AJPH March Issue: Research on Medical Expenses, Medicaid Expansion, Abortion Denial

To request copies of articles or for information on scheduling interviews with an expert, please contact Megan Lowry. Links to the below articles will go live once the embargo lifts.

EMBARGOED UNTIL January 18, 2018, 4 p.m. ET

American Journal of Public Health March Issue research highlights:

Medical expenses are exacerbating income inequality

Newswise — This study concluded that the way we finance medical care exacerbates income inequality and impoverishes millions of Americans, but that this regressive financing pattern improved slightly in the wake of the Affordable Care Act.

The study found that in 2010 medical expenses redistributed nearly 1.5% of all income from poorer to wealthier individuals. In 2014, after ACA implementation 1.37% of all income was distributed from poorer to wealthier individuals.

The study analyzed data from the US Current Population Surveys for calendar years 2010 through 2014.

["The Effects of Household Medical Expenditures on Income Inequality in the United States." Contact: David U. Himmelstein, MD, School of Urban Public Health, City University of New York, New York, NY].

Medicaid expansion tied to lower infant mortality rates

This study found that infant mortality rate decline has been greater in Medicaid expansion states, with greater declines among African American infants. Data showed that mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6).

The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states.

["Medicaid Expansion and Infant Mortality in the United States." Contact: Chintan B. Bhatt, Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL].

Women denied an abortion more likely to experience economic hardship

This study concluded that women denied an abortion were more likely than were women who received an abortion to experience economic hardship and insecurity lasting years, and that laws that restrict access to abortion may result in worsened economic outcomes for women.

Through semiannual telephone interviews with 813 women, researchers found that women denied abortions who gave birth had higher odds of poverty six months after denial than did women who received abortions; women denied abortions were also more likely to be in poverty for four years after denial of abortion. Six months after denial of abortion, women were less likely to be employed full time and were more likely to receive public assistance than were women who obtained abortions, differences that remained significant for four years.

["Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States." Contact: Diana Greene Foster, University of California, San Francisco Oakland, CA].

Evidence to support universal lead screening is limited

This study concluded the evidence for a net societal benefit of universal lead screening approach is limited and is not supported by prominent medical professional groups. In April 2017 the California Health Benefits Review Program completed a systematic review of lead screening effectiveness, commercial insurer surveys regarding screening coverage, and actuarial utilization and cost implication assessments.

The review found universal screening requirements would increase child lead testing by 273%, raise affected populations’ premiums by 0.0043%, and detect an additional 4,777 exposed children one year after implementation.

With legislation requiring universal screening enacted or under consideration in many states, authors note that these findings are important for legislators and advocates to consider in weighing the costs and benefits of such proposals.

[“Universal Lead Screening Requirement: A California Case Study.” Contact: Sara B. McMenamin, UC San Diego, Department of Family Medicine and Public Health, La Jolla, CA].

Find a full list of AJPH research papers published online below:

• Trends in health insurance and type among military veterans: United States, 2000-2016.
• The effects of household medical expenditures on income inequality in the U.S.
• Work as an inclusive part of population health inequities research and prevention
• Democratizing epidemiology in the high school classroom
• First time around: the rise and fall of 'universal health coverage' as a goal of international health politics, 1925-52
• Medicaid expansion and infant mortality in the united states
• Temporal trends and socioeconomic disparities in preventable emergency department visits with non-traumatic dental conditions: the case of Nevada
• Strategies and challenges in preventing workplace violence: experiences of Canadian indoor sex workers
• Fostering interprofessional education through a multidisciplinary, community-based pandemic mass vaccination exercise
• Consideration of a universal lead screening requirement: a California case study
• Ethical issues in social media research for public health
• Patient navigation doubles the likelihood of linkage to and retention in clinical care for HIV-infected individuals leaving jail
• Mortality disparities in racial and ethnic minority groups in the Veterans Health Administration: an evidence review and map
• Socioeconomic outcomes of women who receive and women who are denied wanted abortions
• Explaining delays in global disease outbreak responses
• Slow progress towards smoke-free coverage in Appalachia: key factors inhibiting legislative progress
• The cost-effectiveness of capping freeways for use as parks in the name of population health: the cross-Bronx expressway case study
• Interventions against maternal malaria and indicators of malnutrition: potential impact on pregnancy outcomes

The articles above will be published online January 18, 2018, at 4 p.m. ET by AJPH under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Megan Lowry at APHA, 202-777-3913, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at www.ajph.org. For direct customer service, call 202-777-2516, or email us.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a 145-year perspective and brings together members from all fields of public health. Visit www.apha.org.