Category: Healthcare

Supplements: COVID-19; Racial and Ethnic Disparities: Chapter 13

Mary Pat Campbell

Link:https://adr.usrds.org/2021/supplements-covid-19-disparities/13-covid-19-supplement

Graphic:

Excerpt:

Among beneficiaries with CKD, mortality during COVID-19 hospitalization was approximately 40% during the first wave of the pandemic but decreased thereafter, reaching an average of 18% from July to December (Figure 13.10).

During all of 2020, the incidence of in-hospital death during COVID-19 hospitalizations was 21.5% among older Medicare beneficiaries with CKD, 18.8% among beneficiaries undergoing dialysis, and 19.3% among beneficiaries with a kidney transplant.

Between epidemiologic week 13 of 2020 and epidemiologic week 8 of 2021, the number of prevalent dialysis patients fell from 567,303 to 555,264, an unprecedented decline of over 2% (Figure 13.11).

Among patients undergoing dialysis, mortality was consistently elevated, relative to recent historical norms, between epidemiologic week 12 of 2020 and week 10 of 2021. Among patients with a kidney transplant, excess mortality was persistent through the second quarter of 2021 (Figure 13.12a).

The cumulative number of deaths among dialysis patients in 2020 was 18% higher than in 2019, while the cumulative number of deaths among transplant patients in 2020 was 41% higher than in 2019 (Figure 13.12b).

Publication Date: accessed 9 Feb 2022

Publication Site: U.S. Renal Data System

COVID-19 and its Impact on Kidney Patients Utilizing U.S. Dialysis Centers

Mary Pat Campbell

Link:https://www.kidney.org/news/covid-19-and-its-impact-kidney-patients-utilizing-u-s-dialysis-centers

Excerpt:

The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) stress the precarious position people with kidney failure, who are immunocompromised, face as the recent Omicron wave continues to spread among patients and staff at dialysis facilities. Cases of COVID-19 are causing serious illness, forcing shortened treatment times for patients, and exacerbating shortages in staff and supplies that impede access to this life-sustaining treatment. COVID-19’s impact on people with kidney diseases has resulted in the first decline in the number of patients on dialysis in the United States in the 50-year history of the Medicare ESRD Program.

…..

There are 783,000 individuals in the United States who have kidney failure, and just under 500,000 of these individuals require life-sustaining dialysis delivered in a dialysis center three times a week, four hours a day. During dialysis treatments, patients typically sit near other patients and staff in facilities that are not always well ventilated. Many of these patients are older, low-income, and from historically disadvantaged communities, and most have underlying conditions like diabetes and cardiovascular diseases.

Despite concerted efforts by dialysis organizations, nephrologists, and other clinicians to slow its spread, COVID-19 continues to run rampant through dialysis facilities. According to data from the US Renal Data System, 15.8% of all patients on dialysis in the United States had contracted COVID-19 as of the end of 2020. During the winter 2020 wave, weekly deaths due to COVID-19 peaked at nearly 20% and annual mortality during 2020 was 18% higher than in 2019.[1]

Despite these high rates of infection and mortality, dialysis patients were not prioritized for access to immunization when the vaccines became available a year ago even though evidence shows that the immune response to vaccination is blunted in dialysis patients. Furthermore, although antibody levels decline more rapidly in dialysis patients than in the general population[i], dialysis patients were not prioritized by the Food and Drug Administration (FDA) or the Centers for Disease Control and Prevention (CDC) when third doses of the vaccine were approved in August.[2] In addition, dialysis patients were also excluded from the groups eligible to receive prophylactic long-acting antibody therapy targeting the SARS-CoV-2 virus. Lastly, the National Institutes of Health did not receive funding for COVID-19 research to help people with kidney diseases or failure in any of last year’s relief packages.

[1] https://adr.usrds.org/2021/supplements-covid-19-disparities/13-covid-19-supplement

Publication Date: 18 Jan 2022

Publication Site: National Kidney Foundation

COVID-19 pandemic causes ‘broken heart’ syndrome cases to surge: researchers

Mary Pat Campbell

Link: https://www.foxnews.com/health/broken-heart-cases-surge-covid-pandemic-especially-women-researchers?utm_source=dlvr.it&utm_medium=twitter

Excerpt:

Research has reportedly identified a spike in cases of Takotsubo cardiomyopathy, or “broken heart syndrome,” over the course of the coronavirus pandemic. 

Experts said the potentially fatal stress-induced heart condition is disproportionately affecting women.

“I don’t know how much we can really blame COVID, or how much of this is that we’re just recognizing more of it,” Dr. Noel Bairey Merz, director of the Barbra Streisand Heart Center at Cedars-Sinai in Los Angeles, told “Good Morning America” on Monday. “But, heart disease is the leading killer of women and all ages, including teenagers, midlife women and older women. This is just a component of that major killer. So, it’s really something that needs to be addressed.”

Merz said one in five of those who suffer from the heart-brain disorder will have another attack within a decade.

In an October news release, Cedars-Sinai shared Smidt Heart Institute research published in the Journal of the American Heart Association, which suggests that middle-aged and older women are being diagnosed up to 10 times more often than younger women or men of any age.

The study suggested that the condition has become more common, with incidences rising since well before coronavirus swept the globe. 

Author(s): Julia Musto

Publication Date: 8 Feb 2022

Publication Site: Fox News

The Relation Between COVID-19 and Depression

Mary Pat Campbell

Link:https://www.genre.com/knowledge/publications/cflh21-2-obrien-en.html

Excerpt:

A number of studies have looked at the incidence of Long COVID, including a recently published state-of-the-art review of post-acute sequelae of severe disease.1 This indicates that 33% to 98% of survivors have symptoms or complications for at least a month. The most common of these are fatigue (28.3%‑98%), headache (91.2%), dyspnoea (13.5%‑88%), cough (10%‑13%), chest pain (5%‑42.7%), anxiety or depression (14.6%‑23%) and deficits in smell or taste (13.1%‑67%). The importance of understanding the long-term effects of COVID‑19 is vital in planning future care and management strategies. The National Institutes of Health (NIH) in the U. S. has recently allocated $470 million to build a national study population including diverse research volunteers and, to support large-scale studies on the long-term effects of COVID‑19. This is known as the NIH Researching COVID to Enhance Recovery (RECOVER) study.2

….

A recent study of the effects of the pandemic on anxiety and major depression has estimated a significant increase in the prevalence of both major depressive disorder, with an estimated additional 53.2 million cases worldwide, and anxiety disorders with an additional 76.2 million cases. These findings are particularly concerning because depression and anxiety were already leading causes of disability worldwide. By using the global burden of disease study model, the study gives estimates of additional disability-adjusted life-years (DALYS). Major depressive disorder caused 49.4 million DALYs, and anxiety disorders caused 44.5 million DALYS in 2020.9

Whether the increase in depression and anxiety can be solely ascribed to the effects of the pandemic or whether the disease itself can induce these conditions remains uncertain. Soon after the start of the pandemic, a UK‑wide surveillance study trying to identify neurological and neuropsychiatric complications identified patients with altered mental status, which fulfilled the clinical case definition for psychiatric diagnoses:10

21 of the 23 cases were new diagnoses.

10 had new onset psychosis.

6 had a neurocognitive syndrome.

4 had an affective disorder.

Author(s): Dr. John O’Brien, Life/Health Chief Medical Officer, London

Publication Date: Feb 2022

Publication Site: GenRe

New York pension official, worried about misinformation, seeks Spotify report

Mary Pat Campbell

Link:https://wtvbam.com/2022/02/07/exclusive-new-york-pension-official-worried-about-misinformation-seeks-spotify-report/

Excerpt:

New York State’s top pension official has asked streaming music platform Spotify Technology SA for details about the effectiveness of its new content rules, citing complaints including that podcaster Joe Rogan has spread misinformation about COVID-19 vaccines.

New York State Comptroller Thomas DiNapoli, who oversees funds that hold Spotify shares, requested the report in a letter sent to Spotify Chief Executive Daniel Ek on Feb. 2, which was shown to Reuters.

The letter also urged Spotify to give users an easy mechanism to report content that could violate its rules, and to define how its board oversees content risks and enforcement.

DiNapoli cited reports of Spotify hosting content that has included COVID-19 misinformation, and racist and antisemitic material. Prominent rock musician Neil Young last month left the platform last month because he said Rogan has misled people about vaccines, followed by other stars.

Author(s): Ross Kerber

Publication Date: 7 Feb 2022

Publication Site: WTVB

Pandemic-fueled shortages of home health aides strand patients without care

Mary Pat Campbell

Link:https://www.cnn.com/2022/02/03/health/home-health-care-aide-shortage-khn-partner-wellness/index.html

Excerpt:

Frail older adults are finding it harder than ever to get paid help amid acute staff shortages at home health agencies.

Several trends are fueling the shortages: Hospitals and other employers are hiring away home health workers with better pay and benefits. Many aides have fallen ill or been exposed to Covid-19 during the recent surge of omicron cases and must quarantine for a time. And staffers are burned out after working during the pandemic in difficult, anxiety-provoking circumstances.

The implications for older adults are dire. Some seniors who are ready for discharge are waiting in hospitals or rehabilitation centers for several days before home care services can be arranged. Some are returning home with less help than would be optimal. Some are experiencing cutbacks in services. And some simply can’t find care.

Author(s):Judith Graham, Kaiser Health News

Publication Date: 3 Feb 2022

Publication Site: CNN

Why Coney Island and Brighton Beach were hit so hard by omicron

Mary Pat Campbell

Link:https://gothamist.com/news/why-coney-island-and-brighton-beach-were-hit-so-hard-omicron

Excerpt:

The two zip codes encompassing this region — 11224 and 11235 — have experienced 75 deaths per 100,000 people over the last month, a fatality rate nearly three times the citywide average. The pair of zip codes ranked only behind East New York when it came to the pace of COVID deaths between December 24th and January 20th, while their hospitalization rates were also among the highest in the city.

These two zip codes in southern Brooklyn also have lower vaccination coverage than the city as a whole, a common thread between most of the places hit hardest this winter. The area is averaging 66% full vaccination, compared with 75% citywide. In adjacent Gravesend, fewer than two-thirds of residents are fully vaccinated, and meanwhile, some parts of the city are approaching universal coverage.

….

Hospital leaders said undervaccination is having an outsized effect on these oceanside communities because the area’s demographics make residents prone to severe illness from COVID-19. In Brighton Beach and Coney Island, 26% of residents are over the age of 65, compared with about 14% in the borough as a whole. Many of those elderly residents also have underlying health conditions.

….

Citywide, 89% of New Yorkers between ages 65 to 74 are fully vaccinated, but the rate drops to 63% for people older than 85. Municipal data also show coverage varies by region and by other demographics. For instance, just 62% of white seniors in the Bronx are fully vaccinated, and only 65% of Black seniors in Brooklyn.

Author(s): Caroline Lewis

Publication Date: 7 Feb 2022

Publication Site: Gothamist

A Potential COVID Game-Changer

Mary Pat Campbell

Link:https://www.dailyposter.com/a-potential-covid-game-changer/

Excerpt:

Progressive lawmakers are calling on President Joe Biden to take advantage of the fact that the U.S. Army’s new pan-coronavirus vaccine recipe is not restricted by intellectual property restrictions and share the information with the world.

According to the Army, early research shows that the Spike Ferritin Nanoparticle (SpFn) vaccine, developed by scientists at the Walter Reed Army Institute of Research, can “provide broad protection” against COVID-19 and future variants. The SpFn vaccine must still undergo Phase 2 and 3 of human trials, but if it proves successful, distributing the new vaccine around the globe could be a game-changer in the fight against the COVID pandemic.

Author(s): WALKER BRAGMAN, ANDREW PEREZ

Publication Date: 1 Feb 2022

Publication Site: Daily Poster

Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics

Mary Pat Campbell

Link:https://academic.oup.com/jnci/article/113/12/1648/6312532?login=false

Citation: JNCI: Journal of the National Cancer Institute, Volume 113, Issue 12, December 2021, Pages 1648–1669, https://doi.org/10.1093/jnci/djab131

Graphic:

Excerpt:

Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval [CI] = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = −2.2%, 95% CI = −2.5% to −1.9%) and females (AAPC = −1.7%, 95% CI = −2.1% to −1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females.

Conclusions

Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations.

Author(s): Farhad Islami, MD, PhD, Elizabeth M Ward, PhD, Hyuna Sung, PhD, Kathleen A Cronin, PhD, Florence K L Tangka, PhD, Recinda L Sherman, PhD, Jingxuan Zhao, MPH, Robert N Anderson, PhD, S Jane Henley, MSPH, K Robin Yabroff, PhD, Ahmedin Jemal, DVM, PhD, Vicki B Benard, PhD

Publication Date: 8 July 2021

Publication Site: Journal of the National Cancer Institute

Electronic Health Records in the Age of Coronavirus: The Covid Crisis Has Accelerated Real-World Adoption

Mary Pat Campbell

Link:https://www.soa.org/sections/technology/technology-newsletter/2021/october/att-2021-10-timmins/

Graphic:

Excerpt:

As with most things in the world, early 2020 seems like ancient history. In late January last year, I had just finished a white paper for the SOA[1], stating confidently that Electronic Health Records, or EHRs, were not likely to have a major impact for several years amid slow adoption by executives—with significant strategic differences among stakeholders and little signs of compromise.

Then in February came COVID-19, and the urgent need to move rapidly to telemedicine for both COVID and non-COVID afflictions. Government authorities moved quickly to relax restrictions on interstate telehealth, allowing payer coverage for the transfer of sensitive material online and over mobile networks—including Facebook Messenger, Apple Facetime, and Zoom.[2] Although not permanent while a public health emergency, this created an unexpected precedent for interoperability, the Holy Grail of seamless cross-talk of health data between HIPAA-regulated IT systems.

….

Much remains unknown about the secondary effects of COVID-19, beyond respiratory failure and immune system overload. However, there is likely a significant spike in claims related to COVID-19 building within the insurance industry. It may be important for the insurance industry to monitor these secondary afflictions, at minimum through the claims process (see Figure 3), although the best digital approach to obtain that evolving health information remains unclear at this time. Genomics and epigenetic vulnerability could be a rich data area here.

If insureds would be willing (or mandated) to provide their immunization history to payors, directly or indirectly, this could be a significant asset for actuaries in evaluating this ongoing phenomenon. Claims data also can include non-prescription drug information, which could provide additional clues of COVID exposure.

Author(s): James Timmins

Publication Date: October 2021

Publication Site: Actuarial Technology Today

Suicide Risk Screenings Can Save Lives

Mary Pat Campbell

Link: https://www.pewtrusts.org/en/research-and-analysis/articles/2022/01/25/suicide-risk-screenings-can-save-lives

Excerpt:

Suicide was the 12th leading cause of death in the United States in 2020.

The overall U.S. suicide rate grew 33% from 1999 to 2019, according to the Centers for Disease Control and Prevention. CDC reports even higher increases among certain racial and ethnic groups: American Indian and Alaska Native women (139%) and men (71%), Black women (65%), White women (68%) and men (40%), and Hispanic women (37%). Other people at greater risk of suicide include veterans, people who identify as LGBTQ, youth and young adults, and disaster survivors.

….

According to a recent study, about half of people who died by suicide over the 10-year period examined had seen a health care professional at least once in the month before their death. Additional research suggests that, if they were screened for suicide risk by those providers, many might have received care and survived. Indeed, a 2017 study of eight emergency departments across seven states found 30% fewer suicide attempts among patients who were screened and received evidence-based care compared with patients who were not screened. Another study that looked at veterans affairs hospitals found that patients who were screened and then received clinical interventions were half as likely to experience suicidal behavior and more than twice as likely to attend mental health treatment compared with those who received usual care.

Author(s): Kristen Mizzi Angelone

Publication Date: 25 Jan 2022

Publication Site: Pew

Will the OPEB Ostriches Ever Run Out of Excuses?

Mary Pat Campbell

Link:https://www.governing.com/finance/will-the-opeb-ostriches-ever-run-out-of-excuses

Graphic:

Excerpt:

As one stalwart finance officer once told me, “Our pension funds basically sucked up all the new revenue we’d been hoping to set aside to properly fund OPEB.” Those and other priorities for spending each incremental revenue dollar continued to crowd out the opportunity to institute consistent actuarial funding for OPEB benefits; the path of least resistance for policymakers who lack foresight and a sense of fiscal responsibility has been to keep kicking the can.

So it is that between 2015 and 2019, the state and local sector had clearly sorted itself into three classes of employers: (1) those who had trimmed or modified their OPEB commitments and liabilities to sustainable levels, (2) those who had begun actuarial funding of an OPEB trust fund, and (3) those doing nothing and leaving the problem to their successors and future taxpayers.

Author(s): Girard Miller

Publication Date: 18 Jan 2022

Publication Site: Governing