Databyte

Medicaid: 2016 Uninsured Rates by County

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                    [post_content] => The goal of the Affordable Care Act (ACA) was to expand health care coverage, creating the closest thing to universal coverage the United States has ever seen. Many states increased coverage among previously uninsured residents by expanding Medicaid eligibility.  Thirty-three states and the District of Columbia have expanded Medicaid and three more are considering expansion. The thirteen remaining states are not obligated to do so, due to a Supreme Court ruling that mandatory expansion is unconstitutionally coercive.

A report published in 2018 by Bowers, Gann, and Upton, summarizes data from the 2016 US Census Bureau’s Small Area Health Insurance Estimates program. In the map on the left, states that expanded Medicaid coverage between 2015-2016 are blue. The map on the right, shows health care coverage for low-income individuals by county. Dark blue shows that more new people were covered by health insurance out of the total potential population. In states that expanded Medicaid, 23.4% of counties saw a decrease in their estimated uninsured rates (350 counties out of 1,498). This change is substantially larger than the 5.6% decrease in states that did not expand Medicaid eligibility (92 counties out of 1,643).

Within states that expanded Medicaid, the umbrella of coverage widened through the contribution of Federal Subsidies, allowing for almost 12,000 newly-eligible Americans to gain coverage.

Feature image: "Small Area Health Insurance Estimates: 2016 Small Area Estimates March 2018," Figure 3., Lauren Bowers, Carolyn Gann, and Rachel Upton
                    [post_title] => Medicaid: 2016 Uninsured Rates by County
                    [post_excerpt] => In states that expanded Medicaid, 23.4% of counties saw a decrease in their estimated uninsured rates, which is substantially larger than the decrease seen in states that did not expand Medicaid eligibility. 
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In states that expanded Medicaid, 23.4% of counties saw a decrease in their estimated uninsured rates, which is substantially larger than the decrease seen in states that did not expand Medicaid eligibility. 

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Databyte

The Immigrant Experience in Hurricane Season

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                    [post_content] => Hurricane Harvey ravaged Texas in August of 2017, challenging the health care, wellbeing, and safety of Gulf Coast residents. Immigrant families felt particularly fearful that reporting property damage and losses caused by the storm would draw negative attention from authorities. This fear was heightened as Border Patrol kept checkpoints open immediately following the storm.

Earlier this year, the Kaiser Family Foundation published survey findings on the impact of Harvey on immigrants in the Texas Gulf Coast. The figure above shows that immigrants whose homes Harvey hit reported feeling more worried about seeking help for storm-related damages than their native-born counterparts. About 34% of immigrants responded that they were very worried that reaching out for help would highlight their own or a family member’s status. Only 5% of native-born residents responded similarly. Immigrants were also less likely to have flood or home insurance, or to apply for governmental disaster assistance.

Federal Emergency Management Agency’s policies do not guarantee Disaster Unemployment Assistance to undocumented individuals. Fear of disclosing immigration status may act as a barrier to help seeking and ameliorating storm damage, but such worries may be warranted.

Feature image: Kaiser Family Foundation Disparities Policy, "Hurricane Harvey: The Experiences of Immigrants Living in the Texas Gulf Coast," Bryan Wu, Liz Hamel, Mollyann Brodie, Shao-Chee Sim, and Elena Marks, Figure 6. Published: Mar 20, 2018
                    [post_title] => The Immigrant Experience in Hurricane Season
                    [post_excerpt] => Immigrant families were more fearful that reporting property damage caused by Hurricane Harvey would draw negative attention from authorities. 
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Immigrant families were more fearful that reporting property damage caused by Hurricane Harvey would draw negative attention from authorities.

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Databyte

Buckle up for Safety

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                    [post_content] => Nearly half of the deaths from car crashes in the United States are due to not buckling up. An estimated 2,400 lives could have been saved in 2016 if drivers and passengers had fastened their seat belt.

Back seat passengers tend to buckle their belts less often than persons sitting in the front. An average of 11% fewer back seat passengers reported wearing a seat belt compared to front seat riders.

The data in the table come from a national survey conducted by the Insurance Institute for Highway Safety / Highway Loss Data Institute. The most common reason that back  passengers decided not to wear a seat belt was because they felt safer sitting behind the driver.

Yet back seat passengers who do not strap in are eight times more likely to sustain a serious injury in a car accident. Failure to buckle up is not just a personal risk. Unbuckled passengers become projectiles in a crash, jeopardizing the safety of everyone in the car. Other car passengers are three times as likely to be fatally injured when a passenger behind them doesn’t buckle up.

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Back seat passengers who do not buckle their seat belts are not only more likely to sustain a serious injury in a car accident, but also to injure everyone in the car.

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Databyte

Pseudoscience and Abortion Policy

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                    [post_date] => 2018-06-29 05:30:55
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                    [post_content] => In 2012, when US Representative Todd Akin from Missouri was asked if abortion was justified in cases of rape, he notoriously said that pregnancy as a result of rape is rare because “the female body has ways to try and shut that whole thing down.” Arguments made against abortion, like this one, are often riddled with pseudoscience.

As the map above shows, 29 states, home to 88 million women, have implemented at least two abortion restrictions not backed by scientific evidence.

For example, Texas’s “Woman’s Right to Know” booklet, offered to patients before having an abortion, uses deceptive language to lead readers to believe that abortion increases the risk of breast cancer. The Washington Post’s Fact Checker gave this claim in the booklet three “Pinocchios” on their rating scale, meaning that there was a “significant factual error” present. The American College of Obstetricians and Gynecologists released a statement in 2009 concluding that there is “no association between induced abortion and breast cancer.”

Kentucky’s Senate Bill 5, passed in 2017, made it illegal to have an abortion after the twentieth week of pregnancy. The sponsor of the bill cited fetal pain as justification for the law, calling abortion after 20 weeks an “awful painful experience” for the fetus. However, a review of fetal pain evidence found that fetuses are unlikely to feel pain before the third trimester (around 29 weeks).

Kansas, Texas, and South Dakota have the highest number of these types of pseudoscientific restrictions with seven each.

Feature image: Guttmacher Institute, States Hostile to Abortion Rights, Policy Trends in the States, 2017
                    [post_title] => Pseudoscience and Abortion Policy
                    [post_excerpt] => Twenty-nine states, home to 88 million women, have implemented at least two abortion restrictions not backed by scientific evidence.
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Twenty-nine states, home to 88 million women, have implemented at least two abortion restrictions not backed by scientific evidence.

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Databyte

HIV from Silverware? Fork No!

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                    [post_date] => 2018-06-20 07:00:16
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                    [post_content] => In 1983, the Centers for Disease Control and Prevention identified the main ways that HIV is transmitted, as well as ways that it is not, publishing this information in the Morbidity and Mortality Weekly Report. Even though this information has been widely available for over three decades, misperceptions about HIV transmission persist.

The 2017 Kaiser Family Foundation National Survey of Young Adults on HIV/AIDS included results from nearly 1,800 people between the ages of 18 and 30 years. Interviews were in English and completed either online or by telephone. The graphic shows young Americans’ answers.

A large number of respondents did not know how one becomes infected with HIV. More than one-third of survey respondents believe the virus can be spread through sharing kitchenware (plates, glasses, and silverware) and from a toilet seat. Over half of the survey respondents thought spitting and kissing were ways HIV could be spread. HIV cannot be spread through any of these methods.

These misperceptions contribute to the stigma that HIV-positive individuals continue to face. In the same survey, over half of the respondents reported that they would be uncomfortable having an HIV-positive roommate (51%) or having an HIV-positive individual prepare their food (58%).

Graphic from Kaiser Family Foundation 2017 National Survey of Young Adults on HIV/AIDS chart pack
                    [post_title] => HIV from Silverware? Fork No!
                    [post_excerpt] => Even though accurate information has been widely available for over three decades, misperceptions about HIV transmission persist. 
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Even though accurate information has been widely available for over three decades, misperceptions about HIV transmission persist.

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Databyte

Cancer Mortality Across the US

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                    [post_content] => Although cancer mortality has declined by 20.1% across the United States since 1980, a few cancers are on the rise and clustered in particular counties. Ali H. Mokdad and colleagues gathered death records from the National Center for Health Statistics and the Census Bureau to measure exactly how and where cancer mortality changed between 1980 and 2014.

The graph on the left shows 2014 county-level mortality for all cancers per 100,000 people, with red areas representing counties with the most cancer-related deaths. The highest mortality is clustered in the Midwest, the South, some counties in the Dakotas, and Alaska. The graph on the right displays changes in mortality between 1980 and 2014. Counties experiencing decreases in mortality are represented in blue and green and those experiencing increases are pink and red.

Liver cancer mortality has grown by 87.6% with the largest increases in California, New Mexico, West Texas, and Alaska. Mortality for all other cancers has stayed the same or declined.

Understanding cancer mortality rates for specific counties, rather than national or state averages, allows prevention and treatment programs to be tailored the needs of specific contexts and populations.

Feature image: Figure 1 (detail), Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014, Ali H. Mokdad, Laura Dwyer-Lindgren, Christina Fitzmaurice, Rebecca W. Stubbs, Amelia Bertozzi-Villa, Chloe Morozoff, Raghid Charara. Christine Allen, Mohsen Naghavi, Christopher J. L. Murray, JAMA. 2017;317(4):388-406. doi:10.1001/jama.2016.20324
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Although cancer mortality has declined across the United States since 1980, but a few cancers are on the rise and clustered in particular counties.

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Databyte

US Territories and Breast Cancer Care

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                    [post_date] => 2018-05-31 06:00:42
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                    [post_content] => Residents of US territories, which include the US Virgin Islands, Guam, American Samoa, Puerto Rico, and the Northern Mariana Islands, sometimes have limited access to health care because of lower federal insurance reimbursement and geographic barriers. Some territories are also entangled in financial crisis.

Puerto Rico’s struggle with debt came after 1996, when the island’s government experienced a recession, and borrowed funds for support. Years of unethical loaning by Wall Street made the situation far worse for Puerto Rico, and now, much of their health care is funded by borrowed money. In addition, other territories’ infrastructure sometimes cannot support wide access or efficient and effective medical care. Some areas in Guam, for example, struggle to provide readily available potable water and face frequent power outages. Some hospitals on the US Virgin Islands are old and crumbling and patients who cannot receive the treatment they need are transferred to Puerto Rico and the mainland.

Tracy M. Layne and colleagues assessed differences in the timeliness and quality of breast cancer care among female Medicare beneficiaries in the continental United States and its territories. The researchers looked at timeliness of care as an indicator of quality, based on evidence linking delays in treatment with stress, poor survival, and reemergence of cancer.

The bar chart above shows that women living in the territories were less likely to be diagnosed with breast cancer by the recommended method of needle biopsy than women in the continental United States. After diagnosis, women in the territories are also less likely to undergo breast-conserving surgery within one month of diagnosis and receive radiation therapy within two months after surgery. Regardless of how early the treatments are given, women in the territories are less likely to receive the recommended care for breast cancer than women living in continental United States.

This gap requires further research to identify the social drivers that restrict territory residents from receiving timely recommended breast cancer care, and to assess how discrepancies ultimately affect breast cancer outcomes among both territory and continental US populations.

Feature image: Quality Of Breast Cancer Care In The US Territories: Insights From Medicare, by Tracy M. Layne, Jenerius A. Aminawung, Pamela R. Soulos, Marcella Nunez-Smith, Maxine A. Nunez, Beth A. Jones, Karen H. Wang, and Cary P. Gross. HEALTH AFFAIRS 37, NO. 3 (2018): 421–428 ©2018 Project HOPE— The People-to-People Health Foundation, Inc. doi: 10.1377/hlthaff.2017.1045
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Women in US territories are less likely to receive timely diagnosis and recommended care for breast cancer than women living in continental United States.

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Databyte

Racial Gaps in Children’s Lead Levels

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                    [post_date] => 2018-05-24 07:00:11
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                    [post_content] => The Flint, Michigan water crisis made headlines for months, but it is not the only city in the United States with lead-contaminated water. A USA Today Network investigation found nearly 2,000 water systems across the country have excessive lead levels. Children of color are particularly vulnerable to lead exposure from the water they drink, especially in places where they spend a lot of time: their homes, schools, day care centers, and playgrounds.

In a report released by Child Trends, Vanessa Sacks and Susan Balding call attention to lead poisoning among children of color, especially non-Hispanic black children. As shown in the graph, almost twice as many non-Hispanic black children have lead levels at or above 2 micrograms per deciliter compared to non-Hispanic white children.

High blood levels of lead in children can be fatal, but low blood levels can be harmful as well. Low levels can affect cognitive development and are associated with reduced IQ, reduced attention span, and an increase in antisocial conduct. Guidelines from the Centers for Disease Control and Prevention are unequivocal. No amount of lead in the blood is considered safe for children.

An estimated 15 to 22 million people drink and bathe in water that runs through lead pipes.

Children may also be exposed to lead through paint. According to the American Healthy Homes Survey, 52% of homes built before 1978 contain lead-based paint. Data from this survey also indicate that the older the home, the more likely it is to contain lead-based paint. The U.S. Department of Housing and Urban Development estimates that 3.6 million homes with young children living in them have lead paint. And many communities are exposed to high levels of lead in the air and soil.

So, what are some possible solutions for reducing lead exposure? When it comes to lead-contaminated water, removing lead pipes is a key solution. Removing or covering lead paint using safe techniques is the best way to reduce exposure through paint.

Graph from Child Trends, The United States can and should eliminate childhood lead exposure, by Vanessa Sacks, Susan Balding, February 2, 2018
                    [post_title] => Racial Gaps in Children’s Lead Levels
                    [post_excerpt] => Almost twice as many non-Hispanic black children have lead levels at or above 2 micrograms per deciliter compared to non-Hispanic white children. No amount of lead in the blood is considered safe for children.
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Almost twice as many non-Hispanic black children have lead levels at or above 2 micrograms per deciliter compared to non-Hispanic white children. No amount of lead in the blood is considered safe for children.

...more
Databyte

Recess in Pieces across the US

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                    [post_content] => Obesity rates among US children have tripled in the past three decades. This places children at higher risk for poor health outcomes, such as type II diabetes and cardiovascular disease. They are also more likely to be overweight as adults. While causes can vary between individuals, common solutions include physical activity, healthier food choices, and participation in health-oriented community education events. In 2017, the Council of State Governments published a research brief summarizing physical activity legislation across the United States. School recess is one attractive option for increasing physical activity and it also benefits children’s emotional, social, and mental health. Physical exercise can increase attention span and improve academic performance.

Only five states, shown in green on the map, have legislation mandating recess in elementary schools: Connecticut, Indiana, Missouri, Rhode Island, and Virginia. Each state passed legislation aimed at elementary schools, mandating a recess period (or, in the case of Indiana, physical activity, which may “include the use of recess”). Connecticut, Missouri, and Rhode Island have a minimum recess requirement of 20 minutes, whereas Virginia and Indiana do not mention time in their policies. Eight other states have “general activity” requirements, mandating daily or weekly physical activity, expanding into physical education, field trips, exercise programs, etc. These are: Arkansas, Colorado, Iowa, Louisiana, the Carolinas, Tennessee, and Texas.

All other states supplement mandatory recess with alternative policies, primarily physical education, and vary in their degree of requirement. Massachusetts has mandatory physical education for grades K-12, but no recess requirements. That may change, as Rep. Marjorie Decker introduced a bill in 2017 to provide grades K-5 with 20 minutes of recess.

Bills emphasizing academic achievement, such as the No Child Left Behind Act, encourage increasing class time, often taking time away from recess. Multiple organizations, including the Center for Disease Control, recommend that physical activity and recess should be mandatory.

Feature image: The Council of State Governments, State Policies on Physical Activity in Schools, Matt Shafer, CSG graduate fellow, and Elizabeth Whitehouse, CSG director of education and workforce. 
                    [post_title] => Recess in Pieces across the US
                    [post_excerpt] => School recess is an option for increasing children's physical activity, but only five states have legislation that requires elementary school recess. 
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School recess is an option for increasing children’s physical activity, but only five states have legislation that requires elementary school recess.

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Databyte

Contraception Options Limited in Rural and Suburban Areas

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                    [post_content] => Geography can play a role in what types of contraception are available to women at their local community health centers. Women in rural and suburban areas have fewer contraception options than those in urban areas.

George Washington University and the Kaiser Family Foundation surveyed community health centers across the United States about their family planning services last year. They received responses from 546 health centers representing all 50 states and the District of Columbia.

The figure shows the proportion of rural and urban health centers providing specific types of contraception. Significantly fewer rural and suburban health centers provide long-acting reversible contraception: the implant, hormonal intrauterine device, and copper IUD. This is also true for emergency contraception: over-the-counter methods such as Plan B and prescription methods such as ella.

Long-acting reversible contraception methods are highly effective forms of birth control. Once placed in the body, they can protect women for several years. Emergency contraception is a form of birth control taken after sex to prevent pregnancy. It is sometimes referred to as the “morning after pill.” Poor access to these popular and effective forms of contraception increases the risk of unintended pregnancy for women in rural and suburban areas.

Graph from Community Health Centers and Family Planning in an Era of Policy Uncertainty,
Susan F. Wood, Julia Strasser, Jessica Sharac, Janelle Wylie, Thao-Chi Tran, Sara Rosenbaum, Caroline Rosenzweig,Laurie Sobel, and Alina Salganicoff, published: Mar 15, 2018
                    [post_title] => Contraception Options Limited in Rural and Suburban Areas
                    [post_excerpt] => Geography can affect access to contraception. Women in rural and suburban areas have fewer contraception options than those in urban areas.
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Geography can affect access to contraception. Women in rural and suburban areas have fewer contraception options than those in urban areas.

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