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All sourcesNASA NTRSDOE OSTI
DOE OSTI2025

Geographic, sectoral, and constituent characteristics of US off‐site manufacturing wastewater disposal

This study employs recent US Environmental Protection Agency off-site manufacturing wastewater disposal data and a socioenvironmental assessment tool for the United States to understand the characteristics of such disposal in terms of geography, major contributing sectors and pollutants, and environmental impacts. Environmental impact analyses of manufacturing are insufficient without encompassing the extended physical boundary of waste management. Our analysis reveals that off-site manufacturing wastewater disposal occurs disproportionately in populations residing in census tracts already negatively impacted by environmental hazards (impacted populations, or IPs) with 44% of transfers and 55% of Risk Screening Environmental Indicators (RSEI) Hazard going to these areas, compared to their national share of 37%. Disposal hazard is concentrated in a small number of populations, with a Gini coefficient of 0.99 for RSEI Hazard. Four manufacturing sub-sectors are significant generators: Chemicals, Fabricated Metals, Primary Metals, and Transportation Equipment, with Chemicals off-site wastewater disposal largely occurring in IPs. For individual contaminants, chromium compounds and chromium represent more than 85% of the hazard but less than 10% of transfers. We explore transfer distances and waste generation and disposal hotspots, finding that the Midwest hosts a disproportionate share of off-site wastewater disposal. Further, RSEI Hazard steeply rises at shorter distances and plateaus over distances >500 miles, revealing opportunities to reduce hazard by reducing 20–500-mile transfers. Our findings strongly support targeted mitigation strategies like process substitutions, control technologies, on-site recycling and treatment, and minimizing transfer distances. This article met the requirements for a gold-gold JIE data openness badge described at http://jie.click/badges.

Fuchs, Heidi [Lawrence Berkeley National Laborator↗
DOE OSTI2023

Quantitative approaches for including equity in risk and resilience infrastructure planning analyses

Risk and resilience assessments for critical infrastructure focus on myriad objectives, from natural hazard evaluations to optimizing investments. Although research has started to characterize externalities associated with current or possible future states, incorporation of equity priorities at project inception is increasingly being recognized as critical for planning related activities. However, there is no standard methodology that guides development of equity-informed quantitative approaches for infrastructure planning activities. Here, to address this gap, we introduce a logic model that can be tailored to capture nuances about specific geographies and community priorities, effectively incorporating them into different mathematical approaches for quantitative risk assessments. Specifically, the logic model uses a graded, iterative approach to clarify specific equity objectives as well as inform the development of equations being used to support analysis. We demonstrate the utility of this framework using case studies spanning aviation fuel, produced water, and microgrid electricity infrastructures. For each case study, the use of the logic model helps clarify the ways that local priorities and infrastructure needs are used to drive the types of data and quantitative methodologies used in the respective analyses. The explicit consideration of methodological limitations (e.g., data mismatches) and stakeholder engagements serves to increase the transparency of the associated findings as well as effectively integrate community nuances (e.g., ownership of assets) into infrastructure assessments. Such integration will become increasingly important to ensure that planning activities (which occur throughout the lifecycle of the infrastructure projects) lead to long-lasting solutions to meet both energy and sustainable development goals for communities.

community-based↗
DOE OSTI2020

Leveraging National Laboratory Assets to Address Stability Challenges due to Declining Grid Inertia Using Geographically Distributed Electrical–Thermal Co-Emulation

Due to increased penetration of low-inertia resources into the electric grid, challenges are increasing for maintaining wide-area system stability. Grid stability assessment requires a faithful representation of the multiple-physics interaction at the system level, and timescales of interaction varying in orders of magnitude, from microseconds to seconds to several minutes. Along with the simulation-based techniques, hardware-in-the-loop (HIL), controller HIL, and power HIL techniques have been developed to better understand the emergent behavior of the system with emerging technologies. US National Laboratories have played a vital role in research and development to understand the behavior of individual technologies and devices integrated to the electric grid. Each national laboratory forwards a technological and strategic initiative tied core and enabling capabilities. Due to strategic, efficiency, and economic reasons, not all the labs have assets to conduct research on all technologies concomitantly, so it becomes crucial to integrate the labs across geographies to understand the interplay of different technologies together at the system level. This approach avoids duplication of the assets at different lab facilities and helps understand the integrated system behavior of various technologies representative of actual grid conditions by connecting multiple national labs. This article talks about techniques of connecting three national laboratories to enable co-emulation of electrical–mechanical–thermal characteristics of devices and systems. Such an approach can be used to understand the dynamic and transient interaction of multi-physics in a system level, at-scale emulation using real-time simulation tools and techniques.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2024

Estimating UV-B, UV-Erithemic, and UV-A Irradiances From Global Horizontal Irradiance and MERRA-2 Ozone Column Information

The ground ultraviolet (UV) solar radiation is relevant due to its impacts on plastics degradation (mainly UVA) and on human health (UVB and erithemic UV (UVE)). UV ground measurements are not as ubiquitous as the relatively common global horizontal irradiance (GHI) measurements. Three simple models that estimate the UVA, UVB, and UVE components of solar irradiance from GHI and ozone column information are locally adjusted and validated. Five one-minute datasets from three sites in southeastern South America and two in the United States are used for simultaneous solar irradiance and UV data. All sites correspond to temperate mid-latitude regions. Simultaneous atmospheric total ozone column information is obtained from the reanalysis modern-era retrospective analysis for research and applications (MERRA-2) database for each site. Aside from locally adjusted models, average models with a single set of coefficients are also evaluated. For instance, the best average model is able to estimate UVE with a typical uncertainty below 12% and mean biases between +-3%, relative to the average of the measurements. Similar results are reported for the UVB and UVA components. These results, which can be useful in regions with similar climate and geography, provide a simple way to estimate UV irradiance under all-sky conditions with known uncertainty. This is an alternative to global satellite-based UV estimates, which can have high uncertainties at specific locations. Because MERRA-2 information has a global coverage, when coupled with good satellite-based estimates for GHI, UV irradiances can be estimated by this method over a large territory.

environmental UV radiation↗
DOE OSTI2021

Excess deaths reveal unequal impact of COVID-19 in Ecuador

Latin America has struggled to control the transmission of COVID-19. Comparison of excess death (ED) rates during the pandemic reveals that Ecuador is among the highest impacted countries. In this analysis, we update our previous findings with the most complete all-cause mortality records available for 2020, disaggregated by sex, age, ethnicity and geography. Our study shows that in 2020, Ecuador had a 64% ED rate (95% CI 63% to 65%) or 64% more deaths than expected. Men had a higher ED rate, 75% (95% CI 73% to 76%), than women’s 51% (95% CI 49% to 52%), and this pattern of higher EDs for men than women held for most age groups. The only exception was the 20–29 age group, where women had 19% more deaths, compared to 10% more deaths for men, but that difference is not statistically significant. The analysis provides striking evidence of the lack of COVID-19 diagnostic testing in Ecuador: the confirmed COVID-19 deaths in 2020 accounted for only 21% of total EDs. Our significant finding is that indigenous populations, who typically account for about 5% of the deaths, show almost four times the ED rate of the majority mestizo group. Indigenous women in each age group have higher ED rates than the general population and, in ages between 20 and 49 years, they have higher ED rates than indigenous men. Indigenous women in the age group 20–29 years had an ED rate of 141%, which is commensurate to the ED rate of indigenous women older than 40 years.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Visualizing urban microclimate and quantifying its impact on building energy use in San Francisco

© 2019 Association for Computing Machinery. Weather data at nearby airports are usually used in building energy simulation to estimate energy use in buildings or evaluate building design or retrofit options. However, due to urbanization and geography characteristics, local weather conditions can differ significantly from those at airports. This study presents the visualization of 10-year hourly weather data measured at 27 sites in San Francisco, aiming to provide insights into the urban microclimate and urban heat island effect in San Francisco and how they evolve during the recent decade. The 10-year weather data are used in building energy simulations to investigate its influence on energy use and electrical peak demand, which informs the city's policy making on building energy efficiency and resilience. The visualization feature is implemented in CityBES, an open web-based data and computing platform for urban building energy research.

Hong, T↗
DOE OSTI2025

ORBIT-2: Scaling Exascale Vision Foundation Models for Weather and Climate Downscaling

Sparse observations and coarse-resolution climate models limit effective regional decision-making, underscoring the need for robust downscaling. However, existing AI methods struggle with generalization across variables and geographies and are constrained by the quadratic complexity of Vision Transformer (ViT) self-attention. We introduce ORBIT-2, a scalable foundation model for global, hyper-resolution climate downscaling. ORBIT-2 incorporates two key innovations: (1) Residual Slim ViT (Reslim), a lightweight architecture with residual learning and Bayesian regularization for efficient, robust prediction; and (2) TILES, a tile-wise sequence scaling algorithm that reduces self-attention complexity from quadratic to linear, enabling long-sequence processing and massive parallelism. ORBIT-2 scales to 10 billion parameters across 65,536 GPUs, achieving up to 4.1 ExaFLOPS sustained throughput and 74–98% strong scaling efficiency. It supports downscaling to 0.9 km global resolution and processes sequences up to 4.2 billion tokens. On 7 km resolution benchmarks, ORBIT-2 achieves high accuracy with R2 scores in range of 0.98–0.99 against observation data.

Wang, Xiao [ORNL] (ORCID:0000000165451943)↗
DOE OSTI2026

BLEECAM™ (Benchmarking Life Cycle Environmental, Economic, and Social Metrics for Critical and Advanced Minerals and Materials) [SWR-25-125]

The National Laboratory of the Rockies' (NLR) Benchmarking Life Cycle Environmental, Economic, and Social Metrics for Critical and Advanced Minerals and Materials (BLEECAM™) is an open-source, integrated decision-support tool for evaluating the impacts, risks, and trade-offs across U.S. and global materials supply chains. Funded by the U.S. Department of Energy, BLEECAM supports supply chain and market analysis. The tool integrates multi-objective supply chain optimization, system dynamics, network design, lifecycle assessment, techno-economic modeling, and social impact assessment methods to evaluate how supply chains evolve over time, geography, and deployment scenarios. BLEECAM also supports analysis related to energy infrastructure, data centers and digital infrastructure, advanced manufacturing, and other sectors that depend on critical materials.

Khalifa, SherifA. [National Laboratory of the Rock↗
DOE OSTI2017

Whole-Genome and Epigenomic Landscapes of Etiologically Distinct Subtypes of Cholangiocarcinoma

Cholangiocarcinoma (CCA) is a hepatobiliary malignancy exhibiting high incidence in countries with endemic liver-fluke infection. We analysed 489 CCAs from 10 countries, combining whole-genome (71 cases), targeted/exome, copy-number, gene expression, and DNA methylation information. Integrative clustering defined four CCA clusters - Fluke- Positive CCAs (Clusters 1/2) are enriched in ERBB2 amplifications and TP53 mutations, conversely Fluke-Negative CCAs (Clusters 3/4) exhibit high copy-number alterations and PD-1/PD-L2 expression, or epigenetic mutations (IDH1/2, BAP1) and FGFR/PRKA-related gene rearrangements. Whole-genome analysis highlighted FGFR2 3’UTR deletion as a mechanism of FGFR2 upregulation. Integration of non-coding promoter mutations with protein-DNA binding profiles demonstrates pervasive modulation of H3K27me3-associated sites in CCA. Clusters 1 and 4 exhibit distinct DNA hypermethylation patterns targeting either CpG islands or shores - mutation signature and subclonality analysis suggests that these reflect different mutational pathways. Lastly, our results exemplify how genetics, epigenetics and environmental carcinogens can interplay across different geographies to generate distinct molecular subtypes of cancer.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2019

Diurnal Forcing and Phase Locking of Gravity Waves in the Maritime Continent

Abstract An unfiltered zonal Hovmöller depiction of rainfall in the Maritime Continent (MC) reveals remarkable spatiotemporal continuity of zonally propagating disturbances with a diurnal period, which endure over multiple days and propagate faster than the individual convective storms they coupled with. This phenomenon and its sensitivity to the Madden–Julian oscillation (MJO) during the 2011/12 Dynamics of the MJO (DYNAMO) field campaign is examined here through a well-validated, convection-permitting model simulation conducted on a large domain. We find that these disturbances are zonally propagating diurnal gravity waves excited by vigorous nocturnal mesoscale convective systems over Sumatra and Borneo. These gravity waves are diurnally phase locked: their wavelength very closely matches the distance between these two islands (~1500 km), while their particular zonal phase speed (~±17 m s−1) allows them to propagate this distance in one diurnal cycle. We therefore hypothesize that these waves are amplified by resonant interaction due to diurnal phase locking. While these zonal gravity waves decouple from convection once beyond the MC, their divergent flow signature endures well across the Indian Ocean, provoking the notion that they may influence rainfall at far remote locations. The exact controls over this zonal phase speed remain uncertain; we note, however, that it is roughly consistent with diurnal offshore-propagating modes documented previously. Further study is required to tie this down, and more generally, to understand the sensitivity of these modes to background flow strength and the geography of the MC.

Ruppert, Jr., James H.↗
DOE OSTI2020

Convectively Forced Diurnal Gravity Waves in the Maritime Continent

Long-lived, zonally propagating diurnal rainfall disturbances are a highly pronounced and common feature in the Maritime Continent (MC). A recent study argues that these disturbances can be explained as diurnally phase-locked gravity waves. Here we explore the origins of these waves through regional cloud-permitting numerical model experiments. The gravity waves are reproduced and isolated in the model framework through the combined use of realistic geography and diurnally cyclic lateral boundary conditions representative of both characteristic easterly and westerly background zonal flow regimes. These flow regimes are characteristic of the Madden–Julian oscillation (MJO) suppressed and active phase in the MC, respectively. Tests are conducted wherein Borneo, Sumatra, or both islands and/or their orography are removed. These tests imply that the diurnal gravity waves are excited and maintained directly by latent heating from the vigorous mesoscale convective systems (MCSs) that form nocturnally in both Borneo and Sumatra. Removing orography has only a secondary impact on both the MCSs and the gravity waves, implying that it is not critical to these waves. We therefore hypothesize that diurnal gravity waves are fundamentally driven by mesoscale organized deep convection, and are only sensitive to orography to the measure that the convection is affected by the orography and its mesoscale flows. Factor separation further reveals that the nonlinear interaction of synchronized diurnal cycles in Sumatra and Borneo slightly amplifies this gravity wave mode compared to if either island existed in isolation. This nonlinear feedback appears most prominently at longitudes directly between the two islands.

Ruppert, Jr., James H.↗
DOE OSTI2021

The influence of variability in meridional over turning on global ocean circulation

The Atlantic Meridional Overturning circulation (AMOC) is an important global scale circulation and changes in AMOC can induce significant regional and global climate impacts. In this work, we study the stability of AMOC and its influence on global ocean circulation and the surface climate though analyzing a set of sensitivity experiments using the Community Climate System Model version 1 (CESM1). Results show that a collapsed AMOC can induce changes in global ocean circulation, such as reduced (or reversed) Bering Strait transport, weakened Indonesia throughflow and Agulhas current, but strengthened Drake Passage transport. It also changes the global wind pattern and surface temperature, such as a seesaw-like surface temperature change between Northern and Southern Hemispheres, a weakening of Indian-Australia summer monsoon, a southward shift of the Southern ocean westerlies, etc. We also found that AMOC and the Pacific deep meridional overturning circulation (or PMOC) do not form a natural seesaw under modern day climate and geography. A collapsed AMOC (active PMOC) is not stable under modern conditions if there is no additional freshwater (salt) input in the subpolar North Atlantic (Pacific), suggesting that the modern mean state of AMOC (PMOC) does not depend on local haline forcing although its variability and changes do.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

Household Transportation Energy Affordability by Region and Socioeconomic Factors

Transportation fuel is an important component of household budgets, as 3.3% of total household expenditures are for vehicle fuel nationwide and over 50% of annual household expenditures on energy are for transportation. These average values vary geographically, and higher energy cost burdens are faced by households with lower incomes. Defining transportation energy affordability burden as the percentage of annual household income spent on vehicle fuel, this study aims to quantify affordability as a function of household characteristics and geography. Here, through analysis at the census tract level, this study (i) projects annual household vehicle miles traveled (VMT) based on demographic factors using machine-learning techniques, (ii) estimates local differences in vehicle fuel economy and fuel price, and (iii) quantifies resulting transportation energy affordability by census tract. This study found that the average burden by tract varies from 0.15% to 8%. The variation in affordability can be largely explained by income level and vehicle fuel efficiency. Suburban and rural households spend more on transportation energy compared with urban households because of the usage of less fuel-efficient vehicle technologies and higher annual VMT. Lower-income groups have a wide distribution of the percentage of income spent on transportation energy, 1.2% to 8%, whereas the range for the highest income group ($125,000+) is from 0.15% to 3.9%. This detailed transportation energy affordability analysis provides a better understanding of regional variations in household travel behavior, helps to determine where fuel-efficient vehicle technologies are more likely to be used, and improves estimates of vehicle ownership costs.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2020

A data-driven mobility–energy typology framework for New York State

Exploring multidimensional aspects of differences in technology adoption, travel, and vehicle ownership across settlement types can help inform energy-efficient and affordable mobility system goals. Concurrently, mapping key enablers, barriers, and risks for successfully meeting ambitious goals and targets (e.g. by geography, age, income, education, population density) offer important explanatory power as to context-specific challenges and opportunities. This paper explores how a highly geographically resolved understanding of social, economic, techno-infrastructural, environmental, and governance (SET EG) factors shape variations in technology adoption and associated mobility and energy outcomes in diverse communities of New York State, in terms of electric vehicle adoption rates, alternative commute mode choices, vehicles per household, and vehicle fuel economy. Results indicate the range of two to three times higher adoption rates for electric vehicles by more highly educated, wealthier, “Core Urban” populations relative to the other identified typologies, given the labels “Rural”, “Suburban”, and “Urban” populations. Additionally, commute mode choice is closely linked with population and employment density—more than 89% of Core Urbanites use transit or active modes, compared with just 26% and 18% of Suburban and Rural residents, respectively. Household vehicle ownership varies from approximately 1.9 vehicles per household in Rural areas to only 0.6 in Core Urban settings. Findings on differences among the four settlement types, which go beyond simply rural to urban contexts, suggest an important need to explore how best to manage and anticipate very different types of services that may be supportive in achieving energy-efficient and affordable mobility systems statewide.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2016

The obese gut microbiome across the epidemiologic transition

The obesity epidemic has emerged over the past few decades and is thought to be a result of both genetic and environmental factors. A newly identified factor, the gut microbiota, which is a bacterial ecosystem residing within the gastrointestinal tract of humans, has now been implicated in the obesity epidemic. Importantly, this bacterial community is impacted by external environmental factors through a variety of undefined mechanisms. We focus this review on how the external environment may impact the gut microbiota by considering, the host’s geographic location ‘human geography’, and behavioral factors (diet and physical activity). Moreover, we explore the relationship between the gut microbiota and obesity with these external factors. And finally, we highlight here how an epidemiologic model can be utilized to elucidate causal relationships between the gut microbiota and external environment independently and collectively, and how this will help further define this important new factor in the obesity epidemic.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2025

Demographic drivers of gut microbiome diversity

Abstract The gut microbiome plays a central role in orchestrating metabolic, immune, and neurological functions essential for human health. While extensive research has explored the effects of diseases and pathological conditions on gut microbiome composition, the influence of demographic factors remains underexplored, limiting our understanding of microbiome variations in disease states. This study addresses this gap by investigating the impact of demographic variables, including age, sex, and geography, on gut microbiome diversity in healthy individuals. Using the American Gut Project’s extensive dataset and the QIIME2 bioinformatics pipeline, we conducted a comprehensive analysis of microbial profiles across diverse demographic groups. Our results revealed significant age-related shifts in microbial richness and composition, and geographic location strongly influenced phylogenetic diversity. In contrast, sex exhibited limited impact on microbial diversity within healthy BMI ranges. These findings highlight the critical role of demographic factors in shaping gut microbiome diversity, providing a foundational framework to better contextualize disease-related microbiome variations and advance personalized healthcare approaches.

Biotechnology & Applied Microbiology↗
DOE OSTI2024

Existing evidence on the effects of climate variability and climate change on ungulates in North America: a systematic map

Abstract Background Climate is an important driver of ungulate life-histories, population dynamics, and migratory behaviors. Climate conditions can directly impact ungulates via changes in the costs of thermoregulation and locomotion, or indirectly, via changes in habitat and forage availability, predation, and species interactions. Many studies have documented the effects of climate variability and climate change on North America’s ungulates, recording impacts to population demographics, physiology, foraging behavior, migratory patterns, and more. However, ungulate responses are not uniform and vary by species and geography. Here, we present a systematic map describing the abundance and distribution of evidence on the effects of climate variability and climate change on native ungulates in North America. Methods We searched for all evidence documenting or projecting how climate variability and climate change affect the 15 ungulate species native to the U.S., Canada, Mexico, and Greenland. We searched Web of Science, Scopus, and the websites of 62 wildlife management agencies to identify relevant academic and grey literature. We screened English-language documents for inclusion at both the title and abstract and full-text levels. Data from all articles that passed full-text review were extracted and coded in a database. We identified knowledge clusters and gaps related to the species, locations, climate variables, and outcome variables measured in the literature. Review findings We identified a total of 674 relevant articles published from 1947 until September 2020. Caribou ( Rangifer tarandus ), elk ( Cervus canadensis ), and white-tailed deer ( Odocoileus virginianus ) were the most frequently studied species. Geographically, more research has been conducted in the western U.S. and western Canada, though a notable concentration of research is also located in the Great Lakes region. Nearly 75% more articles examined the effects of precipitation on ungulates compared to temperature, with variables related to snow being the most commonly measured climate variables. Most studies examined the effects of climate on ungulate population demographics, habitat and forage, and physiology and condition, with far fewer examining the effects on disturbances, migratory behavior, and seasonal range and corridor habitat. Conclusions The effects of climate change, and its interactions with stressors such as land-use change, predation, and disease, is of increasing concern to wildlife managers. With its broad scope, this systematic map can help ungulate managers identify relevant climate impacts and prepare for future changes to the populations they manage. Decisions regarding population control measures, supplemental feeding, translocation, and the application of habitat treatments are just some of the management decisions that can be informed by an improved understanding of climate impacts. This systematic map also identified several gaps in the literature that would benefit from additional research, including climate effects on ungulate migratory patterns, on species that are relatively understudied yet known to be sensitive to changes in climate, such as pronghorn ( Antilocapra americana ) and mountain goats ( Oreamnos americanus ), and on ungulates in the eastern U.S. and Mexico.

Malpeli, Katherine C. (ORCID:000000030780918X)↗
DOE OSTI2019

Intrahepatic Cholangiocarcinoma: Socioeconomic Discrepancies, Contemporary Treatment Approaches and Survival Trends from the National Cancer Database

Objective: The aim of this study was to evaluate socioeconomic discrepancies in current treatment approaches and survival trends among patients with intrahepatic cholangiocarcinoma (ICC). Methods: The 2004–2015 National Cancer Database was retrospectively analyzed for histopathologically proven ICC. Treatment predictors were evaluated using multinomial logistic regression and overall survival via multivariable Cox models. Results: Overall, 12,837 ICC patients were included. Multiple factors influenced treatment allocation, including age, education, comorbidities, cancer stage, grade, treatment center, and US state region (multivariable p < 0.05). The highest surgery rates were observed in the Middle Atlantic (28.7%) and lowest rates were observed in the Mountain States (18.4%). Decreased ICC treatment likelihood was observed for male African Americans with Medicaid insurance and those with low income (multivariable p < 0.05). Socioeconomic treatment discrepancies translated into decreased overall survival for patients of male sex (vs. female; hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.16–1.26, p < 0.001), with low income (< $37,999 vs. ≥ $63,000 annually; HR 1.07, 95% CI 1.01–1.14, p = 0.032), and with Medicaid insurance (vs. private insurance; HR 1.13, 95% CI 1.04–1.23, p = 0.006). Both surgical and non-surgical ICC management showed increased survival compared with no treatment, with the longest survival for surgery (5-year overall survival for surgery, 33.5%; interventional oncology, 11.8%; radiation oncology/chemotherapy, 4.4%; no treatment, 3.3%). Among non-surgically treated patients, interventional oncology yielded the longest survival versus radiation oncology/chemotherapy (HR 0.73, 95% CI 0.65–0.82, p < 0.001). Conclusions: ICC treatment allocation and outcome demonstrated a marked variation depending on socioeconomic status, demography, cancer factors, and US geography. Healthcare providers should address these discrepancies by providing surgery and interventional oncology as first-line treatment to all eligible patients, with special attention to the vulnerable populations identified in this study.

62 RADIOLOGY AND NUCLEAR MEDICINE↗