Databyte

Preventive Care Deficit

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                    [post_content] => According to the Centers for Disease Control and Prevention, seven out of ten Americans die from chronic diseases like diabetes, heart disease, and cancer. Costs associated with using preventive services may deter people from getting screened for these conditions. Globally, other industrialized countries have fewer financial barriers to prenatal, pediatric, and other types of primary care.

Routine primary health care is critical to preventing or identifying illness in early stages when it can be treated. It has also been a core objective of population health since the 1978 Alma Ata Health for All Declaration. But research on the use of such care in the United States has focused on specific services like colorectal cancer screening and flu vaccination. Borsky et al. developed a new, more comprehensive method to measure how many adults use the high priority preventive services recommended for them. Their survey asks participants about fifteen types of evidence-based, clinically relevant preventive care, and accounted for inappropriate use and overuse.

The figure shows that, as of 2015, only 8% of all adults age 35 and older received all recommended high-priority clinical preventive services. This measure reflects the survey’s assessment of multiple types of preventive care. Taking a deeper look, Borsky and colleagues found 22.4% of surveyed adults received at least 76% of the recommended care. Compared to women, men were more likely to receive up to 25% of suggested preventive care services. Only 4.7% of all participants did not receive any recommended services. Blood pressure screenings were most commonly received, and shingles vaccinations least.

The researchers argue that the comprehensive nature of their survey instrument will be useful for health systems to assess the preventive services they offer and their receipt. They also emphasize that their questionnaire can be used at both the national and practice-specific level to help identify the impact of changes to local and national policy on preventive service use.

Graph: Health Affairs Vol. 37, NO. 6: Hospitals, Primary Care & More Datawatch, "Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services" by Amanda Borsky, Chunliu Zhan, Therese Miller, Quyen Ngo-Metzger, Arlene S. Bierman, and David Meyers, doi.org/10.1377/hlthaff.2017.1248
                    [post_title] => Preventive Care Deficit
                    [post_excerpt] => Only 8% of surveyed adults age 35 and older received all recommended high-priority clinical preventive services.
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Only 8% of surveyed adults age 35 and older received all recommended high-priority clinical preventive services.

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Databyte

Christmas Copulation Increases Fall Population

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                    [post_date] => 2018-09-20 07:00:01
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                    [post_content] => In 2006, the New York Times ranked the most common birthdays in the United States between 1973 and 1999. In the graph above, more popular birthdays are represented as darker shades of blue. September was the most common month, September 16 the most common date. The least common birth dates were February 29, December 25, and January 1.

The popularity of September birthdays isn’t happenstance. Given that September slides in nine months after December, one could presume that holiday celebrations are connected to the high number of September births. This is further evidenced by a September 16 birth date corresponding with a December 24 conception date.

A 2017 study conducted at Indiana University took a deeper look into the cultural factors that influence incidence of human sex patterns. The researchers analyzed Google search trends and Twitter data to measure intercourse frequency and mood fluctuations around Christmas and Eid-al-Fitr. They found these holidays to be closely tied to frequency of intercourse, even after adjusting for excess free-time. Higher frequency of intercourse was found to be linked to people’s elevation in happiness in direct response to the holiday season. September trends were consistent across all countries that celebrated Christmas on December 25, and birthday trends in predominantly Muslim countries moved in correspondence with the end of Ramadan.

Graph by Erin Polka 
                    [post_title] => Christmas Copulation Increases Fall Population
                    [post_excerpt] => September is the most common birthday month in the United States, with September 16 the most common birth date. The popularity of September birthdays isn’t happenstance.
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September is the most common birthday month in the United States, with September 16 the most common birth date. The popularity of September birthdays isn’t happenstance.

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Databyte

Multi-Dose Vaccines: Not Getting it Done

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                    [post_date] => 2018-09-18 07:00:53
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                    [post_content] => The human papillomavirus (HPV) vaccine is a multi-dose series of shots to prevent an infection that already affects almost 80 million people in the United States. HPV can cause many types of cancer, including anal, genital, oral, and throat cancer. Both women and men are at risk of HPV-related cancers.

Researchers from the University of North Carolina Gillings School of Global Public Health used claims from a database of 1.3 million privately insured individuals to assess the percentage of people receiving the second and third shots in the HPV vaccine series within one year of starting, the recommended vaccination schedule. Data from individuals ages 9 to 26 years from 2006 to 2014 was used.

As shown in the graph above, female patients were more likely than male patients to receive both the second and third shots, demonstrating how difficult it is to get young patients (or the parents who transport them) to return for multiple visits of preventive care.

Though this lack of adherence to vaccination protocol looks bad at first glance, it may not have such bad effects. The CDC recommends that adolescents who start the series before their fifteenth birthday receive only a two-dose series; two shots provide adequate protection against HPV infection. But providers and parents need to be on notice that for many adolescents, males in particular, figuring out ways to get this vaccine series administered in full, will not be an easy task.

Graph: Chrissy Packtor
                    [post_title] => Multi-Dose Vaccines: Not Getting it Done
                    [post_excerpt] => The HPV vaccine requires a series of shots to prevent infection, but it is difficult to get young patients to return for multiple visits of preventive care.
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The HPV vaccine requires a series of shots to prevent infection, but it is difficult to get young patients to return for multiple visits of preventive care.

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Databyte

Out of School, Out of Luck

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                    [post_content] => Out-of-school suspension is linked to lower grades, increased expulsions, and increased risk of incarceration. Disciplinary actions are often distributed unequally, based on gender, race, and personal ability. At the request of Congress, the US Government Accountability Office (GAO) reviewed disciplinary patterns across schools. They found that Black students, boys, and students with disabilities are punished more frequently than other K-12 public school students.

As shown in the Figure, although Black students account for only 15.5% of the K-12 student population, they make up 39% of the nation’s suspensions. Boys are also overrepresented in out-of-school suspensions, as are students living with a disability.

Disciplinary action through suspension is centered around a student’s behavior, which is often influenced by myriad complex social challenges such as poverty, mental illness, and lack of parental support. Most suspensions result from multiple school absences and tardy reports which are commonly linked to difficult family situations. Chronic tardiness most affects low-income students, who often care for younger siblings or work to support their family. Furthermore, teachers’ implicit biases harbored in race and gender stereotypes also contribute to the harshness of punishment delegated. Research shows that students of color suffer from harsher disciplinary outcomes from White teachers than teachers of the same race .

Suspension as a form of punishment starts as early as preschool, where boys and black students make up the majority of suspension cases. Several school officials interviewed by the GAO reported trying to move away from disciplinary actions that remove children from the classroom, which interrupt academic achievement. Between 2016 -2017, seventeen states enacted legislation to restrict and reduce the number of out-of-school suspensions and expulsions. An elementary school official in Georgia reported that they no longer discipline based on tardiness.

Schools in Massachusetts are attempting to collaborate with mental health professionals and social workers to support students undergoing traumatic experiences. Districts in Texas and Massachusetts have introduced “personal break rooms” where children can calm down and redirect their emotions after a frustrating incident.

Feature image: "Students Suspended from School Compared to Student Population, by Race, Sex, and Disability Status, School Year 2013-14." This chart shows whether each group of students was underrepresented or overrepresented among students suspended out of school. From United States Government Accountability Office Report to Congressional Requesters, K-12 Education Discipline Disparities for Black Students, Boys, and Students with Disabilities, March 2018. 
                    [post_title] => Out of School, Out of Luck
                    [post_excerpt] => School suspension is linked to lower grades, increased expulsions, and increased risk of incarceration. Disciplinary actions are often distributed unequally, based on gender, race, and personal ability. 
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School suspension is linked to lower grades, increased expulsions, and increased risk of incarceration. Disciplinary actions are often distributed unequally, based on gender, race, and personal ability.

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Databyte

Nurse Practitioners and Country Living

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                    [post_content] => The association of American Medical Colleges predicts a shortage of 120,000 physicians overall by the year 2030, estimating a shortfall of up to 49,300 primary care physicians in the United States. The role of nurse practitioners in the primary care setting may increase, however, as their numbers are expected to rise over the next decade. In light of these predictions, Barnes and colleagues studied the trends in nurse practitioners who practiced in rural and nonrural primary care settings between 2008 and 2016.

The researchers analyzed a dataset featuring characteristics of doctors' offices, focusing on the number of nurse practitioners, physicians, and physician assistants. As the figure above depicts, they found that the proportion of nurse practitioners as a percentage of total primary care providers grew from 17.6% to 25.2% in rural areas over the observed years. Nonrural areas also saw a growth in the presence of nurse practitioners, from 15.9% to 23%. Although physicians made up the largest proportion of providers in both rural and nonrural settings, their percentage dwindled. Further, the authors found that a greater proportion of rural practices featured nurse practitioners among their provider teams, compared to nonrural practices.

The Agency for Healthcare Research and Quality identifies high-functioning primary care teams as those including multidisciplinary involvement. Considering their findings, and other data documenting the high satisfaction with NP care and their lower practice costs compared to physicians, Barnes and the other researchers suggest that policymakers invest more in nurse practitioner education.

Feature image: "Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners," Hilary Barnes, Michael R. Richards, Matthew D. McHugh, and Grant Martsolf, Health Affairs 37, No. 6 (2018): 908–914  doi:10.1377/hlthaff.2017.1158
                    [post_title] => Nurse Practitioners and Country Living
                    [post_excerpt] => As the American Medical Colleges predicts a shortage of physicians, the role of nurse practitioners may increase. Barnes and colleagues studied the trends in nurse practitioners who practiced in rural and nonrural primary care settings. 
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As the American Medical Colleges predicts a shortage of physicians, the role of nurse practitioners may increase. Barnes and colleagues studied the trends in nurse practitioners who practiced in rural and nonrural primary care settings.

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Databyte

Housing and Emergency Department Shelter

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                    [post_content] => Until recently, Massachusetts had among the top state housing assistance programs in the United States for displaced families and children. In 2012, however, the state’s housing policy underwent changes, requiring shelter-seeking families with children to provide evidence they have stayed somewhere “not meant for human habitation.” The emergency rooms offers not only safety, but also discharge papers that could count as such proof. Other eligibility criteria include having faced domestic violence, natural disasters, and no-fault eviction.

Kanak and colleagues recently observed how often children and young adults used the emergency department as shelter, comparing trends before and after the 2012 policy change. The researchers used medical records of youths below age 21 who visited a Boston hospital’s pediatric emergency room between September 2011 and Aug 2016 and complained of or were billed for homelessness.

As the figure above depicts, they found the median visits per month increased drastically from 3 visits before the policy change to 17 visits after policy change. Most of the children observed were 12 years or younger. The emergency department’s costs and total hospital charges over the 5-year period summed nearly $580,000; only about $19,000 of that amount accrued before the policy policy change.

The researchers also found that more than 8,500 emergency department hours and $200,000 of Medicaid funds was used, and they suggest that this money would have been better spent to fund housing solutions. The University of Illinois Hospital, for example, helps displaced people who continuously present to the emergency department by paying their rent.

Table: “Trends in Homeless Children and Young Adults Seeking Shelter in a Boston Pediatric Emergency Department Following State Housing Policy Changes, 2011–2016," Mia Kanak, Amanda Stewart, Robert Vinci, Shanshan Liu, Megan Sandel, American Journal of Public Health 108, no. 8 (August 1, 2018): pp. 1076-1078. DOI: 10.2105/AJPH.2018.304493
                    [post_title] => Housing and Emergency Department Shelter
                    [post_excerpt] => Kanak and colleagues observed how often children and young adults used the emergency department as shelter before and after a 2012 policy change.
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Kanak and colleagues observed how often children and young adults used the emergency department as shelter before and after a 2012 policy change.

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Databyte

Drug Arrests Before and After Prop 47

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                    [post_content] => In 2014, Californians passed Proposition 47, a ballot initiative that reduced certain drug-related felonies to misdemeanors. Prop 47 also focused money and resources on more serious offenses while investing the savings into treatment for substance use disorders.

Alyssa Mooney and colleagues used data from the California Department of Justice’s Monthly Arrests and Citations Register and the American Community Survey to look at both total drug-related arrests and differences due to race and ethnicity on drug-related arrests before and after the passage of Prop 47.

The figure above shows both total drug arrests (left graph) and felony drug arrests (right graph) in California before and after Prop 47 was implemented. The dashed lines show expected arrest rates if Prop 47 had not passed.

There was an immediate drop in felony arrests after Prop 47 passage. Black individuals did not gain the full benefit of the felony to misdemeanor change because certain drug offenses, such as drug selling, were not reclassified, disproportionately affecting this group.

Graphs from "Racial/Ethnic Disparities in Arrests for Drug Possession After California Proposition 47, 2011–2016"
Alyssa C. Mooney, Eric Giannella, M. Maria Glymour, Torsten B. Neilands, Meghan D. Morris, Jacqueline Tulsky, and May Sudhinaraset, Am J Public Health. 2018;108:987– 993. doi:10.2105/AJPH.2018.304445
                    [post_title] => Drug Arrests Before and After Prop 47
                    [post_excerpt] => New research looked at total drug-related arrests, and differences due to race and ethnicity on drug-related arrests, before and after the passage of Proposition 47.
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New research looked at total drug-related arrests, and differences due to race and ethnicity on drug-related arrests, before and after the passage of Proposition 47.

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Databyte

Infant Mortality and Medicaid Expansion

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                    [post_content] => Medicaid funds many maternal and child health care services in the United States, including 45% of births. Since the Affordable Care Act was implemented in 2014, 34 states have opted to expand their Medicaid programs. But some of the states with the largest proportions—54% to 72%—of births covered by Medicaid did not expand. As of 2016, several of those states, including Alabama and Mississippi, had the highest rates of infant mortality in the country at about 7.4 to 9.1 infant deaths for every 1000 live births.

Bhatt and Beck-Sagué compared infant death rates between states that expanded Medicaid coverage and those that did not. Average death rates among all infants decreased in states that expanded Medicaid, and increased in states that did not.

As shown in the Figure, Black infant mortality decreased overall from 2010 to 2015, but twice as much in Medicaid expansion states (a difference of 1.7 deaths per 1000 live births) compared to non-expansion states (a difference of 0.8 deaths per 1000 live births).

The researchers call for studies to further identify reasons why Medicaid expansion states had better infant outcomes, and what barriers to child health may exist in non-expansion states.

Graphic from "Medicaid Expansion and Infant Mortality in the United States," Chintan B. Bhatt and Consuelo M. Beck-Sagué, American Journal of Public Health, April 2018, Vol 108, No. 4. SupplementsDOI: 10.2105/AJPH.2017.304218.
                    [post_title] => Infant Mortality and Medicaid Expansion
                    [post_excerpt] => Average death rates among all infants decreased in states that expanded Medicaid coverage, and increased in states that did not.
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Average death rates among all infants decreased in states that expanded Medicaid coverage, and increased in states that did not.

...more
Databyte

Clarifying Medical Bankruptcy

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                    [post_date] => 2018-07-19 06:30:40
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                    [post_content] => Medical bankruptcy is a much-debated topic, with most questions focused on exactly how many people file for it and how often it occurs. In 2005, Elizabeth Warren and her colleagues found medical costs led to over 40% of bankruptcies in the United States. This was followed by an update in 2009, pushing the proportion of bankruptcies due to medical expenses to 62%.

The Consumer Financial Protection Bureau’s 2014 report conflicts with this, citing that less than 1% of US adults file for bankruptcy even though 20% of the population has great medical debt. A group of economists recently reexamined this issue, concerned that the discrepancies in statistics were causing a misunderstanding of the problem. They studied a group of patients at a California hospital and looked at how hospital visits related to bankruptcy timing.

The image above shows an increase in people filing for bankruptcy after hospitalization, particularly between one and four years after admission. The researchers suggest that paying for medical bills out of pocket, and losing income because of missed work are key reasons people file for personal bankruptcy. The graph also shows, however, that only 4% of the bankruptcies were related to hospitalization, an association of much smaller magnitude than previously understood.

Warren and colleagues critiqued the economists’ research, stating that focusing only on hospitalization does not account for other medical experiences and expenses like spending time and money in emergency departments, and paying for chronic illness treatments. The economists’ subsequent response argued that estimating a causal relationship requires focusing on an isolated factor, like hospitalization.

Graph from New England Journal of Medicine, "Myth and Measurement — The Case of Medical Bankruptcies" by Carlos Dobkin, Amy Finkelstein, Raymond Kluender, and Matthew J. Notowidigdo, March 22, 2018, N Engl J Med 2018; 378:1076-1078, DOI: 10.1056/NEJMp1716604
                    [post_title] => Clarifying Medical Bankruptcy
                    [post_excerpt] => A group of economists recently reexamined medical bankruptcy, concerned that the discrepancies in statistics were causing a misunderstanding of the problem.
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A group of economists recently reexamined medical bankruptcy, concerned that the discrepancies in statistics were causing a misunderstanding of the problem.

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Databyte

Do Americans Know the Health Impacts of Global Warming?

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                    [post_date] => 2018-07-17 07:00:32
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                    [post_content] => The majority of Americans believe that global warming is real. However, citizens’ understanding of climate-driven health risks has not been described. Dr. Edward Maibach and his team conducted an online survey of US adults to measure respondents’ understanding of the impact of global warming on human health.

As shown in the Figure, survey participants were asked an open-ended question, “In your view, what health problems related to global warming are Americans currently experiencing, if any?” More than half of the 1,275 respondents didn’t provide a response or know of an answer. Eleven percent believed that no health impacts exist. Only 27% named a health-related problem. Respiratory diseases were most frequently cited as a threatened health condition (14%), followed by injuries or deaths due to extreme weather (6%), and skin cancers and other skin diseases (5%). Americans rarely identified other well-known climate-driven health problems such as the spread of insect-borne diseases, the contamination of food and water, and threats to food supplies and mental health, which may not yet be perceived to be as pervasive in the United States .

Graphic: Global warming-related health problems identified by respondents (unprompted). Author's Note on this figure in the original study: Most of the health issues listed above are projected to increase due to climate change; currently, however, we have only limited evidence that climate change will increase skin cancer, and no evidence that it will increase heart disease or other cancers. These responses might, therefore, be considered inaccurate. From The Annals of Global Health, "Do Americans Understand That Global Warming Is Harmful to Human Health? Evidence From a National Survey," Edward W. Maibach, Jennifer M. Kreslake, Connie Roser Renouf, Seth  Rosenthal, Geoff Feinberg, Anthony A. Leiserowitz, https://doi.org/10.1016/j.aogh.2015.08.010
                    [post_title] => Do Americans Know the Health Impacts of Global Warming?
                    [post_excerpt] => The majority of Americans believe that global warming is real, but fewer understand the impact of global warming on health. 
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The majority of Americans believe that global warming is real, but fewer understand the impact of global warming on health.

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