Revisiting Compression of Morbidity and Health Disparities in the 21st Century

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162763/2/milq12472.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162763/1/milq12472_am.pd

Socioeconomic indicators that matter for population health

Increasing research and policy attention is being given to how the socioeconomic environment influences health. This article discusses potential indicators or metrics regarding the socioeconomic environment that could play a role in an incentive-based system for population health. Given the state of the research regarding the influence of socioeconomic contextual variables on health outcomes, the state of data and metrics for these variables at the local level, and the potential for program and policy intervention, we recommend a set of metrics related to the socioeconomic composition of a community (including poverty, unemployment, and public assistance rates); educational attainment and achievement; racial segregation; and social-capital indicators such as density of voluntary organizations and voter turnout. These indicators reflect the evidence that population health gains depend on improvements in many of the fundamental social determinants of health, including meaningful employment, income security, educational opportunities, and engaged, active communities

Impact of health insurance expansions on nonelderly adults with hypertension.

Introduction Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension. Methods We developed a state-transition model to simulate the lifetime health events of the population aged 25 to 64 years. We modeled the effects of insurance coverage expansions on the basis of published findings on the relationship between insurance coverage, use of antihypertensive medications, and CVD-related events and deaths. Results The model projected that currently anticipated health insurance expansions would lead to a 5.1% increase in treatment rate among hypertensive patients. Such an increase in treatment rate is estimated to lead to 111,000 fewer new coronary heart disease events, 63,000 fewer stroke events, and 95,000 fewer CVD-related deaths by 2050. The estimated benefits were slightly greater for men than for women and were greater among nonwhite populations. Conclusion Federal and state efforts to expand insurance coverage among nonelderly adults could yield significant health benefits in terms of CVD prevalence and mortality rates and narrow the racial/ethnic disparities in health outcomes for patients with hypertension

Measurement Error in Prenatal Care Utilization: Evidence of Attenuation Bias in the Estimation of Impact on Birth Weight

Objective: Errors in the measurement of the timing and number of prenatal care visits may produce downward bias in estimates of the impact of prenatal care use on birth outcomes. This paper examines the extent of attenuation bias from measurement error in the estimation of the effect of prenatal care use on birth weight. Methods: Data were analyzed from the 1980 National Natality Survey, a nationally representative sample of live births with information on prenatal care utilization from three sources: birth certificates, medical provider surveys, and maternal surveys. The extent of attenuation bias in estimates of the impact of different measures of prenatal care use on birth weight was examined by comparing estimates robust to measurement error (including instrumental variables) with ordinary least squares results. Results: There is considerable disagreement in measures of prenatal care across the three data sources, with correlations in the utilization measures computed from different sources around 0.5. The results also show evidence of attenuation bias from measurement error in estimates of the impact of prenatal care on birth weight for both White and Black mothers. Attenuation bias was least severe for information from the birth certificate report of prenatal care. Conclusions: Because of measurement error, previous studies may have underestimated the effect of prenatal care utilization on birth weight. Corrected estimates, however, do not suggest that prenatal care is a major predictor of birth weight. In addition, part of what previous analyses have interpreted as adverse selection bias may in fact be attenuation bias due to measurement error.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45323/1/10995_2004_Article_224322.pd

Options for CDC\u27s Cancer Screening Programs: Implications of the Affordable Care Act

Screening to promote early detection of cancer is a fundamental tool in preventive medicine and public health that facilitates earlier treatment and reductions in cancer mortality. Systematic reviews of the research demonstrate that early detection and treatment for breast and cervical cancers can reduce cancer-related mortality. One of the most important barriers to women being screened is the lack of health insurance coverage. The Centers for Disease Control and Prevention (CDC) administers two programs designed to increase screening, particularly among low-income and vulnerable populations: the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer Control Program (CRCCP). NBCCEDP operates through a series of grants provided to state, territorial, and tribal agencies that help fund screening and related promotion/prevention interventions, particularly aimed at low-income uninsured and underinsured women who would otherwise be unable to afford the costs of clinical breast exams, mammograms, Pap smears, cervical exams, and related screening and diagnostic tests. CRCCP operates on a similar basis and serves low-income uninsured and underinsured men and women who cannot afford fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy and related tests

Examining the evidentiary basis of Congress\u27s commerce clause power to address individuals\u27 health insurance status

Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme Court decisions regarding the power of Congress to regulate individual conduct. The Administration, in a brief filed on January 9, 2012, argues that Congressional authority to act can be found under both its taxing powers as well as its power under the Commerce Clause and Necessary and Proper Clause to regulate interstate commerce. The Commerce Clause arguments are of special interest, because it is this basis of power that has received so much attention in the lower court decisions to date

Examining the evidentiary basis of Congress\u27s commerce clause power to address individuals\u27 health insurance status

Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme Court decisions regarding the power of Congress to regulate individual conduct. The Administration, in a brief filed on January 9, 2012, argues that Congressional authority to act can be found under both its taxing powers as well as its power under the Commerce Clause and Necessary and Proper Clause to regulate interstate commerce. The Commerce Clause arguments are of special interest, because it is this basis of power that has received so much attention in the lower court decisions to date

“Pay for Success” Financing and Home‐Based Multicomponent Childhood Asthma Interventions: Modeling Results From the Detroit Medicaid Population

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144303/1/milq12325_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144303/2/milq12325.pd

Understanding the relationship between access to care and facility‐based delivery through analysis of the 2008 Ghana Demographic Health Survey

ObjectiveTo determine the types of access to care most strongly associated with facility‐based delivery among women in Ghana.MethodsData relating to the “5 As of Access” framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression.ResultsIn all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility‐based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access.ConclusionAffordability was an important determinant of facility delivery in Ghana—even among women with health insurance—but social access variables had a mediating role.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135213/1/ijgo224.pd

Symptom Experience and Quality of Life of Women Following Breast Cancer Treatment

Background: Few studies have examined the correlates of breast cancer-related symptoms that persist posttreatment and determined the relationship between symptoms and quality of life (QOL). Methods: A population-based sample of women in the United States with stage 0–II breast cancer (n = 1372) completed a survey including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Cancer-Specific Quality of Life Questionnaire. Described are the presence and frequency of 13 symptom scales and their associations with 10 QOL dimensions. Results: All study participants had completed primary treatment (surgery and radiation and/or chemotherapy, if applicable). Mean time from initial surgical treatment to completion of the questionnaire was 7.2 months (range 0.5–14.9 months). Mean number of symptoms reported was 6.8, with the 5 most common symptom scales being systemic therapy side effects (87.7%), fatigue (81.7%), breast symptoms (72.1%), sleep disturbance (57.1%), and arm symptoms (55.6%). Younger age and poorer health status at diagnosis were associated with worse symptoms. Fatigue had the greatest impact on QOL, with significant differences between those with high and low fatigue across 7 QOL dimensions. Sociodemographic, prior health status, clinical, and treatment/diagnostic factors explained only 9%–27% of the variance in QOL outcomes. Adding symptom experience increased the variance explained to 18%–60%. Conclusions: More attention to the reduction and management of disease and treatment-related symptoms could improve QOL among women with breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63179/1/jwh.2006.0255.pd