MMWR: Mass. reform narrowed insurance gap
Filed under: Health care reform, Health data, Studies
Studying data from the Massachusetts Behavioral Risk Factor Surveillance System has led researchers to conclude that health care legislation in that state has narrowed the gap in insurance coverage for underserved populations. The data did show that “some groups continue to experience lower rates of annual checkup and less access to a personal care provider.”
The percentage of respondents who reported having health insurance rose 5.5%, from 91.3% in the pre-law period to 96.3% in the post-law period.
The report, “Short-Term Effects of Health-Care Coverage Legislation — Massachusetts, 2008″ is in the March 12 issue of the CDC’s Morbidity and Mortality Weekly Report.
New CDC data pinpoint heart disease hot spots
Data from Medicare records of more than 28 million people each year between 2000 and 2006 in the 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands were used to create a county-level report on hospitalizations because of heart disease.
The CDC’s “Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries” shows that the highest hospitalization rates occur among blacks compared to other racial and ethnic groups and rates were highest in Appalachia, the Mississippi Delta, Texas and Oklahoma.
For more county-level health data, be sure to take a look at the County Health Rankings recently released by the Robert Wood Johnson Foundation and the University of Wisconsin.
Survey looks at use of leftover pain meds
One in five people in Utah have been prescribed pain medication in the past year, according to new figures from the Morbidty and Mortality Weekly report from the Centers for Disease Control and Prevention.
While the survey only takes into account the use of pain medications in Utah, the CDC notes that “This percentage is comparable to the 18.4% of insured persons aged ≥18 years who reported receiving a prescription for opioids in a national study in 2002.”
The report says that deaths in Utah as a result of “poisoning by prescription pain medications” increased nearly 600 percent from 1999 to 2007. It also looks at the problem of leftover medication and people using medications not prescribed to them:
An estimated 72% of respondents who were prescribed an opioid had leftover medication, and 71% of those with leftover medication kept it; during the same period, 97% of those who used opioids that were not prescribed to them said they received them from friends or relatives.
The state has set out some recommendations for health care providers aimed at reducing the availability of unused medications.
The data comes from the Behavioral Risk Factor Surveillance System, an on-going telephone survey system that collects information about health risk behaviors, preventive health practices and health care access. Utah is apparently the first state to include pain medication questions in the BRFSS, “although Kansas added a module of questions regarding chronic pain in 2005 and 2007 with one follow-up question asking how the pain was treated.”
CDC health overview: Diagnostic scans tripled
Filed under: Health data, Hot Health Headline, Studies
The CDC has released the 2009 version of Health, United States, their annual summary of health numbers and trends. It’s an epic heap of data; get the full PDF here.
For a 574-page, 10.22 MB government document, it’s surprisingly easy to navigate. There’s a table of contents, links and a nifty little feature which allows you to pull up a spreadsheet of the data from any chart or graph. In addition to the lead story on medical technology and scanning, the report includes 150 data tables. That’s a bit too much to summarize here, so we’ll settle for the CDC’s version of the highlights:
- … the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.
- The rate of adults aged 45 and over discharged from the hospital after receiving at least one knee replacement procedure increased 70 percent from 1996 to 2006 (26.5 per 10,000 population in 1996 to 45.2 per 10,000 in 2006).
- From 1988-1994 to 2003-2006, use of antidiabetic drugs among adults aged 45 years and over increased about 50 percent, and the use of statin drugs to lower cholesterol among this age group increased almost tenfold.
- The number of new organ transplantations per 1 million people increased 31 percent for kidney transplants (43.7 per 1 million in 1997 vs. 57.2 in 2006) and 42 percent for liver transplants between 1997 and 2006 (15.6 per 1 million in 1997 vs. 22.2 in 2006).
- Life expectancy at birth increased more for the black than for the white population between 1990 and 2007, thereby narrowing the gap in life expectancy between these two racial groups. Overall U.S. life expectancy in 2007 was 77.9 years.
- In 2007, 20 percent of U.S. adults were current cigarette smokers, a slight decrease from 21 percent in the previous three years. Men were more likely to be current cigarette smokers than women (22 percent vs. 17 percent).
- In 2005-2006, 30 percent of adults often or almost always had trouble sleeping in the past month.
- In 2007, 20 percent of adults 18 years and over had at least one emergency department visit in the past year, and 7 percent had two or more visits.
- The percentage of the population taking at least one prescription drug during the previous month increased from 38 percent in 1988-1994 to 47 percent in 2003-2006, and the percentage taking three or more prescription drugs increased from 11 percent to 21 percent.
Mumps outbreak hits more than 1,500 in N.Y., N.J.
More than 1,500 cases of mumps in New York and New Jersey have prompted the CDC to update the public on the outbreak in its Morbidity and Mortality Weekly Report.
According to the CDC, the outbreak appears to have originated with an 11-year-old boy who returned from a trip to the United Kingdom and then attended a summer camp for observant Jewish boys. The illness was transmitted to other attendees and staff members and has since spread as those people returned home. The CDC says 97 percent of the people with mumps “are members of the tradition-observant Jewish community.”
Child with mumps (Photo: Public Health Image Library)
The CDC’s report includes information about how many of the people found to have mumps have been vaccinated - 88 percent had received one dose and 75 percent had received two doses.
The CDC says that, since 1967, when the mumps vaccine was licensed, to the early 2000s, the number of reported cases has gone from 186,000 to less than 500 annually but points out that “the effectiveness of the mumps component of the MMR vaccine is lower than that of the measles and rubella components.”
“The CDC hypothesized that the relatively closed social world of the communities and the large family sizes within them have played a role in preventing the disease from spreading further,” according to a brief from the Center for Infectious Disease Research and Policy.
OIG: CDC missed most conflicts of interest in 2007
The Department of Health and Human Services Office of Inspector General’s latest report covers “CDC’s ethics program for special government employees on federal advisory committees” (53-page PDF), which is significantly more interesting than that sentence makes it sound. For the report, OIG went through conflict-of-interest disclosure forms filed in 2007 for 246 members of FDA advisory committees and found that a striking number of them were incomplete or not properly acted upon. On one hand, “federal bureaucrats are real sticklers when it comes to filing paperwork” is hardly a headline, but on the other hand,the CDC’s ethics agreements are key to preserving the integrity of the committee advisory process.
Here are a few highlights taken from the report:
- For almost all special Government employees, CDC did not ensure that financial disclosure forms were complete in 2007. CDC certified OGE Forms 450 with at least one omission in 2007 for 97 percent of SGEs. Most of the forms had more than one type of omission.
- CDC did not identify or resolve potential conflicts of interest for 64 percent of special Government employees in 2007. Sixty-four percent of SGEs had potential conflicts of interest in 2007 that CDC did not identify and/or resolve before it certified their OGE Forms 450.
- CDC did not ensure that 41 percent of special Government employees received required ethics training in 2007.
- Fifteen percent of special Government employees did not comply with ethics requirements during committee meetings in 2007.
Auditors found that measurable conflicts of interest existed in many cases (58 percent) that had, nonetheless, been approved unresolved by CDC officials.
CDC: Nearly 1 percent of U.S. kids have autism
An average of one in 110 children have an autism spectrum disorder, according to a new study of the health and education records of 8 percent of 8-year-old children in the United States. In its release, the CDC says “These results reflect data collected in multiple communities throughout the U.S. from 2006 showing an estimated prevalence of ASDs to be about one percent of 8-year-olds in the U.S.”
The study, from the CDC’s Autism and Developmental Disabilities Monitoring Network, looked at the records of 307,790 children in 11 study sites and identified 2,757 with an autism spectrum disorder. ASD prevalence was higher in boys than in girls and varied by race and ethnicity. The study also found that the overall prevalence of ASD has increased since earlier studies.
“These results indicate an increased prevalence of identified ASDs among U.S. children aged 8 years and underscore the need to regard ASDs as an urgent public health concern.” In the report, the CDC acknowledges the need to “understand how complex genetic and environmental factors interact to result in the symptoms which make up the autism spectrum.”
The CDC reports that, based on its examination of the records, most children with an ASD are getting special education services in the public schools, though not all were categorized as having an ASD. Other reasons for them receiving special education included specific learning disabilities, speech and language impairments, other health impairments and intellectual disabilities.
Interestingly, the Age of Autism blog reported the news from this study as early as Wednesday, despite the CDC’s embargo that didn’t lift until noon Eastern time on Friday, bringing to mind earlier questions about embargoes. More about that here.
Media briefing
The CDC is having a telephone-only briefing with Catherine Rice, Ph.D., a behavioral health scientist with the National Center on Birth Defects and Developmental Disabilities, to discuss the data at noon Eastern time. The briefing will be available via listen-only audio web site. The CDC will make a transcript of the briefing available on its Web site.
Hoban reports on uneven H1N1 death disclosure
Filed under: Health data, Health journalism, Hot Health Headline, Public health
WUNC reporter and AHCJ member Rose Hoban put together a story about uneven disclosure of H1N1 deaths by public health officials and the possible benefits and risks of providing more information. In the end, Hoban reported, it comes down to balancing individual privacy and the public interest.
On the official side, Hoban spoke to Megan Davies, M.D., North Carolina’s epidemiologist, who referred to the lack of a “compelling public health need” to provide H1N1 death data on a county-by-county level, pointing out that in many areas it would be easy for locals to take that information, match it with recent death records and come up with the name of the infected person. Davies said that, in cases like that, she fears the infected person’s family would be stigmatized.
“The fear of contagion’s a really primitive thing that comes up in people,” Davies said.
Additionally, Hoban says, officials are bound by medical ethics, state laws and federal health privacy regulations (which, she notes, generally don’t cover people who are already dead).
For another perspective, Hoban spoke with AHCJ board member Felice Freyer of The Providence Journal. Freyer discussed AHCJ’s report that disclosure had been uneven across the country, and said that officials should share information unless there’s a compelling reason not to.
“Public health officials can’t do their job if they don’t have the trust of the public and no-ones going to trust them if they hide information for no reason,” Freyer said.
Former CDC lead legal counsel Gene Matthews agreed, noting that “Too little information can be a bigger headache than too much.” According to Matthews, this problem has been exacerbated by the Internet where, “If the public health officials don’t provide enough information, the outsiders will simply make it up.”
CBS questions CDC’s H1N1 prevalence estimates
CBS’s Sharyl Attkisson reviewed state and federal data (collected through FOIA and other open records requests) and found that H1N1 may not be as prevalent as the Centers for Disease Control and Prevention have estimated. The story turns on a July 24 memo announcing to states that the CDC would no longer count H1N1 cases and statistics from state tests taken before the memo that show that even tests of the most likely patients usually came back negative for H1N1.
The high level of misdiagnosis of “probable” or “presumed” H1N1 could result inaccurate reports of outbreaks as well as in people assuming they’ve survived H1N1 and are now immune when they’ve actually suffered something that may or may not even be influenza.
Related: The CDC talked a bit about reporting and data in its Oct. 20 news briefing. Read the rough transcript of that briefing, provided by the CDC. And, The Associated Press’ Mike Stobbe, an AHCJ board member, offers more explanation about the surveillance of H1N1.
Attkisson’s report:
OIG: Are we ready for a flu pandemic?
The Department of Health and Human Services’ Office of Inspector General has released two reports assessing just how prepared Americans are for a flu pandemic. Their findings? Communities are on the right track when it comes to preparing for a surge in patient numbers, but they’re not as ready as they could be. Likewise, there’s still more to be done before local organizations will be ready to distribute vaccines and antiviral drugs.
A surge of flu victims
In the Southern Hemisphere, where the flu season has already struck, the biggest systemic issue was lack of space in intensive care units overwhelmed by H1N1 victims. Are American communities doomed to more of the same? After reviewing the coordination, volunteer recruitment/organization, medical equipment, alternate care and triage and admission guidelines of 10 localities as of late summer 2008, the OIG’s answer is a resounding “not quite.” (Get the full 37-page report here.)
The OIG’s to-do list for the assistant secretary for preparedness and response?
- Keep emphasizing those five areas that we evaluated
- Make sure that, when states and localities do medical surge preparedness exercises, they then document and address the lessons they learned from those activities.
- Those lessons everyone just documented? Make sure they share them with everyone else too. Preferably through the CDC. Then the feds can work to address specific local issues.
- Consider working with states (or even the federal government) to “develop appropriate legal protections for medical professionals and volunteers who respond to public health emergencies and who may need to alter standards of care.”
Getting vaccines/antivirals to the right place, at the right time
According to HHS, “even a mild pandemic could cause between 2 million and 7.4 million deaths worldwide” and H1N1 looks to be a “moderate” one. Vaccination is a key component of the prevention plan, which is why the OIG evaluated the pandemic flu plans of 10 communities in the categories of “Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.” In general, they found that the communities need to practice more, plan for all eight categories and make those plans “actionable.” In general, folks were best at planning for receiving/staging and dispensing and worst at planning for security, storage and transportation.(Read the whole 57-page report here.)
Based on those findings, the OIG recommended that the CDC:
- Work with states to figure out why folks are still in the “early stages” of planning and help them make some progress
- Prioritize which of the eight areas states should focus on in order to improve local readiness as quickly as possible.
- Emphasize “actionable” plans that “identify the organizations or individuals responsible for carrying out specific actions and the sources that would be necessary to staff distribution and dispensing positions” that are “supported by valid, detailed formal agreements with partnering agencies.”
- Again, make sure locals keep track of what they’ve learned in preparedness exercises and that they make plans to correct any deficiencies. Also, make sure they share plans and “emerging promising practices.”
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
