December 2020 highlights from AJPH

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health December issue research highlights:

• Bringing U.S. health spending in line with other nations an ‘unprecedented’ challenge
• Pregnant Black and Hispanic women less likely to get medication for opioid addiction
• U.S. support for safety net policies up during the pandemic
• Caregiving during young adulthood tied to poorer mental health

Bringing U.S. health spending in line with other nations an ‘unprecedented’ challenge

When it comes to how much Americans spend on health care, the U.S. would have to achieve “unprecedented” spending declines to come into parity with other wealthy nations, finds a study in the December issue of AJPH.

To conduct the study, researchers compared the U.S. against 34 other countries in the Organization for Economic Cooperation and Development, using multiple sources of spending data and projections from 1970 through 2040. In general, the U.S. has spent more per person on health care than every other wealthy nation since 1976, the study reported. In 2018, for example, the U.S. spent about $11,100 per person, while the median per person expenditure among the 34 OECD countries was closer to $4,300.

To come into parity with other high-resource nations, sustained annual declines of 7% and 3.3% would be required by 2030 and 2040, respectively, researchers found, adding that “such declines do not have historical precedent among U.S. states or OECD nations.”

“Excess spending reduces the ability of the United States to meet critical public health needs and affects the country’s economic competitiveness,” the study stated. “Rising health care spending has been identified as a threat to the nation’s health. Public health can add voices, leadership and expertise for reversing this course.”

[Author contact: J. Mac McCullough, College of Health Solutions, Arizona State University, Phoenix, Arizona. “Reduction in U.S. Health Care Spending Required to Meet the Institute of Medicine’s 2030 Target”]

Pregnant Black and Hispanic women less likely to get medication for opioid addiction

Black and Hispanic women are less likely to receive medication for opioid use disorders during pregnancy than their white peers, according to a new study in the December AJPH.

The study is based on data on opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts, and looked for racial and ethnic disparities in both medication use and care for infants with neonatal opioid withdrawal syndrome. Among the 1,710 deliveries to women with opioid use disorder in the data, more than 89% were white.

Overall, researchers found that Black and Hispanic women were significantly less likely to receive any medication for opioid addiction during pregnancy, compared to their white counterparts. However, they found no statistically significant differences by race and ethnicity in infant care, such as pharmaceutical treatment of neonatal opioid withdrawal, rooming mother and baby together, and making sure the newborn receives breast milk during hospitalization.

Researchers noted that recommended treatment for opioid use disorder during pregnancy is medication with methadone or buprenorphine, combined with behavioral therapy.

“There should be no treatment differences attributable to health status in pregnancy, as all pregnant women with (opioid use disorder) are recommended to initiate (medication for opioid use disorder),” the study stated. “Yet, similar to previous studies, our analysis identified racial and ethnic disparities in prenatal (medication for opioid use disorder) treatment.”

[Author contact: Davida M. Schiff, MassGeneral Hospital for Children, Boston, Massachusetts. “Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother-Infant Dyads in Massachusetts (2017-2019)”]

U.S. support for safety net policies up during the pandemic

Public support for social safety net policies went up during the early days of the U.S. COVID-19 outbreak, finds a study published in December in AJPH.

From April 7-13, researchers fielded a representative online survey of nearly 1,500 U.S. adults, asking about support for 11 safety net policies, including two weeks of paid sick leave, universal health insurance, increasing the federal minimum wage to $15 and providing a universal basic income.

Among respondents, 77% supported paid sick leave, and a majority supported universal health insurance and a hike in the minimum wage. Overall, public support for an active government role to improve people’s lives had gone up by 10 percentage points since September 2019, according to the study. All of the unemployment policies garnered majority support as well, including expanding unemployment insurance and public spending on construction projects.

Fewer than half of respondents supported policies such as single-payer health insurance and publicly funded leave to care for a sick family member.

“As unemployment rates soar, many U.S. adults have experienced the dual blows of job loss and health insurance loss,” researchers wrote. “As the rapidly escalating economic crisis requires additional governmental responses, ongoing tracking of public opinion on policy can provide some direction for policymakers.”

[Author contact: Colleen L. Barry, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. “Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020”]

Caregiving during young adulthood tied to poorer mental health

Young adults who care for sick or disabled family or friends also experience poorer mental health, according to a study in December’s AJPH.

To conduct the study, researchers examined data from “emerging adults” — people ages 18 to 25 — who participated in the 2015-2017 Behavioral Risk Factor Surveillance System’s caregiving module. The final sample included about 3,000 young adult caregivers, about 2,300 expectant caregivers who anticipated having to care for someone in the next two years, and more than 12,200 non-caregivers.

Researchers estimated nearly one in five emerging U.S. adults were functioning as a caregiver, and nearly 14% were expecting to so within two years. Over 20% of young caregivers experienced frequent mental distress, compared with 13.5% and 12.8% among expectant caregivers and non-caregivers, respectively. Cigarette smoking was more prevalent among caregivers compared to non-caregivers, but did not differ with expectant caregivers. No association was found between caregiving and drinking and e-cigarette use.

The study noted that as of 2015, about 43.5 million U.S. adults were providing informal care to family or friends who were ill, injured or living with a disability.

“The necessity of informal caregiving and its public health importance is already a current area of focus; this study highlights that emerging adults warrant particular attention,” researchers wrote.

[Author contact: Deborah L. Grenard, Department of Veterans Affairs-Seattle, Seattle, Washington. “Impact of Caregiving During Emerging Adulthood on Frequent Mental Distress, Smoking and Drinking Behaviors: United States, 2015-2017”]

Check out the full list of AJPH research papers that published online in our First Look area:

• Fighting the Institutionalization of Racism in Medicaid
• Reduction in US Health Care Spending Required to Meet the Institute of Medicine’s 2030 Target
• Excess Medical Care Spending: The Categories, Magnitude, and Opportunity Costs of Wasteful Spending in the U.S.
• Immediate and long-term implications of the COVID-19 pandemic for people with disabilities
• Covid-19 and the rise of Participatory SIGINT: an examination of the rise in government surveillance through mobile applications
• Dental Radiographs for Age Estimation in US Asylum Seekers: Methodological, Ethical, and Health Issues
• Global Policy Surveillance: creating and using comparative national data on health law and policy
• Public support for Social Safety-Net policies for Covid-19 in the US, April 2020
• County reclassifications and Rural-urban mortality disparities in the United States (1970-2018)
• Real-time spatiotemporal analysis of micro-epidemics of influenza and COVID-19 based on hospital-network data: Co-localization of neighborhood-level hotspots
• Deaths attributed to psychiatric disorders in the United States, 2010-2018
• Racial and Ethnic Disparities in Maternal and Infant Outcomes among Opioid-Exposed Mother-Infant Dyads in Massachusetts (2017-2019)
• Estimation of the outbreak severity and evaluation of epidemic prevention ability of COVID-19 by province in China
• Effectiveness of Penalties for lockdown violations during the COVID-19 pandemic in Germany.
• COVID-19 and mortality inequities in the surge in death rates by ZIP Code characteristics: Massachusetts, January 1 to May 19, 2020
• Impact of Caregiving during emerging adulthood on frequent mental distress, smoking, and drinking behaviors, United States 2015 – 2017

The articles above will be published online October 15, at 4 p.m. ET by AJPH.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

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