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Pacheco J, Gollust SE, Callaghan T, Motta M. A Call for Measuring Partisanship in US Public Health Research. Am J Public Health 2024; 114:772-776. [PMID: 38754062 PMCID: PMC11224640 DOI: 10.2105/ajph.2024.307691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Julianna Pacheco
- Julianna Pacheco is with the Department of Political Science, University of Iowa, Iowa City. Sarah E. Gollust is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Timothy Callaghan and Matthew Motta are with the Department of Health Law, Policy, and Management at the Boston University School of Public Health, Boston, MA
| | - Sarah E Gollust
- Julianna Pacheco is with the Department of Political Science, University of Iowa, Iowa City. Sarah E. Gollust is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Timothy Callaghan and Matthew Motta are with the Department of Health Law, Policy, and Management at the Boston University School of Public Health, Boston, MA
| | - Timothy Callaghan
- Julianna Pacheco is with the Department of Political Science, University of Iowa, Iowa City. Sarah E. Gollust is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Timothy Callaghan and Matthew Motta are with the Department of Health Law, Policy, and Management at the Boston University School of Public Health, Boston, MA
| | - Matthew Motta
- Julianna Pacheco is with the Department of Political Science, University of Iowa, Iowa City. Sarah E. Gollust is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Timothy Callaghan and Matthew Motta are with the Department of Health Law, Policy, and Management at the Boston University School of Public Health, Boston, MA
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Saloner B. The Overdose Crisis in the 2024 Election-Political Fights and Practical Problems. JAMA 2024; 331:1621-1622. [PMID: 38648055 DOI: 10.1001/jama.2024.4997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
This Viewpoint discusses the 2024 presidential election in the context of the addiction and overdose crisis in the US, which has been a unifying challenge and a source of major ideological division in US politics.
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Affiliation(s)
- Brendan Saloner
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kennedy-Hendricks A, Ettman CK, Gollust SE, Bandara SN, Abdalla SM, Castrucci BC, Galea S. Experience of Personal Loss Due to Drug Overdose Among US Adults. JAMA HEALTH FORUM 2024; 5:e241262. [PMID: 38819798 PMCID: PMC11143465 DOI: 10.1001/jamahealthforum.2024.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Since 1999, over 1 million people have died of a drug overdose in the US. However, little is known about the bereaved, meaning their family, friends, and acquaintances, and their views on the importance of addiction as a policy priority. Objectives To quantify the scope of the drug overdose crisis in terms of personal overdose loss (ie, knowing someone who died of a drug overdose) and to assess the policy implications of this loss. Design, Setting, and Participants This cross-sectional study used data from a nationally representative survey of US adults (age ≥18 years), the fourth wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March to April 2023. Main Outcomes and Measures Respondents reported whether they knew someone who died of a drug overdose and the nature of their relationship with the decedent(s). They also reported their political party affiliation and rated the importance of addiction as a policy issue. Logistic regression models estimated the associations between sociodemographic characteristics and political party affiliation and the probability of experiencing a personal overdose loss and between the experience of overdose loss and the perceived salience of addiction as a policy issue. Survey weights adjusted for sampling design and nonresponse. Results Of the 7802 panelists invited to participate, 2479 completed the survey (31.8% response rate); 153 were excluded because they did not know whether they knew someone who died of a drug overdose, resulting in a final analytic sample of 2326 (51.4% female; mean [SD] age, 48.12 [0.48] years). Of these respondents, 32.0% (95% CI, 28.8%-34.3%) reported any personal overdose loss, translating to 82.7 million US adults. A total of 18.9% (95% CI, 17.1%-20.8%) of all respondents, translating to 48.9 million US adults, reported having a family member or close friend die of drug overdose. Personal overdose loss was more prevalent among groups with lower income (<$30 000: 39.9%; ≥$100 000: 26.0%). The experience of overdose loss did not differ across political party groups (Democrat: 29.0%; Republican: 33.0%; independent or none: 34.2%). Experiencing overdose loss was associated with a greater odds of viewing addiction as an extremely or very important policy issue (adjusted odds ratio, 1.37; 95% CI, 1.09-1.72) after adjustment for sociodemographic and geographic characteristics and political party affiliation. Conclusions and Relevance This cross-sectional study found that 32% of US adults reported knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue. The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine K. Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah E. Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Sachini N. Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Salma M. Abdalla
- Department of Epidemiology and Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Rodriguez JM, Bae B. Political Ideology Direction of Policy Agendas and Maternal Mortality Outcomes in the U.S., 1915-2007. Matern Child Health J 2024; 28:865-872. [PMID: 38165586 PMCID: PMC11001747 DOI: 10.1007/s10995-023-03859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/04/2024]
Abstract
OBJECTIVES The causes for persistently high and increasing maternal mortality rates in the United States have been elusive. METHODS We use the shift in the ideological direction of the Republican and the Democratic parties in the 1960s, to test the hypothesis that fluctuations in overall and race-specific maternal mortality rates (MMR) follow the power shifts between the parties before and after the Political Realignment (PR) of the 1960s. RESULTS Using time-series data analysis methods, we find that, net of trend, overall and race-specific MMRs were higher under Democratic administrations than Republican ones before the PR (1915-1965)-i.e., when the Democratic Party was a protector of the Jim Crow system. This pattern, however, changed after the PR (1966-2007), with Republican administrations underperforming Democratic ones-i.e., during the period when the Republican Party shifted toward a more economically and socially conservative agenda. The pre-post PR partisan shifts in MMRs were larger for Black (9.5%, p < . 01 ) relative to White mothers (7.4%, p < . 05 ) during the study period. CONCLUSIONS FOR PRACTICE These findings imply that parties and the ideological direction of their agendas substantively affect the social determinants of maternal health and produce politized health outcomes.
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Affiliation(s)
- Javier M Rodriguez
- Department of Politics & Government, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
| | - Byengseon Bae
- Department of Politics & Government, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA.
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Warraich HJ, Kumar P, Nasir K, Joynt Maddox KE, Wadhera RK. Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis. BMJ 2022; 377:e069308. [PMID: 35672032 PMCID: PMC9171631 DOI: 10.1136/bmj-2021-069308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess recent trends in age adjusted mortality rates (AAMRs) in the United States based on county level presidential voting patterns. DESIGN Cross sectional study. SETTING USA, 2001-19. PARTICIPANTS 99.8% of the US population. MAIN OUTCOME MEASURES AAMR per 100 000 population and average annual percentage change (APC). METHODS The Centers for Disease Control and Prevention WONDER database was linked to county level data on US presidential elections. County political environment was classified as either Democratic or Republican for the four years that followed a November presidential election. Additional sensitivity analyses analyzed AAMR trends for counties that voted only for one party throughout the study, and county level gubernatorial election results and state level AAMR trends. Joinpoint analysis was used to assess for an inflection point in APC trends. RESULTS The study period covered five presidential elections from 2000 to 2019. From 2001 to 2019, the AAMR per 100 000 population decreased by 22% in Democratic counties, from 850.3 to 664.0 (average APC -1.4%, 95% confidence interval -1.5% to -1.2%), but by only 11% in Republican counties, from 867.0 to 771.1 (average APC -0.7%, -0.9% to -0.5%). The gap in AAMR between Democratic and Republican counties therefore widened from 16.7 (95% confidence interval 16.6 to 16.8) to 107.1 (106.5 to 107.7). Statistically significant inflection points in APC occurred for Democratic counties between periods 2001-09 (APC -2.1%, -2.3% to -1.9%) and 2009-19 (APC -0.8%, -1.0% to -0.6%). For Republican counties between 2001 and 2008 the APC was -1.4% (-1.8% to -1.0%), slowing to near zero between 2008 and 2019 (APC -0.2%, -0.4% to 0.0%). Male and female residents of Democratic counties experienced both lower AAMR and twice the relative decrease in AAMR than did those in Republican counties. Black Americans experienced largely similar improvement in AAMR in both Democratic and Republican counties. However, the AAMR gap between white residents in Democratic versus Republican counties increased fourfold, from 24.7 (95% confidence interval 24.6 to 24.8) to 101.3 (101.0 to 101.6). Rural Republican counties experienced the highest AAMR and the least improvement. All trends were similar when comparing counties that did not switch political environment throughout the period and when gubernatorial election results were used. The greatest contributors to the widening AAMR gap between Republican and Democratic counties were heart disease (difference in AAMRs 27.6), cancer (17.3), and chronic lower respiratory tract diseases (8.3), followed by unintentional injuries (3.3) and suicide (3.0). CONCLUSION The mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.
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Affiliation(s)
- Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pankaj Kumar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, TX, USA
| | - Karen E Joynt Maddox
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Rishi K Wadhera
- Harvard Medical School, Boston, MA, USA
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Oude Groeniger J, Gugushvili A, de Koster W, van der Waal J. Population health, not individual health, drives support for populist parties. PNAS NEXUS 2022; 1:pgac057. [PMID: 36741456 PMCID: PMC9896918 DOI: 10.1093/pnasnexus/pgac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/13/2022] [Indexed: 02/07/2023]
Abstract
Recent electoral shifts toward populist parties may have been partly driven by deteriorating health, although empirical evidence on this link is primarily confined to ecological designs. We performed both ecological- and individual-level analyses to investigate whether changes in health are associated with changes in the support for populist parties. Data were used on the strategic Dutch case, the only liberal democracy featuring leftist and rightist populist politicians in parliament for over a decade. We used: (a) fixed effects models to examine whether changes in the standardized mortality ratios and self-assessed health (SAH) in municipalities were associated with changes in the populist vote share in four parliamentary elections (2006/2010/2012/2017); and (b) 10 waves of panel data collected in 2008 to 2018 to investigate if changes in individual-level SAH were linked to movement in the sympathy, intention to vote, and actual voting for populist parties. The ecological analyses showed that: changes in municipality mortality ratios were positively linked to changes in the vote share of right-wing populist parties, while changes in the prevalence of less-than-good SAH were negatively associated with changes in the vote share for left-wing populist parties. The individual-level analyses identified no such associations. Our findings imply that support for populist parties may be driven by health concerns at the ecological, but not the individual, level. This suggests that sociotropic (e.g. perceiving population health issues as a social problem), but not egotropic (e.g. relating to personal health issues like experienced stigma), concerns may underlie rising support for populist parties.
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Affiliation(s)
| | - Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Postboks 1096, Blindern, 0317 Oslo, Norway,Nuffield College, University of Oxford, New Rd, Oxford OX1 1NF, UK
| | - Willem de Koster
- Department of Public Administration and Sociology, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Jeroen van der Waal
- Department of Public Administration and Sociology, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Fraser T, Aldrich DP, Panagopoulos C, Hummel D, Kim D. The harmful effects of partisan polarization on health. PNAS NEXUS 2022; 1:pgac011. [PMID: 36712795 PMCID: PMC9802430 DOI: 10.1093/pnasnexus/pgac011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 09/26/2021] [Accepted: 02/11/2022] [Indexed: 02/01/2023]
Abstract
Partisan polarization significantly drives stress and anxiety among Americans, and recent aggregate-level studies suggest polarization may be shaping their health. This individual-level study uses a new representative dataset of 2,752 US residents surveyed between December 2019 and January 2020, some US residents report more days of poor physical and mental health per month than others. Using negative binomial models, zero inflated models, and visualizations, we find evidence that polarization is linked to declines in physical health: the more distant an individual feels politically from the average voter in their state, the worse health outcomes he or she reports. By uncovering the individual-level political correlates of health, this study aims to encourage further study and attention to the broader consequences of political polarization on American communities.
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Affiliation(s)
- Timothy Fraser
- To whom correspondence should be addressed: 960A Renaissance Park, 360 Huntington Ave, Boston, MA 02115.
| | - Daniel P Aldrich
- Political Science Department, Northeastern University, Boston, MA 02115, USA
| | - Costas Panagopoulos
- Political Science Department, Northeastern University, Boston, MA 02115, USA
| | - David Hummel
- Economics Department, Northeastern University, Boston, MA 02115, USA
| | - Daniel Kim
- Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA
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State Legislators' Divergent Social Media Response to the Opioid Epidemic from 2014 to 2019: Longitudinal Topic Modeling Analysis. J Gen Intern Med 2021; 36:3373-3382. [PMID: 33782896 PMCID: PMC8606510 DOI: 10.1007/s11606-021-06678-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The opioid epidemic is widely recognized as a legislative priority, but there is substantial variation in state adoption of evidence-based policy. State legislators' use of social media to disseminate information and to indicate support for specific initiatives continues to grow and may reflect legislators' openness to opioid-related policy change. OBJECTIVE We sought to identify changes in the national dialogue regarding the opioid epidemic among Democratic and Republican state legislators and to estimate changing partisanship around understanding and addressing the epidemic over time. DESIGN Longitudinal natural language processing analysis. PARTICIPANTS A total of 4083 US state legislators in office between 2014 and 2019 with any opioid-related social media posts. MAIN MEASURES Association between opioid-related post volume and state overdose mortality, as measured by Kendall's rank correlation coefficient. Latent Dirichlet allocation analysis of all social media posts to identify key opioid-related topics. Longitudinal analysis of differences in the prevalence of key topics among Democrats and Republicans over time. KEY RESULTS In total, 43,558 social media posts met inclusion criteria, with the vast majority to Twitter (n=28,564; 65.6%) or Facebook (n=14,283; 32.8%). Posts were more likely to mention fentanyl and less likely to mention heroin over time. The volume of opioid-related content was positively associated with state-level unintentional overdose mortality among both Democrats (tau=0.42, P<.001) and Republicans (tau=0.39, P<.001). Democrats' social media content has increasingly spoken to holding pharmaceutical companies accountable, while Republicans' social media content has increasingly spoken to curbing illicit drug trade. Overall, partisanship across topics increased from 2016 to 2019. CONCLUSION The volume of opioid-related social media posts by US state legislators between 2014 and 2019 is associated with state-level overdose mortality, but the content across parties is significantly different. Democrats' and Republicans' social media posts may reflect growing partisanship regarding how best to address the overdose epidemic.
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A crisis in my community? Local-level awareness of the opioid epidemic and political consequences. Soc Sci Med 2021; 291:114497. [PMID: 34710820 DOI: 10.1016/j.socscimed.2021.114497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
The opioid epidemic has had a profound effect on American public health, and studies suggest it has had a profound effect on American politics as well. Research suggests a relationship between the severity of the opioid crisis in a community and aggregate-level political behavior, including voting for Donald Trump in 2016, but there is very little individual-level data establishing the mechanism for this relationship. Using a question on a nationally representative survey fielded after the 2018 election, we explore Americans' perceptions of the severity of the opioid epidemic in their community, and whether these perceptions predict political behavior and attitudes. We find that relative estimates of local opioid overdoses are significantly influenced by the actual county-level overdose death rate, and that the relationship between reality and perception is strongest for the most knowledgeable and informed citizens. There is also evidence that the social construction of the opioid epidemic as a crisis primarily affecting White suburban or rural Americans affects these perceptions, as both White and non-urban respondents are significantly more attentive to objective mortality rates than others. Turning to political behavior, we find no evidence that these estimates affected validated voter turnout or U.S. House vote choice in the 2018 midterm election. Assessing public approval outcomes, we found a nonlinear effect of these estimates on support for President Trump, a pattern which is partially consistent with the existing literature. We also observed that those who believed the opioid epidemic to be worse than average in their communities reported lower approval of their state legislatures, though we found no such relationship for ratings of governors. These findings raise important questions about the micro-level mechanisms that link aggregate-level public health with political outcomes.
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Nguyen AV, Ross E, Westra J, Huang N, Nguyen CY, Raji M, Lall R, Kuo YF. Opioid Utilization in Geriatric Patients After Operation for Degenerative Spine Disease. J Neurosurg Anesthesiol 2021; 33:315-322. [PMID: 32091468 PMCID: PMC7442665 DOI: 10.1097/ana.0000000000000682] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few studies have investigated opioid utilization by geriatric patients after spinal surgery, a population in whom degenerative spine disease (DSD) is highly prevalent. We aimed to quantify rates of chronic, continuous opioid utilization by geriatric patients following spine surgery for DSD-related diagnoses. MATERIALS AND METHODS Utilizing a national 5% Medicare sample database, we investigated individuals aged above 66 years who underwent spinal surgery for a DSD-related diagnosis between the years of 2008 and 2014. The outcomes of interest were the rate of and risk factors for continuous opioid utilization at 1-year following anterior cervical discectomy and fusion, posterior cervical fusion, 360-degree cervical fusion, lumbar microdiscectomy, lumbar laminectomy, posterior lumbar fusion, anterior lumbar fusion, or 360-degree lumbar fusion for a DSD-related diagnosis. RESULTS Of the 14,583 Medicare enrollees who met study criteria, 6.0% continuously utilized opioids 1-year after spinal surgery. When stratified by preoperative opioid utilization (with the prior year divided into 4 quarters), the rates of continuous utilization at 1-year postsurgery were 0.3% of opioid-naive patients and 23.6% of patients with opioid use in all 4 quarters before surgery. Anxiety, benzodiazepine use within the year before surgery, and Medicaid dual-eligibility were associated with prolonged opioid utilization. CONCLUSIONS Of opioid-naive geriatric patients who underwent surgery for DSD, 0.3% developed chronic, continuous opioid use. Preoperative opioid use was the strongest predictor of prolonged utilization, which may represent suboptimal use of nonopioid alternatives, pre-existing opioid use disorders, delayed referral for surgical evaluation, or over-prescription of opioids for noncancer pain.
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Affiliation(s)
- Anthony V. Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Evan Ross
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- Preventive Medicine and Community Health, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Nicole Huang
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Christine Y. Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishi Lall
- Department of Surgery, Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Preventive Medicine and Community Health, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA
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Hamamsy T, Danziger M, Nagler J, Bonneau R. Viewing the US presidential electoral map through the lens of public health. PLoS One 2021; 16:e0254001. [PMID: 34288913 PMCID: PMC8294501 DOI: 10.1371/journal.pone.0254001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
Health, disease, and mortality vary greatly at the county level, and there are strong geographical trends of disease in the United States. Healthcare is and has been a top priority for voters in the U.S., and an important political issue. Consequently, it is important to determine what relationship voting patterns have with health, disease, and mortality, as doing so may help guide appropriate policy. We performed a comprehensive analysis of the relationship between voting patterns and over 150 different public health and wellbeing variables at the county level, comparing all states, including counties in 2016 battleground states, and counties in states that flipped from majority Democrat to majority Republican from 2012 to 2016. We also investigated county-level health trends over the last 30+ years and find statistically significant relationships between a number of health measures and the voting patterns of counties in presidential elections. Collectively, these data exhibit a strong pattern: counties that voted Republican in the 2016 election had overall worse health outcomes than those that voted Democrat. We hope that this strong relationship can guide improvements in healthcare policy legislation at the county level.
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Affiliation(s)
- Tymor Hamamsy
- Center for Social Media and Politics, NYU, New York, NY, United States of America
- Center for Data Science, New York University, New York, NY, United States of America
- * E-mail:
| | - Michael Danziger
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, United States of America
| | - Jonathan Nagler
- Center for Social Media and Politics, NYU, New York, NY, United States of America
- Department of Politics, NYU, New York, NY, United States of America
| | - Richard Bonneau
- Center for Social Media and Politics, NYU, New York, NY, United States of America
- Center for Data Science, New York University, New York, NY, United States of America
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, NY, United States of America
- Department of Biology, New York University, New York, NY, United States of America
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12
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Kavanagh NM, Goel RR, Venkataramani AS. County-Level Socioeconomic and Political Predictors of Distancing for COVID-19. Am J Prev Med 2021; 61:13-19. [PMID: 33947527 PMCID: PMC7988444 DOI: 10.1016/j.amepre.2021.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, governments have implemented social distancing measures to slow viral transmission. This work aims to determine the extent to which socioeconomic and political conditions have shaped community-level distancing behaviors during the COVID-19 pandemic, especially how these dynamics have evolved over time. METHODS This study used daily data on physical distancing from 15‒17 million cell phone users in 3,037 U.S. counties. County-level changes in the average distance traveled per person were estimated relative to prepandemic weeks as a proxy for physical distancing. Pooled ordinary least squares regressions estimated the association between physical distancing and a variety of county-level demographic, socioeconomic, and political characteristics by week from March 9, 2020 to January 17, 2021. Data were collected until January 2021, at which point the analyses were finalized. RESULTS Lower per capita income and greater Republican orientation were associated with significantly reduced physical distancing throughout nearly all the study period. These associations persisted after adjusting for a variety of county-level demographic and socioeconomic characteristics. Other county-level characteristics, such as the shares of Black and Hispanic residents, were associated with reduced distancing at various points during the study period. CONCLUSIONS These results highlight the importance of dynamic socioeconomic and political gradients in preventive behavior and imply the need for nimble policy responses.
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Affiliation(s)
- Nolan M Kavanagh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rishi R Goel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Atheendar S Venkataramani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Xiang A, Hou W, Rashidian S, Rosenthal RN, Abell-Hart K, Zhao X, Wang F. Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level. JMIR Public Health Surveill 2021; 7:e23426. [PMID: 33881409 PMCID: PMC8100884 DOI: 10.2196/23426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/09/2021] [Accepted: 02/20/2021] [Indexed: 02/04/2023] Open
Abstract
Background Opioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD). Objective We aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State. Methods This cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation. Results Several areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors. Conclusions At the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.
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Affiliation(s)
- Anthony Xiang
- Stony Brook University, Stony Brook, NY, United States
| | - Wei Hou
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | | | - Richard N Rosenthal
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | | | - Xia Zhao
- Stony Brook University, Stony Brook, NY, United States
| | - Fusheng Wang
- Stony Brook University, Stony Brook, NY, United States
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Niederdeppe J, Avery RJ, Liu J, Gollust SE, Baum L, Barry CL, Welch B, Tabor E, Lee NW, Fowler EF. Exposure to televised political campaign advertisements aired in the United States 2015-2016 election cycle and psychological distress. Soc Sci Med 2021; 277:113898. [PMID: 33848716 DOI: 10.1016/j.socscimed.2021.113898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/24/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Prior research suggests the potential for political campaign advertisements to increase psychological distress among viewers. The current study tests relationships between estimated exposure to campaign advertising and the odds of respondents reporting that a doctor told them they have anxiety, depression, insomnia, or (as a negative control) cancer. METHODS A secondary analysis of U.S. data on televised campaign ad airings from January 2015 to November 2016 (n = 4,659,038 airings) and five waves of a mail survey on television viewing patterns and self-reported medical conditions from November 2015 to March 2017 (n = 28,199 respondents from n = 16,204 unique households in the U.S.). FINDINGS A 1 percent increase in the estimated volume of campaign advertising exposure was associated with a 0.06 [95% CI 0.03-0.09] percentage point increase in the odds of a respondent being told by a doctor that they have anxiety in the past 12 months. We observed this association regardless of the political party of the ad sponsor, the political party of the respondent, or their statistical interaction. We also observed this association for both Presidential campaign ads and non-Presidential (including local, state, and U.S. congressional election) campaign ads, providing evidence that these relationships were not driven by the unique divisiveness of the race between Donald Trump and Hilary Clinton. Some topic-specific models offered additional evidence of association between estimated volume of campaign advertising exposure and the odds of being told by a doctor that they have depression or insomnia, but these patterns were less consistent across models that utilized different categories of campaign exposure. Campaign ad exposure was not associated with cancer, which served as a negative control comparison. CONCLUSIONS There was a consistent positive association between the volume of campaign advertising exposure and a reported diagnosis of anxiety among American adults.
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Affiliation(s)
- Jeff Niederdeppe
- Department of Communication, 476 Mann Library Building, Cornell University, Ithaca, NY, 14853, USA.
| | - Rosemary J Avery
- Department of Policy Analysis and Management, 2303 Martha Van Rensselear Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Jiawei Liu
- Department of Communication, 476 Mann Library Building, Cornell University, Ithaca, NY, 14853, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, 420 Delaware Street SE, MMC 729, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA
| | - Laura Baum
- Wesleyan Media Project and Department of Government, 238 Church St, Wesleyan University, Middletown, CT, 06459, USA
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, 624 Broadway, Hampton House 482, Baltimore, MD, 21205, USA; Johns Hopkins Center for Mental Health and Addiction Policy Research, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Brendan Welch
- Department of Policy Analysis and Management, 2303 Martha Van Rensselear Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Emmett Tabor
- Department of Policy Analysis and Management, 2303 Martha Van Rensselear Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Nathaniel W Lee
- Department of Policy Analysis and Management, 2303 Martha Van Rensselear Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Erika Franklin Fowler
- Wesleyan Media Project and Department of Government, 238 Church St, Wesleyan University, Middletown, CT, 06459, USA
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de Oliveira Costa J, Bruno C, Baranwal N, Gisev N, Dobbins TA, Degenhardt L, Pearson SA. Variations in Long-term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000-2019). Br J Clin Pharmacol 2021; 87:3706-3720. [PMID: 33629352 DOI: 10.1111/bcp.14798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
Routinely collected data have been increasingly used to assess long-term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full-text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline-recommended.
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Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Navya Baranwal
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy A Dobbins
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Lipkin JS, Thorpe JM, Gellad WF, Hanlon JT, Zhao X, Thorpe CT, Sileanu FE, Cashy JP, Hale JA, Mor MK, Radomski TR, Good CB, Fine MJ, Hausmann LRM. Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees. J Opioid Manag 2021; 16:409-424. [PMID: 33428188 DOI: 10.5055/jom.2020.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify sociodemographic profiles of patients prescribed high-dose opioids. DESIGN Cross-sectional cohort study. SETTING/PATIENTS Veterans dually-enrolled in Veterans Health Administration and Medicare Part D, with ≥1 opioid pre-scription in 2012. MAIN OUTCOME MEASURES We identified five patient-level demographic characteristics and 12 community variables re-flective of region, socioeconomic deprivation, safety, and internet connectivity. Our outcome was the proportion of vet-erans receiving >120 morphine milligram equivalents (MME) for ≥90 consecutive days, a Pharmacy Quality Alliance measure of chronic high-dose opioid prescribing. We used classification and regression tree (CART) methods to identify risk of chronic high-dose opioid prescribing for sociodemographic subgroups. RESULTS Overall, 17,271 (3.3 percent) of 525,716 dually enrolled veterans were prescribed chronic high-dose opioids. CART analyses identified 35 subgroups using four sociodemographic and five community-level measures, with high-dose opioid prescribing ranging from 0.28 percent to 12.1 percent. The subgroup (n = 16,302) with highest frequency of the outcome included veterans who were with disability, age 18-64 years, white or other race, and lived in the Western Census region. The subgroup (n = 14,835) with the lowest frequency of the outcome included veterans who were with-out disability, did not receive Medicare Part D Low Income Subsidy, were >85 years old, and lived in communities within the second and sixth to tenth deciles of community public assistance. CONCLUSIONS Using CART analyses with sociodemographic and community-level variables only, we identified sub-groups of veterans with a 43-fold difference in chronic high-dose opioid prescriptions. Interactions among disability, age, race/ethnicity, and region should be considered when identifying high-risk subgroups in large populations.
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Affiliation(s)
- Jacob S Lipkin
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - Joseph T Hanlon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - John P Cashy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas R Radomski
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Center for Value Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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Gibson DC, Raji MA, Baillargeon JG, Kuo YF. Regional and temporal variation in receipt of long-term opioid therapy among older breast, colorectal, lung, and prostate cancer survivors in the United States. Cancer Med 2021; 10:1550-1561. [PMID: 33423372 PMCID: PMC7940244 DOI: 10.1002/cam4.3709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older cancer survivors have high rates of long-term opioid therapy (≥90 days/year). However, the geographical and temporal variation in long-term opioid therapy rates for older cancer survivors is not known. METHODS A retrospective cohort study was conducted using SEER-Medicare data. Persons aged ≥66 years, diagnosed with breast, colorectal, lung, or prostate cancer from 1991 to 2011, and alive ≥5 years after diagnosis were included. Persons were followed from 1/1/2008 until 12/31/2016. Persons were assigned to a census region in their state of residence each year. Individuals who were covered by an opioid prescription for at least 90 days in a calendar year were classified as having received long-term opioid therapy. Multivariable analysis was conducted using generalized estimating equations. RESULTS Temporal trends significantly varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, opioid-naïve cancer survivors in the south and non-naïve survivors in the south and west experienced significant declines in long-term opioid therapy in 2015 and 2016. Significant declines were observed in 2016 for opioid-naïve and non-naïve cancer survivors residing in the northeast and among opioid-naïve cancer survivors living in the Midwest. CONCLUSION The annual trends in the receipt of long-term opioid therapy significantly varied by region among older cancer survivors. Variation in a clinical practice suggests the need for more research and interventions to improve efficiency, process, cost, and quality of care.
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Affiliation(s)
- Derrick C Gibson
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Jacques G Baillargeon
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
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18
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Cotti CD, Gordanier JM, Ozturk OD. The relationship of opioid prescriptions and the educational performance of children. Soc Sci Med 2020; 265:113406. [PMID: 33070016 DOI: 10.1016/j.socscimed.2020.113406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
One of the more salient aspects of the opioid crisis in America has been the disparate impact it has had on communities. This paper considers the possibility that opioid abuse might have negative spillovers onto student performance in schools within the communities most affected. We use administrative data on individual children's test scores (grades 3 through 8) in South Carolina from the 2005-06 to 2016-17 academic years. These data are then linked to county-level changes in opioid prescriptions rates. Findings show that an increase in the opioid prescription rate in a county is associated with a statistically significant reduction in white student test scores, but no such decline was found among non-white students. This relationship is robust to controls for changing county-level economic conditions, time-varying controls for student-level poverty, county characteristics, and county time trends. Among white students, the association is strongest among rural students in households that are not receiving SNAP or TANF benefits. Given the importance of educational attainment, this reduction in test scores associated with high rates of opioid prescriptions may indicate that there will be long-lasting spillover effects of the opioid crisis.
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Affiliation(s)
- Chad D Cotti
- University of Wisconsin -Oshkosh College of Business, 800 Algoma Blvd, Oshkosh, WI, 54901, USA.
| | - John M Gordanier
- University of South Carolina, Darla Moore School of Business Economics Department, 1014 Greene Street, Columbia, SC, 29208, USA.
| | - Orgul D Ozturk
- University of South Carolina, Darla Moore School of Business Economics Department, 1014 Greene Street, Columbia, SC, 29208, USA.
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19
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Shen Y, Bhagwandass H, Branchcomb T, Galvez SA, Grande I, Lessing J, Mollanazar M, Ourhaan N, Oueini R, Sasser M, Valdes IL, Jadubans A, Hollmann J, Maguire M, Usmani S, Vouri SM, Hincapie-Castillo JM, Adkins LE, Goodin AJ. Chronic Opioid Therapy: A Scoping Literature Review on Evolving Clinical and Scientific Definitions. THE JOURNAL OF PAIN 2020; 22:246-262. [PMID: 33031943 DOI: 10.1016/j.jpain.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 01/24/2023]
Abstract
The management of chronic noncancer pain (CNCP) with chronic opioid therapy (COT) is controversial. There is a lack of consensus on how COT is defined resulting in unclear clinical guidance. This scoping review identifies and evaluates evolving COT definitions throughout the published clinical and scientific literature. Databases searched included PubMed, Embase, and Web of Science. A total of 227 studies were identified from 8,866 studies published between January 2000 and July 2019. COT definitions were classified by pain population of application and specific dosage/duration definition parameters, with results reported according to PRISMA-ScR. Approximately half of studies defined COT as "days' supply duration >90 days" and 9.3% defined as ">120 days' supply," with other days' supply cut-off points (>30, >60, or >70) each appearing in <5% of total studies. COT was defined by number of prescriptions in 63 studies, with 16.3% and 11.0% using number of initiations or refills, respectively. Few studies explicitly distinguished acute treatment and COT. Episode duration/dosage criteria was used in 90 studies, with 7.5% by Morphine Milligram Equivalents + days' supply and 32.2% by other "episode" combination definitions. COT definitions were applied in musculoskeletal CNCP (60.8%) most often, and typically in adults aged 18 to 64 (69.6%). The usage of ">90 days' supply" COT definitions increased from 3.2 publications/year before 2016 to 20.7 publications/year after 2016. An increasing proportion of studies define COT as ">90 days' supply." The most recent literature trends toward shorter duration criteria, suggesting that contemporary COT definitions are increasingly conservative. PERSPECTIVE: This study summarized the most common, current definition criteria for chronic opioid therapy (COT) and recommends adoption of consistent definition criteria to be utilized in practice and research. The most recent literature trends toward shorter duration criteria overall, suggesting that COT definition criteria are increasingly stringent.
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Affiliation(s)
- Yun Shen
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Tychell Branchcomb
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Sophia A Galvez
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Ivanna Grande
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Julia Lessing
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Mikela Mollanazar
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Natalie Ourhaan
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Razanne Oueini
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Michael Sasser
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Ivelisse L Valdes
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Ashmita Jadubans
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Josef Hollmann
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Michael Maguire
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Silken Usmani
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida
| | - Juan M Hincapie-Castillo
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Lauren E Adkins
- University of Florida Health Science Center Libraries, Gainesville, Florida
| | - Amie J Goodin
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida.
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Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns. J Gen Intern Med 2020; 35:2584-2592. [PMID: 32333312 PMCID: PMC7459076 DOI: 10.1007/s11606-020-05823-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/26/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prescription opioid overprescribing is a focal point for legislators, but little is known about opioid prescribing patterns of primary care nurse practitioners (NPs) and physician assistants (PAs). OBJECTIVE To identify prescription opioid overprescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). DESIGN Retrospective, cross-sectional analysis of Medicare Part D enrollee prescription data. PARTICIPANTS Twenty percent national sample of 2015 Medicare Part D enrollees. MAIN MEASURES We identified potential opioid overprescribing as providers who met at least one of the following: (1) prescribed any opioid to > 50% of patients, (2) prescribed ≥ 100 morphine milligram equivalents (MME)/day to > 10% of patients, or (3) prescribed an opioid > 90 days to > 20% of patients. KEY RESULTS Among 222,689 primary care providers, 3.8% of MDs, 8.0% of NPs, and 9.8% of PAs met at least one definition of overprescribing. 1.3% of MDs, 6.3% of NPs, and 8.8% of PAs prescribed an opioid to at least 50% of patients. NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. CONCLUSIONS Most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Efforts to reduce opioid overprescribing should include targeted provider education, risk stratification, and state legislation.
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Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents. J Am Med Dir Assoc 2020; 22:124-131.e1. [PMID: 32605815 DOI: 10.1016/j.jamda.2020.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Current information on opioid use in nursing home residents, particularly those with dementia, is unknown. We examined the temporal trends in opioid use by dementia severity and the association of dementia severity with opioid use in long-term care nursing home residents. DESIGN Repeated measures cross-sectional study. SETTING Long-term care nursing homes. PARTICIPANTS Using 20% Minimum Data Set (MDS) and Medicare claims from 2011-2017, we included long-term care residents (n = 734,739) from each year who had 120 days of consecutive stay. In a secondary analysis, we included residents who had an emergency department visit for a fracture (n = 12,927). MEASUREMENTS Dementia was classified as no, mild, moderate, and severe based on the first MDS assessment each year. In the 120 days of nursing home stay, opioid use was measured as any, prolonged (>90 days), and high-dose (≥90 morphine milligram equivalent dose/day). For residents with a fracture, opioid use was measured within 7 days after emergency department discharge. Association of dementia severity with opioid use was evaluated using logistic regression. RESULTS Overall, any opioid use declined by 8.5% (35.2% to 32.2%, P < .001), prolonged use by 5.0% (14.1% to 13.4%, P < .001), and high-dose by 21.4% (1.4% to 1.1%, P < .001) from 2011 to 2017. Opioid use declined across 4 dementia severity groups. Among residents with fracture, opioid use declined by 9% in mild, 9.5% in moderate, and 12.3% in severe dementia. The odds of receiving any, prolonged, and high-dose opioids decreased with increasing severity of dementia. For example, severe dementia reduced the odds of any [23.5% vs 47.6%; odds ratio (OR) 0.56, 95% confidence interval (CI) 0.55-0.57], prolonged (9.8% vs 20.7%; OR 0.69, 95% CI 0.67-0.71), and high-dose (1.0% vs 2.3%; OR 0.69, 95% CI 0.63-0.74) opioids. CONCLUSIONS AND IMPLICATIONS Use of opioids declined in nursing home residents from 2011 to 2017, and the use was lower in residents with dementia, possibly reflecting suboptimal pain management in this population.
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Grogan CM, Bersamira CS, Singer PM, Smith BT, Pollack HA, Andrews CM, Abraham AJ. Are Policy Strategies for Addressing the Opioid Epidemic Partisan? A View from the States. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:277-309. [PMID: 31808787 DOI: 10.1215/03616878-8004886] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT In contrast to the Affordable Care Act, some have suggested the opioid epidemic represents an area of bipartisanship. This raises an important question: to what extent are Democrat-led and Republican-led states different or similar in their policy responses to the opioid epidemic? METHODS Three main methodological approaches were used to assess state-level policy responses to the opioid epidemic: a legislative analysis across all 50 states, an online survey of 50 state Medicaid agencies, and in-depth case studies with policy stakeholders in five states. FINDINGS Conservative states pursue hidden and targeted Medicaid expansions, and a number of legislative initiatives, to address the opioid crisis. However, the total fiscal commitment among these Republican-led states pales in comparison to states that adopt the ACA Medicaid expansion. Because the state legislative initiatives do not provide treatment, these states spend substantially less than states with Democratic control. CONCLUSIONS Rather than persistently working to retrench all programs, conservatives have relied on policy designs that emphasize devolution, fragmentation, and inequality to both expand and retrench benefits. This strategy, which allocates benefits differentially to different social groups and obfuscates responsibility, allows conservatives to avoid political blame typically associated with retrenchment.
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Gollust SE, Miller JM. Framing the Opioid Crisis: Do Racial Frames Shape Beliefs of Whites Losing Ground? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:241-276. [PMID: 31808785 DOI: 10.1215/03616878-8004874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Although research has begun to examine perceptions of being on the losing side of politics, it has been confined to electoral politics. The context of health disparities, and particularly the opioid crisis, offers a case to explore whether frames that emphasize racial disadvantage activate loser perceptions and the political consequences of such beliefs. METHODS White survey participants (N = 1,549) were randomized into three groups: a control which saw no news article, or one of two treatment groups which saw a news article about the opioid crisis framed to emphasize either the absolute rates of opioid mortality among whites or the comparative rates of opioid mortality among whites compared to blacks. FINDINGS Among control group participants, perceiving oneself a political loser was unrelated to attitudes about addressing opioids, whereas those who perceived whites to be on the losing side of public health had a less empathetic response to the opioid crisis. The comparative frame led to greater beliefs that whites are on the losing side of public health, whereas the absolute frame led to more empathetic policy opinions. CONCLUSIONS Perceptions that one's racial group has lost ground in the public health context could have political consequences that future research should explore.
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Wasfy JH, Healy EW, Cui J, Stewart C. Relationship of public health with continued shifting of party voting in the United States. Soc Sci Med 2020; 252:112921. [PMID: 32203851 DOI: 10.1016/j.socscimed.2020.112921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the U.S. presidential election of 2016, communities with poorer public health shifted votes to the Republican party. Whether this trend has persisted beyond 2016 is unclear. METHODS We created a county-level measure of public health (the "unhealthy" component) by performing principal component analysis on 9 health statistics. We then estimated shifting of votes by defining "net vote shift" as the percentage of Republican votes in the 2018 U.S. House of Representatives election minus the percentage of Republican votes in the same election in 2016. Finally, we performed linear regression to assess the independent, county-level association of the unhealthy component with net vote shift after adjusting for county-level demographic factors. RESULTS The mean county-level net vote shift was -6.4 percentage points (SD 12.6 percentage points), consistent with a mean net vote shift toward the Democratic party. After adjustment for demographic covariates, the unhealthy score was associated with higher net vote shift (17.7 percentage points shift toward Republican per unit unhealthy, p = .0323). CONCLUSIONS In the 2018 congressional elections, despite an overall shift toward the Democratic Party there is evidence of ongoing shifting of community voting in unhealthy communities toward the Republican party.
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Affiliation(s)
- Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Emma W Healy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinghan Cui
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Growing sense of social status threat and concomitant deaths of despair among whites. SSM Popul Health 2019; 9:100449. [PMID: 31993479 PMCID: PMC6978487 DOI: 10.1016/j.ssmph.2019.100449] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/17/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background A startling population health phenomenon has been unfolding since the turn of the 21st century. Whites in the United States, who customarily have the most favorable mortality profile of all racial groups, have experienced rising mortality rates, without a commensurate rise in other racial groups. The two leading hypotheses to date are that either contemporaneous economic conditions or longer-term (post-1970s) economic transformations have led to declining economic and social prospects of low-educated whites, culminating in “deaths of despair.” We re-examine these hypotheses and investigate a third hypothesis: mortality increases are attributable to (false) perceptions of whites that they are losing social status. Methods Using administrative and survey data, we examined trends and correlations between race-, age- and, education-specific mortality and a range of economic and social indicators. We also conducted a county-level fixed effects model to determine whether changes in the Republican share of voters during presidential elections, as a marker of growing perceptions of social status threat, was associated with changes in working-age white mortality from 2000 to 2016, adjusting for demographic and economic covariates. Findings Rising white mortality is not restricted to the lowest education bracket and is occurring deeper into the educational distribution. Neither short-term nor long-term economic factors can themselves account for rising white mortality, because parallel trends (and more adverse levels) of these factors were being experienced by blacks, whose mortality rates are not rising. Instead, perceptions – misperceptions – of whites that their social status is being threatened by their declining economic circumstances seems best able to reconcile the observed population health patterns. Conclusion Rising white mortality in the United States is not explained by traditional social and economic population health indicators, but instead by a perceived decline in relative group status on the part of whites – despite no actual loss in relative group position. Rising U.S. white mortality is wide-sweeping, spanning all education levels. Economic conditions of whites are declining in absolute, but not relative terms. Declining absolute economic conditions of whites do not explain their rising mortality. Rising white Mortality is better explained by perceived loss of relative status.
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Kuo YF, Raji MA, Goodwin JS. Association of Disability With Mortality From Opioid Overdose Among US Medicare Adults. JAMA Netw Open 2019; 2:e1915638. [PMID: 31730188 PMCID: PMC6902804 DOI: 10.1001/jamanetworkopen.2019.15638] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/26/2019] [Indexed: 01/12/2023] Open
Abstract
Importance Patients qualifying for Medicare disability have the highest rates of opioid use compared with older Medicare beneficiaries and commercial insurance beneficiaries. Research on opioid overdose deaths in this population can help identify appropriate interventions. Objective To assess the rate of opioid overdose death and to identify its associated risk factors. Design, Setting, and Participants This cohort study included a 20% national sample of Medicare enrollees aged 21 to 64 years whose initial Medicare entitlement was based on disability and who resided in 50 US states and Washington, DC, in 2012 to 2016. Data analyses were performed from March 15, 2019, through September 23, 2019. Exposures Fifty-five chronic or potentially disabling conditions were selected from the Centers for Medicare & Medicaid Services Chronic Disease Data Warehouse. Main Outcomes and Measures Opioid overdose death rate estimated from Medicare National Death Index linkage data. Results Among 1 766 790 Medicare enrollees younger than 65 years who qualified for Medicare because of disability, the mean (SD) age was 52.2 (10.2) years, and 866 914 (49.1%) were women. These enrollees represent 14.9% (95% CI, 14.9%-15.0%) of the entire Medicare population and accounted for 80.8% (95% CI, 78.9%-82.7%) of opioid overdose deaths among all Medicare enrollees. Opioid overdose mortality in this population increased from 57.4 per 100 000 (95% CI, 53.9-61.0 per 100 000) in 2012 to 77.6 per 100 000 (95% CI, 73.5-81.8 per 100 000) in 2016. Results from the stepwise logistic regression model revealed that 3 categories of conditions are associated with opioid overdose death: substance abuse, psychiatric diseases, and chronic pain. Among the 11.1% (95% CI, 11.0%-11.2%) of adults with disability who had all 3 conditions, the rate of opioid overdose death was 363.7 per 100 000 (95% CI, 326.7-402.6 per 100 000), which is 23.4 times higher than the rate for individuals with none of the conditions (15.5 per 100 000; 95% CI, 11.6-20.1 per 100 000). Conclusions and Relevance This study identifies differences in opioid overdose mortality among subgroups of Medicare enrollees younger than 65 years who qualify for Medicare because of disability. Understanding the heterogeneity of medical and psychiatric conditions associated with opioid use and misuse is key to developing specific, data-driven interventions targeted to each subgroup of high-risk populations.
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Affiliation(s)
- Yong-Fang Kuo
- Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston
- Institute for Translational Science, The University of Texas Medical Branch at Galveston, Galveston
| | - Mukaila A. Raji
- Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston
| | - James S. Goodwin
- Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston
- Institute for Translational Science, The University of Texas Medical Branch at Galveston, Galveston
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Rodriguez JM. The politics hypothesis and racial disparities in infants' health in the United States. SSM Popul Health 2019; 8:100440. [PMID: 31334324 PMCID: PMC6617336 DOI: 10.1016/j.ssmph.2019.100440] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022] Open
Abstract
We propose the politics hypothesis-i.e., the hypothesis that political forces comprise either a powerful predecessor of the social determinants of health or are essential social determinants of health themselves. We examine the hypothesis that political actors like presidents, their ideology, and institutions like the political parties they represent shape overall and race-specific health outcomes. Using census and Vital Statistics data among many other sources, we apply both theory- and data-driven statistical methods to assess the role of the president's party and the president's political ideology as predictors of overall and race-specific infant mortality in the United States, 1965-2010. We find that, net of trend, Republican presidencies and socially-conservative ideology of U.S. presidents are strongly associated with slower declines of infant mortality rates, overall and for white and black infants, compared to Democratic and socially-liberal presidents in the U.S. Approximately half (46%) of the white-black infant mortality gap, about 20,000 additional infant deaths, and most if not all the infant mortality rate gap between the U.S. and the rest of the developed world, can be attributed to the 28 years of Republican administrations during the study period. These findings are consistent with the politicization of public health and the conceptualization of politics as a powerful predecessor, in the causal chain, of the social determinants of health. Understanding the political ideological and institutional contexts in which health policies and healthcare and welfare programs are implemented, as well as how governments construct culture and social psychology, provide a more comprehensive framework for understanding and improving population patterns of disease, mortality, and entrenched racial disparities in health in the U.S.
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Affiliation(s)
- Javier M. Rodriguez
- Department of Politics and Government, Inequality and Policy Research Center, Institute for Democratic Renewal, Claremont Graduate University, USA
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Raji MA, Abara NO, Salameh H, Westra JR, Kuo YF. Association between cannabis laws and opioid prescriptions among privately insured adults in the US. Prev Med 2019; 125:62-68. [PMID: 31125629 PMCID: PMC6582995 DOI: 10.1016/j.ypmed.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/23/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Abstract
We examine the association between opioid prescription patterns in privately insured adults and changes in state cannabis laws among five age groups (18-25, 26-35 36-45, 46-55 and 56-64 years). Using the 2016 Clinformatics Data Mart, a nationwide commercial health insurance database, we performed a cross-sectional analysis of two types of opioid prescribing (>30-day and >90-day prescriptions) among all adults aged 18-64 based on the stringency of cannabis laws. We found a significant interaction between age and cannabis law on opioid prescriptions. Age-stratified multilevel multivariable analyses showed lower opioid prescription rates in the four younger age groups only in states with medical cannabis laws, when considering both >30 day and >90 day opioid use [>30 day adjusted odds ratio (aOR) = 0.56, in 18-25, aOR = 0.67 in 26-35, aOR = 0.67 in 36-45, and aOR = 0.76 in 46-54 years; >90 day aOR = 0.56, in 18-25, aOR = 0.68 in 26-35, aOR = 0.69 in 36-45, and aOR = 0.77 in 46-54 years, P < 0.0001 for all]. This association was not significant in the oldest age group of 55-64 years. There was no significant association between opioid prescriptions and other categories of cannabis laws (recreational use and decriminalization) in any of the age groups studied.
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Affiliation(s)
- Mukaila A Raji
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America.
| | - N Ogechi Abara
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America
| | - Habeeb Salameh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Jordan R Westra
- Office of Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Office of Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America
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Frequency and Risk Factors for Prolonged Opioid Prescriptions After Surgery for Brachial Plexus Injury. J Hand Surg Am 2019; 44:662-668.e1. [PMID: 31078338 PMCID: PMC7193763 DOI: 10.1016/j.jhsa.2019.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 02/07/2019] [Accepted: 04/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We hypothesized that patients with preoperative opioid prescriptions and diagnoses of depression and anxiety would be at increased risk for prolonged opioid prescriptions after surgery for brachial plexus injury (BPI). METHODS Using an administrative database of privately insured patients, we assembled a cohort of BPI surgery patients and a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain medications were examined 12 months before surgery to 180 days after surgery. The primary outcome was prolonged opioid prescription, defined as receiving a prescription 90 to 180 days after the index (BPI surgery or randomly selected date of service for controls). Multivariable regression was used to examine risk factors for postoperative opioid use, including diagnoses of depression, anxiety, drug abuse, tobacco use, and preoperative use of opioids and neuropathic pain medications. A subgroup analysis was performed for opioid-naive BPI patients between 30 days to 1 year before surgery. RESULTS Among BPI surgery patients (n = 1,936), 27.7% had prolonged opioid prescriptions. Among opioid-naive BPI patients (n = 911), 10.8% had prolonged opioid prescriptions. In controls (n = 19,360), frequency of prolonged opioid prescriptions was 0.11%. Among all BPI patients, after adjustment for age and sex, predictors of prolonged postoperative opioid prescriptions in BPI patients were preoperative opioids, preoperative neuropathic pain medication use, histories of drug abuse, tobacco use, and anxiety. CONCLUSIONS Prolonged postoperative opioids prescriptions after BPI reconstruction are higher than previous estimates among other surgical patients. In addition to establishing normative data among this population, our findings serve to increase awareness of risk factors for prolonged opioids after BPI reconstruction and encourage coordinated multidisciplinary care. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Johnson MI. The Landscape of Chronic Pain: Broader Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E182. [PMID: 31117297 PMCID: PMC6572619 DOI: 10.3390/medicina55050182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023]
Abstract
Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an assortment of contemporary topics related to chronic pain and its management to nurture debate about research, practice and health care policy. The review discusses the phenomenon of pain, the struggle that patients have trying to legitimize their pain to others, the utility of the acute-chronic dichotomy, and the burden of chronic pain on society. The review describes the introduction of chronic primary pain in the World Health Organization's International Classification of Disease, 11th Revision and discusses the importance of biopsychosocial approaches to manage pain, the consequences of overprescribing and shifts in service delivery in primary care settings. The second half of the review explores pain perception as a multisensory perceptual inference discussing how contexts, predictions and expectations contribute to the malleability of somatosensations including pain, and how this knowledge can inform the development of therapies and strategies to alleviate pain. Finally, the review explores chronic pain through an evolutionary lens by comparing modern urban lifestyles with genetic heritage that encodes physiology adapted to live in the Paleolithic era. I speculate that modern urban lifestyles may be painogenic in nature, worsening chronic pain in individuals and burdening society at the population level.
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Affiliation(s)
- Mark I Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, City Campus, Leeds Beckett University, Leeds LS1 3HE, UK.
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Sinha CB, Bakshi N, Ross D, Krishnamurti L. Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic: A Qualitative Study. JAMA Netw Open 2019; 2:e194410. [PMID: 31125105 PMCID: PMC6632133 DOI: 10.1001/jamanetworkopen.2019.4410] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 11/14/2022] Open
Abstract
Importance The hallmark of sickle cell disease (SCD) is vaso-occlusive pain that may be acute and episodic or may progress to chronic, persistent pain with unpredictable and disabling exacerbations. Patients with SCD rely on opioids almost exclusively for acute and chronic pain management. Objective To understand how the current opioid epidemic and subsequent guidelines from the Centers for Disease Control and Prevention are associated with the management of acute and chronic pain for patients with SCD. Design, Setting, and Participants Qualitative study using semistructured interview guides. Interviews 1 hour or longer were conducted over the telephone. Participants were adults (aged ≥18 years) diagnosed with SCD who experienced pain on 3 or more days per week recruited from national SCD conferences, symposiums, and 2 sickle cell clinics. Open coding analysis facilitated thematic analysis of interview transcripts. Data collection took place from May 2017 to June 2018. Main Outcomes and Measures Participant perspective of any changes to their pain management associated with the 2016 guidelines from the Centers for Disease Control and Prevention. Results The 15 adults interviewed had a median (range) age of 32 (21-52) years; 13 (87%) were female; and all were of African American race/ethnicity. Participants reported that recently their opioid prescriptions had become more restrictive, were more closely monitored, and were increasingly difficult to fill in pharmacies. Participants also described increased stigmatization about opioid use and that their medical care was being affected by the physician's exclusive focus on reducing pain medication use. There was an emerging interest among adult patients in the consideration of the use of alternative therapies, including marijuana, to manage pain. Conclusions and Relevance These findings suggest that from the perspective of adults living with SCD, the opioid epidemic may have negatively affected patients' care by increasing barriers to opioids. Patients reported decreased opioid dosing, increased stigmatization regarding opioid use, physician preoccupation with opioid dosage interfering with comprehensive care, and lack of access to alternative therapies.
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Affiliation(s)
- Cynthia B. Sinha
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
| | - Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Diana Ross
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Now with the Department of Pediatric Hematology/Oncology/BMT, Emory University, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
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The flywheel: the Affordable Care Act is picking up momentum. Br J Gen Pract 2019; 69:250-251. [DOI: 10.3399/bjgp19x702545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Narayan KMV, Patel SA, Cunningham SA, Curran J. Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities? Ann Intern Med 2019; 170:330-331. [PMID: 30743267 DOI: 10.7326/m18-3653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- K M Venkat Narayan
- Rollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)
| | - Shivani A Patel
- Rollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)
| | - Solveig A Cunningham
- Rollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)
| | - James Curran
- Rollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)
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Affiliation(s)
- Olveen Carrasquillo
- Departments of Medicine and Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
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Rivara FP, Fihn SD. JAMA Network Open-The Year in Review, 2018. JAMA Netw Open 2019; 2:e190326. [PMID: 30794292 DOI: 10.1001/jamanetworkopen.2019.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, Washington
- Editor
| | - Stephan D Fihn
- Department of Medicine, University of Washington, Seattle, Washington
- Deputy Editor
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Nicogossian A, Stabile B, Kloiber O, Septimus EJ. Medical and Public Health Challenges of Addiction. WORLD MEDICAL & HEALTH POLICY 2018. [DOI: 10.1002/wmh3.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rosenquist JN. The Opiates and the (Voting) Masses. JAMA Netw Open 2018; 1:e180451. [PMID: 30646076 DOI: 10.1001/jamanetworkopen.2018.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James Niels Rosenquist
- Center for Quantitative Health, Massachusetts General Hospital, Harvard Medical School, Boston
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