[Report] Mortality Among Blacks or African Americans with HIV Infection (is declining) — United States, 2008–2012

L0052223 A circle incorporating the words \’African American againstCredit: Wellcome Library, London. Wellcome Imagesimages@wellcome.ac.uki mages.wellcome.ac.uk A circle incorporating the words \’African American against AIDS\’; advertisement by the Sacramento County Department of Health and Human Services. Colour lithograph.

 

From the 6 February 2015 MMWR article

…The results of these analyses indicate that black persons living with HIV experienced higher numbers and rates of deaths during 2008–2012 than other races/ethnicities. However, the numbers and rates of death declined consistently during the same period. The death rate per 1,000 persons living with HIV among blacks decreased 28% during 2008–2012, more than the overall decline (22%) seen among all persons living with HIV. Other than among blacks, such a consistent decline was observed only among Hispanics or Latinos…

Related articles

• Death Rate in African-Americans Infected With HIV Drops 28%
• Gap in death rate narrows for blacks, whites with HIV
• Race Matters: New Study Shows Death Rate Among Blacks With HIV Is Still Highest In The Nation

[News article] Web-savvy older adults who regularly indulge in culture may better retain ‘health literacy’ — ScienceDaily

Web-savvy older adults who regularly indulge in culture may better retain ‘health literacy’ — ScienceDaily.

From the news article

Date:November 25, 2014

Source:BMJ-British Medical Journal

Summary:Older people who are active Internet users and who regularly indulge in a spot of culture may be better able to retain their health literacy, and therefore maintain good health, suggests research.

…

There was a link between age and declining health literacy, and being non-white, having relatively low wealth, few educational qualifications, and difficulties carrying out routine activities of daily living.

Poorer memory and executive function scores at the start of the study were also linked to greater health literacy decline over the subsequent six years.

Around 40% of the entire sample said they never used the internet or email, while one in three (32%) said they did so regularly. Similar proportions said they had consistently engaged in civic (35%) and/or leisure (31%) activities over the six year follow-up period.

Almost four out of 10 (39%) said they had regularly engaged in cultural activities, such as going to the cinema, theatre, galleries, concerts or the opera, during this time.

Across all time points, internet use and engagement in civic, leisure, or cultural activities were lower among those whose health literacy declined.

After taking account of influential factors, only the links between regular internet use and engaging in cultural activities remained statistically significant.

But each factor appeared to exert an additive effect, and a combination of all four seemed to afford the best protection against health literacy decline, a finding that was independent of any tailing off in cognitive function.

This is an observational study so no definitive conclusions can be drawn about cause and effect.

,,,

[News article] Health Insurance, Death Rates and the Affordable Care Act

Health Insurance, Death Rates and the Affordable Care Act.

From the 12 May 2014 article at Pew State and Consumer Initiatives

The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act. 

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.” 

 

                                        A portion of the chart

The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person’s life expectancy.

…..

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Why the Fragility of Health Outcomes Research May Be a Good Outcome for Health One Comment

From the 5 April 2012 article by DAVID SHAYWITZ, MD at The Health Care Blog

Durably improving health is really, really hard.
I’ve discussed this in the context of drug discovery, which must contend with the ever-more-apparent reality that biology is incredibly complex, and science remarkably fragile.  I’ve discussed this in the context of patient behavior, focusing on the need to address what Sarah Cairns-Smith and I have termed the “behavior gap.”
Here, I’d like to focus on a third challenge: measuring and improving the quality of patient care.
I’ve previously highlighted the challenges faced by Peter Pronovost of Johns Hopkins in getting physicians to adhere to basic checklists, or to regularly do something as simple and as useful as washing hands, topics that have been discussed extensively and in a compelling fashion by Atul Gawande and others….

…Consider the recent JAMA article (abstract only) by Lindenauer et al. analyzing why the mortality rate of pneumonia seems to have dropped so dramatically from 2003-2009.  Originally, this had been attributed to a combination of quality initiatives (including a focus on processes of care) and clinical advances.  The new research, however, suggests a much more prosaic explanation: a change in the way hospitals assign diagnostic codes to patients; thus, while rates for hospitalization due to a primary diagnosis of pneumonia decreased by 27%, the rates for hospitalization for sepsis with a secondary diagnosis of pneumonia increased by 178%, as Sarrazin and Rosenthal highlight in an accompanying editorial (public access not available).
Why did the coding pattern change? Multiple explanations were proposed by the authors; possibilities range from the benign — changes in diagnostic guidelines, greater awareness of sepsis, etc. – to the cynical (and quite likely) — utilizing different coding to maximize reimbursement.
One key take-home is that reliable measurement of health variables is so much more of a challenge than is typically appreciated, and ensuring that we’re robustly measuring what we think we’re measuring, rather than a paraphenomenon, is going to be very important.  We’re learning this lesson the hard way in so many areas of science, and health outcomes research is unlikely to be the solitary exception.
A second and equally important lesson is to remember that in many cases in health outcome research, the people who are doing the measurements and assessments often have a significant stake in the results, introducing the very real possibility of data distortion….

 

Death rate measure used to judge hospital quality may be misleading

From the 3 January 2012 press release

Hospitals, health insurers and patients often rely on patient death rates in hospitals to compare hospital quality. Now a new study by researchers at Yale School of Medicine questions the accuracy of that widely used approach and supports measuring patient deaths over a period of 30 days from admission even after they have left the hospital….

…The study compared two widely used approaches to assessing hospital quality. One approach uses mortality rates of patients who die during their initial hospitalization, and the other uses rates of patients who die within 30 days, whether or not they have been discharged.

Drye and colleagues focused on mortality rates for patients with heart attack, heart failure, and pneumonia. For these conditions, one-third to one-half of deaths within 30 days occur after the patient leaves the hospital, but this proportion often varies by hospital.

“We were concerned that only counting deaths during the initial hospitalization can be misleading,” said Drye. “Because some hospitals keep their patients for less time than others due to patient transfers to other facilities or because they send patients home more quickly.”

Drye and her colleagues found that quality at many U.S. hospitals looked quite different using the two different accounting methods.

The team also found that measures looking only at deaths in the hospital favor hospitals that keep their patients for a shorter length of time.

“To assess current and future patient management strategies,” said Drye. “We should assess all patients for a standard time period, such as 30 days.”…

Citation: Annals of Internal Medicine 156:19-26. (January 3, 2012)

Read entire press release

Related articles

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• Measuring In-Hospital Mortality Favors Hospitals with Short Stays (forbes.com)

Study takes aim at education-based death rate disparities

From the 15 December 2011 news release via Eureka alerts

WASHINGTON, DC — A study in the December issue of the American Sociological Review has brought new understanding as to why death rates for less educated middle aged adults are much higher than for their more educated peers despite increased awareness and treatments aimed at reducing health disparities.

[Full text of the article  The Enduring Association between Education and Mortality: The Role of Widening and Narrowing Disparities is free at http://asr.sagepub.com/content/76/6/913.full.pdf+html

Click here for the accompanying 7 minute interview podcast.  The author talks about the findings in his work, implications, and touches on the processes of doing the research and writing the paper. The author comes across as knowledgeable, reflective, willing to learn from others,  grateful for financial support, and driven to share his knowledge for the benefit of all]

For decades, data has shown that middle aged adults with low education levels—that is high school or less—are twice as likely to die as those with higher education levels. Professor Richard Miech, of the Department of Health and Behavioral Sciences at the University of Colorado Denver’s College of Liberal Arts and Sciences, and his colleagues wanted to better understand why this persists. They found that as new causes of death emerge, people with lower education levels are slower to respond with behavioral changes, creating a moving target that often remains a step ahead of prevention. Almost all causes of death that are on the increase are fueled by high rates of mortality among people with lower education, a trend that counters any progress made in the reduction of today’s health disparities….

Read the entire Eureka News alert

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