The Official Who Investigates Suspicious Deaths in Your Town May Be a Doctor — Or Not

Link: https://khn.org/news/article/coroners-medical-examiners-doctor-or-not-death-investigations/

Excerpt:

When a group of physicians gathered in Washington state for an annual meeting, one made a startling revelation: If you ever want to know when, how — and where — to kill someone, I can tell you, and you’ll get away with it. No problem.

That’s because the expertise and availability of coroners, who determine cause of death in criminal and unexplained cases, vary widely across Washington, as they do in many other parts of the country.

….

Each state has its own laws governing the investigation of violent and unexplained deaths, and most delegate the task to cities, counties, and regional districts. The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner. Some death investigators work for elected sheriffs who try to avoid controversy or owe political favors. Others own funeral homes and direct bodies to their private businesses.

Overall, it’s a disjointed and chronically underfunded system — with more than 2,000 offices across the country that determine the cause of death in about 600,000 cases a year.

…..

Belcher’s crusade succeeded in changing some aspects of Washington’s coroner system when state lawmakers approved a new law last year, but efforts to reform death investigations in California, Georgia, and Illinois have recently failed.

Rulings on causes of death are often not cut-and-dried and can be controversial, especially in police-involved deaths such as the 2020 killing of George Floyd. In that case, Minnesota’s Hennepin County medical examiner ruled Floyd’s death a homicide but indicated a heart condition and the presence of fentanyl in his system may have been factors. Pathologists hired by Floyd’s family said he died from lack of oxygen when a police officer kneeled on his neck and back.

….

In 2009, the National Research Council recommended that states replace coroners with medical examiners, describing a system “in need of significant improvement.”

Massachusetts was the first state to replace coroners with medical examiners statewide in 1877. As of 2019, 22 states and the District of Columbia had only medical examiners, 14 states had only coroners, and 14 had a mix, according to the Centers for Disease Control and Prevention.

Author(s): Samantha Young

Publication Date: 20 Dec 2022

Publication Site: Kaiser Health News

As the Monkeypox Spread Recedes, There Are Lessons To Learn

Link: https://reason.com/2022/12/01/as-the-monkeypox-spread-recedes-there-are-lessons-to-learn/

Graphic:

Excerpt:

After close to 30,000 infections, 15 reported deaths, and more than one million doses of vaccine, it appears as though the widespread nature of the U.S. monkeypox outbreak may be nearing an end.

The most recent data from the Centers for Disease Control and Prevention (CDC) show a seven-day average of seven new monkeypox cases per dayThis is a massive decline from the more than 400 cases per day reported during the height of the outbreak in late July and early August. Though, to be clear, it may be some time before we have no cases of monkeypox in the U.S. at all.

There are several explanations for this success, some more obvious than others. The most obvious: This strain of monkeypox was overwhelmingly spread between men who have sex with other men. While monkeypox is technically not a sexually transmitted infection—it can be spread through physical contact with rashes and sores of an infected person—this particular strain seemed stubbornly resistant to nonsexual spread. Los Angeles County data, for example, shows that only 43 of the 2,388 confirmed cases were in women. So, the number of demographic groups at risk of infection was much lower than the number at risk of catching COVID-19.

Author(s): SCOTT SHACKFORD

Publication Date: 1 Dec 2022

Publication Site: Reason

Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now?

Link: https://www.kff.org/policy-watch/why-do-vaccinated-people-represent-most-covid-19-deaths-right-now/

Graphic:

Excerpt:

The waning protection from vaccines is why CDC recommends recent booster shots, and why it’s especially important for people at higher risk to stay up-to-date on boosters. Per current recommendations, most adults should have received at least 2-3 booster doses by now (including the new bivalent booster), in addition to their primary series. However, only 14% of adults overall and 31% of older adults (65 years and older) have received the latest bivalent boosters. The CDC data show that about 95% of adults who died from COVID-19 in 2022 in these jurisdictions were over age 50, and about 8 in 10 were age 65 or older, underscoring the need for older adults to stay up-to-date on recommended booster shots.

The fall in the share of deaths that are among unvaccinated people could also be explained by changes in the unvaccinated population. By this far into the pandemic, it is estimated that many unvaccinated people have had COVID-19 at least once and while hundreds of thousands of unvaccinated people have needlessly died from COVID, those who survived may have gained some immune protection against the virus that can help protect them against severe outcomes when they have subsequent infections. However, this protection from a past infection can also diminish over time, which is why it is still recommended that unvaccinated people with prior COVID-19 infections get vaccinated and stay up-to-date on boosters.

Author(s): Cynthia Cox Follow @cynthiaccox on Twitter , Krutika Amin Follow @KrutikaAmin on Twitter , Jennifer Kates Follow @jenkatesdc on Twitter , and Josh Michaud Follow @joshmich on Twitter

Publication Date: 30 Nov 2022

Publication Site: KFF

Maternal Mortality Rates in the United States, 2020

Link: https://stacks.cdc.gov/view/cdc/113967

Graphic:

Excerpt:

This report updates a previous one that showed maternal mortality rates for 2018 and 2019 (2).
In 2020, 861 women were identified as having died of maternal causes in the United States,
compared with 754 in 2019 (3). The maternal mortality rate for 2020 was 23.8 deaths per
100,000 live births compared with a rate of 20.1 in 2019 (Table).
In 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000
live births, 2.9 times the rate for non-Hispanic White women (19.1) (Figure 1 and Table). Rates
for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and
Hispanic women. The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women
were significant. The observed increase from 2019 to 2020 for non-Hispanic White women was
not significant.

Author(s): Donna L. Hoyert

Publication Date: 23 Feb 2022

Publication Site: CDC Stacks

DOI: https://dx.doi.org/10.15620/cdc:113967

A Woke Panic on Maternal Mortality

Link: https://www.city-journal.org/a-woke-panic-on-black-maternal-mortality

Excerpt:

The Centers for Disease Control and Prevention has created the public concern about black maternal mortality. In February, the CDC released data showing that the maternal mortality rate for black women is 2.9 times higher than the rate for white women. It’s a worrisome statistic, yet the CDC’s own data, as well as a study from the CDC Foundation, provide crucial (and generally unreported) context.

To be clear, even a single death of a pregnant woman is one too many. But the overwhelming majority of women survive motherhood: in 2020, according to the CDC, 861 women in the United States died related to pregnancy, out of a total of about 3.6 million births—a rate of 0.02 percent. Just over 350 were white, while just under 300 were black. Scientifically speaking, it’s hard to draw society-wide conclusions from such a small sample. It’s even harder when you recognize that the CDC statistics include deaths that occurred up to a year after delivery, as well as those caused by underlying and preexisting medical conditions that pregnancy may have aggravated. And the CDC admits that the systems for identifying mortality rates are prone to error.

….

The panel found that less than about a third of the preventable deaths, across all races, were attributable to individual providers. It did not cite racial bias as the reason. Yet the academic and media narrative leads to the assumption that black mothers are dying because doctors and nurses are racist. This leads to a corresponding claim that black mothers would die less often if they saw black doctors, which some call “racial concordance.” These are strange assertions, since Hispanic maternal mortality is lower than the rate for whites, which wouldn’t be true if medical professionals were racist. Yet these claims are still being used to justify discriminatory and dangerous policies across health care.

Author(s): Stanley Goldfarb, Benita Cotton-Orr

Publication Date: 18 Nov 2022

Publication Site:

Guns Aren’t a Public Health Issue

Link: https://reason.com/video/2022/09/30/guns-arent-a-public-health-issue/

Graphic:

Excerpt:

The takeaway from the story of Dickey, Rosenberg, and the 1993 gun study at the center of the piece is that the congressman was correct to begin with. The CDC shouldn’t be studying gun violence.

Titled “Gun Ownership as a Risk Factor for Homicide in the Home” and published in The New England Journal of Medicine, the 1993 study looked at 388 people who had been killed in their homes and matched them to 388 neighbors of similar age, sex, and race. One hundred and seventy-four of the victims lived in houses where at least one gun was present versus only 139 of the matched controls.

With scary music and breathless claims, the video tells viewers that if you had a gun in your house, you were 200 percent more likely to be killed with a gun in your home and 400 percent more likely to kill yourself. 

These are both exaggerations and misstatements of the study results. It didn’t address suicide risk at all, nor gun homicides. It found households in which a resident had been murdered at home by any means had a 25 percent greater frequency of having a gun, not 200 percent. But this doesn’t mean owning a gun increases your risk of being killed by 25 percent. 

This is a classic statistical error known as the “base rate fallacy” and is particularly important when studying rare events, like people murdered in their homes. Suppose 10 people are murdered in their homes, and five of those homes had guns. A matched set of 10 people who were not murdered in their homes found only four homes had guns. So there are 25 percent more guns in the homes of murder victims than matched nonmurder victims (Five vs. four).

But what if you put those 20 people in the context of another million, none of whom were murdered in their homes, half of whom had guns in their homes and half of whom didn’t. The rate for gun owners to be murdered at home becomes five out of 500,009, while the rate for non-gun owners becomes five out of 500,011. So now we find that the risk is 0.0004 percent higher.

In other words, being murdered in your home means you have a 25 percent higher chance of having a gun, but having a gun means you have only a 0.0004 percent greater chance of being murdered in your home. Those are not the same thing.

The finding that owning a gun made study subjects less safe was also a conclusion selected from much stronger statistical results that didn’t fit the authors’ political views and, thus, weren’t mentioned in the study. Yes, 25 percent more victims’ homes had guns than control homes, but 38 percent more victims had controlled security access to their property. Why not lobby against gates as a public health matter? Twenty times as many victims had gotten in trouble at work because of drinking, so why worry about guns when drinking at work is two orders of magnitude more dangerous? Renting and living alone were far more dangerous than having a gun. Victims were less likely than controls to own a rifle or a shotgun, so why not a government program to trade in handguns for long guns?

Author(s): JOHN OSTERHOUDT AND AARON BROWN

Publication Date: 30 Sept 2022

Publication Site: Reason

Most Americans don’t plan to get a flu shot this season — lots of them say they’ll mask to avoid germs instead

Link: https://www.cnbc.com/2022/10/04/fewer-americans-plan-to-get-a-flu-shot-this-season-2022.html

Excerpt:

Only 49% of U.S. adults plan to get their flu shot this flu season, according to a survey conducted by the National Foundation for Infectious Diseases (NFID). Even 1 in 5 of those who are at higher risk for influenza-related complications say they won’t get vaccinated.

People who are more likely to have severe outcomes from a flu infection include those over the age of 65, pregnant people, children younger than five years old, and individuals with underlying conditions, according to the Centers for Disease Control and Prevention.

….

Most Americans agree. Nearly 70% believe that getting an annual flu vaccination is the best way to prevent influenza-related deaths and hospitalizations, the NFID found. And yet many people remain hesitant to get their vaccine.

Instead, more U.S. adults are gravitating towards masking as a form of protection against the flu. A higher percentage of Americans (58%) plan to mask at least sometimes this flu season than intend to get vaccinated.

Author(s): Renée Onque

Publication Date: 4 Oct 2022

Publication Site: CNBC

Can the CDC Repair Its Reputation?

Link: https://knowledge.wharton.upenn.edu/article/can-the-cdc-repair-its-reputation/

Graphic:

Excerpt:

The Centers for Disease Control and Prevention must learn from the mistakes it made during the height of the COVID-19 pandemic if it wants to win back public trust, according to Wharton health care management professor Ingrid Nembhard.

She thinks CDC Director Rochelle Walensky is on the right path to do just that. Walensky, who was appointed by President Joe Biden in 2021, has announced a major overhaul to modernize the agency and get the public messaging right.

….

Nembhard is particularly hopeful about Walensky’s focus on changing the culture at the CDC. The infrastructure to conduct the science and disseminate the information is vital, but so is the culture. Reports have surfaced that paint the agency as clunky with a risk-averse culture.

“If you have all of the structures but nobody is speaking up, where are you?” Nembhard said. “You don’t have all the information that you need, and I think that’s been one of the realities that we’ve seen them having to deal with. You really do need to have your systems in place to be flexible, to be able to manage under ever-changing circumstances.”

Author(s): Angie Basiouny

Publication Date: 13 Sept 2022

Publication Site: Knowledge @ Wharton

5 Worst States for Working-Age Death Increases in July

Link: https://www.thinkadvisor.com/2022/09/12/5-worst-states-for-working-age-death-increases-in-july/

Graphic:

Excerpt:

Early government mortality numbers show that the number of U.S. deaths has stayed very high this summer, both for members of the general population and for working-age people.

For all U.S. residents, for the period from July 3 through Aug. 27, the number of deaths recorded in the U.S. Centers for Disease Control and Prevention’s FluView reports was 426,881, according to the report released Friday, which included data sent to the CDC by Sept. 3.

The “all cause” total for the general population was down just 0.8% from the total for the comparable period in 2021, and it was 22% higher than the total for the comparable period in 2019, before the COVID-19 pandemic began.

For U.S. residents ages 25 through 64, the all-cause death total during that same period was 113,665, according to early, weighted data in the CDC’s Weekly Counts of Deaths by Jurisdiction and Age reports, as of Sept. 8.

Author(s): Allison Bell

Publication Date: 12 Sept 2022

Publication Site: Think Advisor

Two Key Takeaways From The New CDC Life Expectancy Data

Link: https://www.forbes.com/sites/ebauer/2022/09/02/two-key-takeaways-from-the-new-cdc-life-expectancy-data/?sh=6ce149f31cfc

Excerpt:

To what extent, are these drops of life expectancy due to Covid-19, rather than other causes?

From 2019 to 2020, the CDC reports that 90% of the drop in Hispanic life expectancy was attributable to Covid; the corresponding rates were 68% for whites and 59% for blacks. (No breakdown was provided for the AIAN or Asian categories.) However, the CDC data splits its breakdowns into “contributions to decreases” and “contributions to increases” rather than overall net effect. Those readers who are used to looking at data and charts will expect a “waterfall” style chart; the CDC version is not this, and is not particularly helpful.

In any event, relative to the 2020 baseline, the further decreases in life expectancy during 2021 had multiple causes. Only among the White demographic group was Covid the cause of over half of the decline; unintentional injury (including overdoses) was the second-largest contributing factor and for the AIAN demographic group, worsening rates of death due to chronic liver disease and cirrhosis played almost as substantial a role.

And, finally, it is important to understand that the CDC data shows a continued improvement in life expectancy due to reductions in death due to such causes as influenza/pneumonia, COPD/emphysema, Alzheimer disease, diabetes, and perinatal conditions (infant deaths). In fact, strikingly, in 2021, heart disease was a contributor to increased life expectancy in the Black, Hispanic, and Asian demographic groups, but a contributor to decreased life expectancy for the White and AIAN groups.

Again, though, the way the CDC provides its information means that, when it comes down to it, there is much that is simply missing; we do not know the magnitude of the improvements in life expectancy due to these causes, just that it exists. It even seems likely, or at least possible, that some of the apparent improvement in mortality due to these factors was actually because deaths were actually recorded as Covid deaths instead (whether due to multiple causes of death or other reasons).

Author(s): Elizabeth Bauer

Publication Date: 2 Sept 2022

Publication Site: Forbes

Racial Disparities in Maternal Health

Link: https://www.usccr.gov/files/2021/09-15-Racial-Disparities-in-Maternal-Health.pdf

Graphic:

Excerpt:

Over the past two decades, the U.S. maternal mortality rate has not improved while maternal
mortality rates have decreased for other regions of the world. Furthermore, the rate at which
women in the U.S. experience short-term or long-term negative health consequences due to
unexpected outcomes of pregnancy or childbirth has also steadily increased over the past few
decades, with nearly 50,000 women in the U.S. experiencing these health consequences in 2014.
Significant racial and ethnic disparities persist in both the rate of women in the U.S. who die due
to complications of pregnancy or delivery and the rate that women experience negative health
consequences due to unexpected pregnancy or childbirth outcomes.

…..

Compared to any other racial or ethnic group,7 Black8 women experience the highest rates of
nearly all of Centers for Disease Control and Prevention’s (CDC) severe maternal morbidity9
indicators.10 Black women in the U.S. are 3 to 4 times more likely to die from pregnancy-related
complications than White11 women in the U.S., and Native American12 women are more than 2
times more likely to die from pregnancy-related complications than White women in the U.S.13
Pregnancy-related mortality is also slightly elevated for Asian women (a 1.1 disparity ratio),14
and for Hispanic women in some geographic areas.15 Moreover, the risk of pregnancy-related
death is so elevated for Black women in certain regions of the U.S. that it is comparable to the

rate of pregnancy-related deaths16 in some developing countries.17 This racial disparity has not
improved in decades,18 and is also seen in other middle to high-income countries with
multiethnic populations.19 According to the World Health Organization (WHO), the U.S.
maternal mortality ratio ranked 56th in the world in 2017.20 According to the National Center for
Health Statistics (NCHS), in 2018, the maternal mortality rate in the U.S. was 17.4 maternal
deaths per 100,000 live births, with 658 women dying of maternal causes.21 In 2019, the
maternal mortality rate in the U.S. was 20.1 maternal deaths per 100,000 live births, with 754
women dying of maternal causes.

Author(s): U.S. Commission on Civil Rights

Publication Date: September 2021

Publication Site: U.S. Commission on Civil Rights

Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health

Link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3924645

Full Citation:

Heriot, Gail L., Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health (September 15, 2021). San Diego Legal Studies Paper 21-028, Available at SSRN: https://ssrn.com/abstract=3924645 or http://dx.doi.org/10.2139/ssrn.3924645

Abstract:

On September 15, 2021, the U.S. Commission on Civil Rights published a report entitled Racial Disparities in Maternal Health (the “Report”). This Dissenting Statement and Rebuttal (the “Statement”) is a part of that report.

Among other things, the Statement points out several errors in Report. For example, the Report incorrectly states that maternal mortality has increased 50% over the last generation. What has actually happened is that changes in death certificates have caused more deaths to be classified as maternal in nature. The Report also emphasizes the theory that racism plays a prominent role in causing racial disparities in maternal mortality. The Statement points out in response that maternal mortality rates for Hispanic and Asian American mothers are lower than the rate for white mothers. This tends to detract from the theory that racism is what’s causing the disparities.

Author(s): Gail L. Heriot

Publication Date: 13 Oct 2021

Publication Site: SSRN