates researchers to investigate SOE financial performance and behavior. Thus, this study aims to prove that the influence of financial distress on SOE and POE behavior is different. Design/methodology/approach: The researcher employs a quantitative approach to test the hypotheses. The data collected using documentation of financial data of 55 SOE and 135 POE listed in Indonesia Stock Exchange year 2014-2018. Distress status determines using Altman Z-score and earnings management measured using the Modified Jones Model. This study examines two groups of samples originating to test hypotheses using two independent sample t-tests. Findings: The research results succeeded in proving that SOE and POE react to a distressing condition in different ways. While SOE responds in the increasing pattern, means income maximization, the POE were in the opposite direction. Research limitations/implications: Scoring bankrupt prediction use only one equation, that is Altman Z-score, thus there are bias potential due to “no one-size-fits-all” view point. Practical implications: This result suggests that the government and other shareholders should be careful in making decisions concerning distressed SOE. Originality/value: Most earnings study was conducted in good financial performance in order to get a general conclusion. Since other scholars focus on how SOE performance in a “normal” situation, this research tries to investigate their behavior in the “abnormal situation.

This study aims to investigate the effect of corporate social responsibility disclosure (CSRD) on financial distressed risk (FDR) among firms listed on the Tehran Stock Exchange (TSE). This paper also examines whether there is a negative linkage between institutional ownership as a corporate governance mechanism and corporate bankruptcy. The final research purpose is to analyze if there is a moderating effect of institutional owners on the relationship between CSRD and FDR too. The study sample consists of 200 firms listed on the TSE between 2013 and 2018, and the statistical model is logistic regression. When FDR is assessed under both Article 141 of Iran’s business law and the Altman Z-score model, our results on the main research hypotheses are quite similar. Considering the social and cultural conditions and economic situation of the Iranian market, the results show that firms with a high level of CSR disclosure are not able to make themselves more creditworthy and do not have better access to financing, resulting in more financial insolvency. Our findings confirm institutional shareholders play a vital role in facilitating a firm’s emergence from bankruptcy. The results also demonstrate financial distress risk is less seen among companies with more institutional owners that disclose more CSR information. In other words, since the goals related to CSR are long-term and Iranian institutional investors have a long-term horizon towards the company, the presence of more institutional owners within a firm push managers to provide additional voluntary CSR disclosure so firms can maintain the trust of their shareholders at the highest possible level and prevent financial distress. Our additional analysis indicates there is a positive association between financial leverage and firm failure, whereas the current ratio and ROA are negatively connected with corporate bankruptcy. Finally, when FDR is assessed on the Altman Z-score model, our evidence supports a negative relation between purchase and sale-related party transactions and bankruptcy risk, which is consistent with the efficient transaction hypothesis.

An investigation is presented in this paper to study the performance of Artificial Intelligence running Multiple Models (AIMM) using time series of river flows. This is a modelling strategy, which is formed by first running two Artificial Intelligence (AI) models: Support Vector Machine (SVM) and its hybrid with the Fire-Fly Algorithm (FFA) and they both form supervised learning at Level 1. The outputs of Level 1 models serve as inputs to another AI Model at Level 2. The AIMM strategy at Level 2 is run by Artificial Neural Network (MM-ANN) and this is compared with the Simple Averaging (MM-SA) of both inputs. The study of the performances of these models (SVM, SVM-FFA, MM-SA and MM-ANN) in the paper shows that the ability of SVM-FFA in matching observed values is significantly better than that of SVM and that of MM-ANN is considerably better than each SVM and/or SVM-FFA but the performances are deteriorated by using the MM-SA strategy. The results also show that the residuals of MM-ANN are less noisy than those shown by the models at Level 1 and those at Level 2 do not display any trend.

We examine whether low interest rates foster non-viable firms in Europe by analyzing two classes of firms: zombies and distressed. Controlling for the business cycle and recession periods, we find a significantly negative effect of short-term rates on the likelihood of being a zombie, while no effect for distressed firms is detected. A decrease in inflation and a lower state of the business cycle is associated with a rise in both zombies and distressed firms. Examining a non- conventional monetary policy program, we find no evidence of credit misallocation. Therefore, concurring monetary and macroeconomic phenomena likely explain the presence of non-viable firms, although with dissimilarities between zombies and distressed firms.

The socioeconomic status has impact on trauma, but, how area deprivation index (ADI) or distressed communities index (DCI), relates to mechanisms of injury (MOI) is unknown. All trauma cases in 2021 with 9 or 5-zip codes of living location were included. MOI patterns based on ADI or DCI score was examined. Binary logistic regression was performed to assess the relationship between MOI and neighborhoods with socioeconomic disadvantage. Overall, 3933 patients for ADI and 4497 patients for DCI metric were included. Greater disadvantage areas determined by ADI or DCI were strongly associated with increased penetrating injuries (both p ​< ​0.001). Assault/abuse mechanisms and vehicular injurie were associated with DCI (both p ​< ​0.001) but not ADI. Direct comparison of ADI versus DCI categorizations showed a weak correlation (R ​= ​0.35, p ​< ​0.001). There was only a weak correlation between DCI and ADI, with DCI demonstrating greater ability to differentiate injury mechanism patterns and incidence. [Display omitted] •Socioeconomic status indices were associated with mechanisms of injury in trauma.•Mechanisms of injury varied depending on the socioeconomic status index used.•Socioeconomic status indices are only mildly correlated and are not interchangeable.

We sought to identify associations between living in an economically distressed community and the oncologic features and mutational status of papillary thyroid cancer (PTC). Patients with PTC were identified retrospectively. Community distress was estimated using the Distressed Communities Index (DCI). Logistic regression was used to assess associations between DCI, oncologic features, and tumor mutational status. Among 1062 patients, those from “at risk” (9.6%) or “distressed” (7.1%) communities were more likely to have tumors >4 ​cm (aOR 2.13, 95% CI 1.15–3.95), experience disease recurrence (aOR 1.84, 95% CI 1.16–2.91), and die due to thyroid cancer (aOR 3.56, 95% CI 1.26–10.05) compared to those in “prosperous” (41.6%) communities. No associations were found between DCI and tumor mutations or multifocality. Patients from “distressed” communities are diagnosed with more advanced thyroid cancer with higher rates of recurrence and death despite no differences in tumor mutational profile. [Display omitted] •The impact of socioeconomic factors on PTC tumor mutational status is unknown.•Patients from “distressed” communities have worse outcomes, regardless of mutations.•DCI independently predicts larger tumors, recurrence, and mortality for PTC patients.•DCI may serve as a more relevant predictor of PTC outcomes than race alone.