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INTRODUCTION: We examined differences in the timeliness of the initiation of home health care by race and the quality of home health agencies (HHA) among patients with Alzheimer's disease and related dementias (ADRD). METHODS: Medicare claims and home health assessment data were used for the study cohort: individuals aged ≥65 years with ADRD, and discharged from the hospital. Home health latency was defined as patients receiving home health care after 2 days following hospital discharge. RESULTS: Of 251,887 patients with ADRD, 57% received home health within 2 days following hospital discharge. Black patients were significantly more likely to experience home health latency (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.11–1.19) compared to White patients. Home health latency was significantly higher for Black patients in low‐rating HHA (OR = 1.29, 95% CI = 1.22–1.37) compared to White patients in high‐rating HHA. DISCUSSION: Black patients are more likely to experience a delay in home health care initiation than White patients. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the potential geospatial relationship between agricultural pesticide use and two cancer metrics (pediatric cancer incidence and total cancer incidence) across each of the 11 contiguous states in the Western United States at state and county resolution. The pesticide usage data were collected from the U.S. Geological Survey Pesticide National Synthesis Project database, while cancer data for each state were compiled from the National Cancer Institute State Cancer Profiles. At the state spatial scale, this study identified a significant positive association between the total mass of fumigants and pediatric cancer incidence, and also between the mass of one fumigant in particular, metam, and total cancer incidence (P‐value < 0.05). At the county scale, the relationship of all cancer incidence to pesticide usage was evaluated using a multilevel model including pesticide mass and pesticide mass tertiles. Low pediatric cancer rates in many counties precluded this type of evaluation in association with pesticide usage. At the county scale, the multilevel model using fumigant mass, fumigant mass tertiles, county, and state predicted the total cancer incidence (R‐squared = 0.95, NSE = 0.91, and Sum of square of residuals [SSR] = 8.22). Moreover, this study identified significant associations between total fumigant mass, high and medium tertiles of fumigant mass, total pesticide mass, and high tertiles of pesticide mass relative to total cancer incidence across counties. Fumigant application rate was shown to be important relative to the incidence of total cancer and pediatric cancer, at both state and county scales. Plain Language Summary: The objective of the study was to evaluate the associations between agricultural pesticide usage and cancer incidence among adults and children. The analysis was conducted in the 11 neighboring states in the western U.S. We collected the information on agricultural pesticide usage from the U.S. Geological Survey Pesticide National Synthesis Project database. The data on cancer incidence among adults and children were collected from the National Cancer Institute State Cancer Profiles. We find that the agricultural pesticide type, namely fumigants, are associated with the cancer incidence among adults and children in the western U.S. The most predominant fumigant, metam was also found to be associated with cancer incidence among adults. A model was developed in this study to predict cancer incidence among adults using pesticide usage information. The study infers that the agricultural pesticide type, fumigants are important relative to cancer incidence among adults and children. Key Points: This study analyzed the geospatial relationship between cancer metrics and pesticide usage in the 11 western states of the United StatesA multilevel model was employed, which accurately estimated the cancer incidence at county spatial resolutionFumigants were found to be statistically significantly associated with cancer incidence at both state and county spatial scales [ABSTRACT FROM AUTHOR]