The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion

2020 ◽  
pp. 107755872091962 ◽  
Author(s):  
Brandon W. Yan ◽  
Frank A. Sloan ◽  
W. John Boscardin ◽  
Felicia Guo ◽  
R. Adams Dudley
Keyword(s):  
Health Care ◽  
Drug Overdose ◽  
Mortality Data ◽  
Medicaid Expansion ◽  
Opioid Epidemic ◽  
Mortality Benefit ◽  
Difference In Differences ◽  
All Cause Mortality ◽  
Control And Prevention ◽  
Overdose Deaths

Although the Affordable Care Act’s Medicaid expansion reduced uninsurance, less is known about its impact on mortality, especially in the context of the opioid epidemic. We conducted a difference-in-differences study comparing trends in mortality between expansion and nonexpansion states from 2011 to 2016 using the Centers for Disease Control and Prevention mortality data. We analyzed all-cause deaths, health care amenable deaths, drug overdose deaths, and deaths from causes other than drug overdose among adults aged 20 to 64 years. Medicaid expansion was associated with a 2.7% reduction ( p = .020) in health care amenable mortality, and a 1.9% reduction ( p = .042) in mortality not due to drug overdose. However, the expansion was not associated with any change in all-cause mortality (0.2% reduction, p = .84). In addition, drug overdose deaths rose more sharply in expansion versus nonexpansion states. The absence of all-cause mortality reduction until drug overdose deaths were excluded indicate that the opioid epidemic had a mitigating impact on any potential lives saved by Medicaid expansion.

scholarly journals Confronting Two Crises: The COVID-19 Pandemic, the Opioid Epidemic, and the Industrial Hygienist

2021 ◽  
pp. 104829112110295
Author(s):  
Jonathan Rosen ◽  
Peter Harnett
Keyword(s):  
Disease Control ◽  
Drug Overdose ◽  
Industrial Hygiene ◽  
Prevention Programs ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Crisis ◽  
The Impact ◽  
Overdose Deaths ◽  
Industrial Hygienist

This article was originally written for and published in the January 2021 issue of The Synergist, a monthly publication of the American Industrial Hygiene Association. The article addresses the convergence of the COVID-19 and opioid crises, the impact of the opioid crisis on the workplace and workers, and the role that industrial hygienists can play in developing workplace programs to prevent and respond to opioid misuse. While the article is specifically written for industrial hygienists, the review and recommendations will be useful to others who are developing workplace opioid prevention programs. Note that the data presented in this article were current as of January 2021. Centers for Disease Control and Prevention’s latest available data are for the twelve-month period ending October 2020 and include 88,990 total overdose deaths and 91,862 predicted, when reporting is completed. Source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm (accessed on 15 June 2021).

The Effect of Louisiana Medicaid Expansion on Affordability of Health Care

2021 ◽  
pp. 003335492110414
Author(s):  
Yixue Shao ◽  
Charles Stoecker
Keyword(s):  
Health Care ◽  
Household Income ◽  
Analytical Models ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Annual Household Income ◽  
Difference In Differences ◽  
Percentage Points ◽  
Health Care Affordability

Objectives Louisiana extended Medicaid coverage on July 1, 2016, to previously ineligible populations. We aimed to estimate the effect of Louisiana’s Medicaid expansion on self-reported affordability of health care. Methods We used 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS measured affordability of health care by asking respondents 2 questions: (1) whether they could not see a doctor due to cost in the previous 12 months and (2) whether they could not get a prescribed medication due to cost in the previous 12 months. We estimated difference-in-differences and difference-in-difference-in-differences analytical models using multivariable linear regression that compared trends in Louisiana with trends in states that did not expand Medicaid during the study period. Results Compared with adults aged <65 with annual household income >138% of the federal poverty level (FPL) in nonexpansion states, Medicaid expansion in Louisiana decreased the percentage of adults aged <65 with annual household income ≤138% FPL who reported being unable to see a doctor due to cost by 5.1 percentage points (95% CI, −6.5 to −3.6; P < .001) and unable to afford prescribed medication by 7.9 percentage points (95% CI, −9.2 to −6.6; P < .001). We found similar estimates when we limited the comparison group to Southern nonexpansion states. Conclusions Louisiana’s Medicaid expansion lowered cost barriers to health care. Further research may find improvements in health care affordability in states that have not yet expanded Medicaid.

scholarly journals Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016

2019 ◽  
Vol 135 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Sumedha Gupta ◽  
Alex Cohen ◽  
Evan M. Lowder ◽  
Bradley R. Ray
Keyword(s):  
Drug Overdose ◽  
Geographic Area ◽  
Opioid Epidemic ◽  
Data Set ◽  
Marion County ◽  
True Number ◽  
Vital Records ◽  
Simple Imputation ◽  
Overdose Deaths ◽  
Imputation Approach

Objectives: Understanding the scope of the current opioid epidemic requires accurate counts of the number of opioid-involved drug overdose deaths. Given known errors and limitations in the reporting of these deaths, several studies have used statistical methods to develop estimates of the true number of opioid-involved overdose deaths. This study validates these procedures using a detailed county-level database of linked toxicology and vital records data. Methods: We extracted and linked toxicology and vital records data from Marion County, Indiana (Indianapolis), during a 6-year period (2011-2016). Using toxicology data as a criterion measure, we tested the validity of multiple imputation procedures, including the Ruhm regression-based imputation approach for correcting the number of opioid-involved overdose deaths. Results: Estimates deviated from true opioid-involved overdose deaths by 3% and increased in accuracy during the study period (2011-2016). For example, in 2016, 231 opioid-involved overdose deaths were noted in the toxicology data, whereas the corresponding imputed estimate was 233 opioid-involved overdose deaths. A simple imputation approach, based on the share of opioid-involved overdose deaths among all drug overdose deaths for which the death certificate specified ≥1 drug, deviated from true opioid-involved overdose deaths by ±5%. Conclusions: Commonly used imputation procedures produced estimates of the number of opioid-involved overdose deaths that are similar to the true number of opioid-involved overdose deaths obtained from toxicology data. Although future studies should examine whether these results extend beyond the geographic area covered in our data set, our findings support the continued use of these imputation procedures to quantify the extent of the opioid epidemic.

Accidental Overdose Deaths in Oklahoma, 2002–2017: Opioid and Methamphetamine Trends

2020 ◽  
Vol 44 (7) ◽  
pp. 672-678
Author(s):  
Rachel Bonk ◽  
Ross J Miller ◽  
Joshua Lanter ◽  
Cheryl Niblo ◽  
Jesse Kemp ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Sharp Increase ◽  
The State ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Death Rates ◽  
Synthetic Opioids ◽  
Accidental Overdose ◽  
Overdose Deaths

Abstract To evaluate trends related to accidental overdose deaths in Oklahoma, with a focus on opioids and methamphetamine. All accidental drug overdose deaths in the state of Oklahoma from 2002 to 2017 were reviewed. Opioids were grouped into the following categories: all opioids, prescription opioids, synthetic opioids and heroin. Age-adjusted death rates for methamphetamine and each opioid category were calculated and analyzed. Accidental overdoses accounted for 9,936 deaths during the study period. Of these, opioids were seen in 62.9%, with prescription opioids comprising 53.8%, synthetic opioids 10.3% and heroin 2.8%. Synthetic opioids, despite a recent upward nationwide trend, showed a slight overall decrease (−6.8%) from 2009 to 2017. In contrast, methamphetamine showed a 402.2% increase from 2009 to 2017 and an overall increase of 1,526.7%. Methamphetamine was involved in the most overdoses (1,963), followed by oxycodone (1,724). Opioid-related deaths were most common among white individuals (90.3%) and showed a slight male predilection (56.9%). With the intent of assessing the opioid epidemic as it relates to accidental overdoses in Oklahoma, this study suggests that opioid-related overdoses have slowed in recent years amidst a sharp increase in methamphetamine deaths.

scholarly journals Pandemic meets epidemic: Co-location of COVID-19 and drug overdose deaths in the United States

2021 ◽  
Vol 6 (4) ◽  
pp. 174-178
Author(s):  
Navya Tripathi ◽  
Nancy Hardt
Keyword(s):  
United States ◽  
Spatial Correlation ◽  
Drug Overdose ◽  
Hot Spot ◽  
State Level ◽  
The United States ◽  
Time Step ◽  
Access To Treatment ◽  
Control And Prevention ◽  
Overdose Deaths

Drug overdose deaths (DOD) in the last two decades have increased over 300 percent. In 2019 alone, 71,000 deaths represented a 7% increase from the previous year. According to recent data released by the Center for Disease Control and Prevention (CDC), 81,230 overdose deaths occurred in the United States from June 2019 to May 2020, the highest number of DOD recorded in a 12-month period. Early 2020 saw the spread of the COVID-19 pandemic in the United States, which CDC suggests has amplified the previously alarming rise in drug-related mortalities. A hot spot analysis of COVID-19 and DOD rates, as well as a spatial correlation between the two datasets at the state level on a monthly time step, showed a significant increase in DOD during the COVID-19 pandemic. This study, conducted for the period of March through July 2021, showed a spatial correlation between the two types of mortalities in the initial months of 2020. Furthermore, the hot spots for both types of mortalities were concentrated in the northeastern states. The COVID-19 mortalities shifted southeast in July 2020, but DOD data was unavailable for further analysis. Since DOD are a leading contributor to preventable deaths, the results of the study may help focus the efforts of effective and innovative programs to reduce substance use disorder and related mortality through increased access to treatment. During the pandemic, access to such facilities was reduced.

Changes in cancer mortality rates after the adoption of the Affordable Care Act.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2003-2003
Author(s):  
Anna Lee ◽  
Kanan Shah ◽  
Junzo P. Chino ◽  
Fumiko Chino
Keyword(s):  
Affordable Care Act ◽  
Cancer Mortality ◽  
Mortality Rates ◽  
Differential Mortality ◽  
Medicaid Expansion ◽  
Mortality Benefit ◽  
Difference In Differences ◽  
Black Patients ◽  
The Us ◽  
The Affordable Care Act

2003 Background: The Affordable Care Act (ACA) was designed to improve health status in the US primarily through improving access to health insurance. As adoption of Medicaid expansion varied at the state level, this study aims to compare cancer mortality rates over time between states who did (EXP) and did not adopt (NonEXP) Medicaid expansion. Methods: Age-adjusted mortality rates per 100,000 were gathered from the National Center for Health Statistics from 1999-2017 to establish trends. Only deaths due to cancer in patients less than 65 were included. Absolute change in cancer mortality was calculated from 2011-2013 and then from 2015-2017 with 2014 as washout year. Changes within subpopulations (gender, race, ethnicity) were also assessed. Mortality changes between EXP and NonEXP groups were via “difference in differences” analysis. Results: Overall age-adjusted cancer mortality in the US fell from 1999-2017 from 66.9 to 48.8 per 100,000. EXP states had higher population (157 vs 118 million) with less black/African Americans (19.2 vs 21.8 million) and more Hispanics (33.0 vs 21.7 million) than NonEXP states (all examples from 2017). The overall age-adjusted cancer mortality was consistently worse in NonEXP states, cancer mortality fell from 64.7 to 46.0 per 100,000 in EXP states and from 69.0 to 51.9 per 100,000 in NonEXP states from 1999-2017 (both trends p < 0.001, comparison p < 0.001). Comparing the mortality changes in the peri-ACA years (2011-2013 vs 2015-2017) between the 2 cohorts, the difference in differences between EXP and NonEXP states was -1.1 and -0.6 per 100,000 respectively (p = 0.006 EXP, p = 0.14 NonEXP). The estimated overall cancer mortality benefit gained in EXP states after Medicaid expansion (∆∆∆) is -0.5 per 100,000 (p = NS). In EXP states, this translates to an estimated 785 less cancer deaths in 2017. Age-adjusted cancer mortality per 100,000 was worse in NonEXP states for black patients (58.5 EXP vs 63.4 NonEXP in 2017) however there was no differential mortality benefit after ACA expansion when comparing between the peri-ACA years. Of the subpopulations assessed, Hispanics in EXP states had the highest differential cancer mortality benefit at -2.1 per 100,000 (p = 0.07). Conclusions: This is the first study to show a directly measured cancer survival benefit from the ACA on a national scale using a comprehensive database. Hispanic populations appear to have the highest differential cancer mortality benefit after Medicaid expansion. Further study is needed to elucidate why other populations like black patients did not appear to reap the same mortality decrease.

scholarly journals Illicit drug overdose deaths resulting from income assistance payments: Analysis of the ‘check effect’ using daily mortality data

2016 ◽  
Vol 33 ◽  
pp. 83-87 ◽  
Author(s):  
Michael C. Otterstatter ◽  
Ashraf Amlani ◽  
Tianxiu Hugh Guan ◽  
Lindsey Richardson ◽  
Jane A. Buxton
Keyword(s):  
Drug Overdose ◽  
Illicit Drug ◽  
Mortality Data ◽  
Daily Mortality ◽  
Income Assistance ◽  
Overdose Deaths

scholarly journals Unclassified drug overdose deaths in the opioid crisis: emerging patterns of inequity

2019 ◽  
Vol 26 (8-9) ◽  
pp. 767-777 ◽  
Author(s):  
Andrew J Boslett ◽  
Alina Denham ◽  
Elaine L Hill ◽  
Meredith C B Adams
Keyword(s):  
Regression Models ◽  
Mortality Data ◽  
Specific Drug ◽  
Opioid Epidemic ◽  
Multivariate Logistic Regression ◽  
Economic Disparities ◽  
Logistic Regression Models ◽  
Opioid Crisis ◽  
Overdose Mortality ◽  
Overdose Deaths

Abstract Objective Examine whether individual, geographic, and economic phenotypes predict missing data on specific drug involvement in overdose deaths, manifesting inequities in overdose mortality data, which is a key data source used in measuring the opioid epidemic. Materials and Methods We combined national data sources (mortality, demographic, economic, and geographic) from 2014–2016 in a multi-method analysis of missing drug classification in the overdose mortality records (as defined by the use of ICD-10 T50.9 on death certificates). We examined individual disparities in decedent-level multivariate logistic regression models, geographic disparities in spatial analysis (heat maps), and economic disparities in a combination of temporal trend analyses (descriptive statistics) and both decedent- and county-level multivariate logistic regression models. Results Our analyses consistently found higher rates of unclassified overdoses in decedents of female gender, White race, non-Hispanic ethnicity, with college education, aged 30–59 and those from poorer counties. Despite the fact that unclassified drug overdose death rates have reduced over time, gaps persist between the richest and poorest counties. There are also striking geographic differences both across and within states. Discussion Given the essential role of mortality data in measuring the scale of the opioid epidemic, it is important to understand the individual and community inequities underlying the missing data on specific drug involvements. Knowledge of these inequities could enhance our understanding of the opioid crisis and inform data-driven interventions and policies with more equitable resource allocations. Conclusion Multiple individual, geographic, and economic disparities underlie unclassified overdose deaths, with important implications for public health informatics and addressing the opioid crisis.

COVID 19 Aftermath - A Oral Health Care Provider Prospective

2020 ◽  
Author(s):  
Reena Sirohi
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Care Providers ◽  
Oral Health Care ◽  
Public Health Emergency ◽  
Care Providers ◽  
Close Proximity ◽  
Enormous Amount ◽  
Control And Prevention ◽  
Global Concern

The outbreak of the coronavirus disease 2019(COVID-19) is a public health emergency of global concern. Based on the data published by the Chinese Center for Disease Control and Prevention (China CDC), the majority of patients were asymptomatic or having mild symptoms but can release an enormous amount of viral load. It posed a worldwide challenge for containment of the infection of COVID-19. As, oral health care providers work in close proximity to the patients’ mouth, they are at higher risk for infection. The aim of this article is to emphasize on special measures to be taken for prevention and potential interventions.

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