DCMedical News: Thursday, July 14, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, July 14, 2022
What’s Killing Us? Excess Mortality 1933-2021
In a pre-print from medRxiv (here) Drs. Bassett, Woolhandler, Himmelstein and colleagues examine “excess deaths” in the U.S. The one sentence summary: “In 2021, 1.1 million U.S. deaths – including 1 in 2 deaths under age 65 years – would have been averted if the U.S. had the mortality rates of other wealthy nations.” A comment on the article from The Incidental Economist is here.
The one paragraph summary: “We assessed how many U.S. deaths would have been averted each year, 1933-2021, if U.S. age-specific mortality rates had equaled those of [18] other wealthy nations. The annual number of excess deaths in the U.S. increased steadily beginning in the late 1970s, reaching 626,353 in 2019. Excess deaths surged during the COVID-19 pandemic. In 2021, there were 1,092,293 “Missing Americans” and 25 million years of life lost due to excess mortality relative to peer nations. In 2021, half of all deaths under 65 years and 91% of the increase in under-65 mortality since 2019 would have been avoided if the U.S. had the mortality rates of its peers. Black and Native Americans made up a disproportionate share of Missing Americans, although the majority were White.”
More: “Even before the pandemic, U.S. residents died at younger ages than people in other wealthy nations, particularly from drug overdoses, suicides, and cardiometabolic disorders. U.S. life expectancy began diverging from peer countries’ in 1980 and has declined in absolute terms since 2014. In 2018 – prior to COVID-19 – the U.S. suffered 461,000 excess deaths relative to other wealthy countries (17% of all deaths in the U.S. that year), a number that was, coincidentally, similar to the number of U.S. deaths due to COVID-19 each year in 2020 and 2021. Excess mortality in the U.S. relative to other nations has been linked to structural racism, economic inequality, and underinvestment in public health and social safety net programs in the U.S. . . These fundamental causes are rendered invisible when excess mortality is computed relative to a U.S. baseline. Additionally, whereas studies of U.S. health disparities typically focus on differences between U.S. racial and ethnic groups, the declining health of White U.S. residents has made it difficult to interpret trends in disparities. External comparisons shed light on the exceptional nature of U.S. mortality trends and the experiences of U.S. racial and ethnic groups.”
COVID-19
A Research Letter in JAMA Internal Medicine (here) on leading causes of death during the COVID pandemic finds “From March 2020 to October 2021, COVID-19 accounted for 1 in 8 deaths in the US and was a top 5 cause of death in every age group aged 15 years and older. Cancer and heart disease deaths exceeded COVID-19 deaths overall and in most age groups, whereas accidents were the leading cause of death among those aged 1 to 44 years. Compared with the 2020 time period, deaths from COVID-19 in the 2021 time period decreased in ranking among those aged 85 years or older but increased in ranking among those aged 15 to 54 years, and became the leading cause of death among those aged 45 to 54 years.”
Income Inequality
A study in JAMA on California deaths (here) focused on income inequality, with equivocal results: “This retrospective analysis of census tract–level income and mortality data in California from 2015 to 2021 demonstrated a decrease in life expectancy in both 2020 and 2021 and an increase in the life expectancy gap by income level relative to the prepandemic period that disproportionately affected some racial and ethnic minority populations. Inferences at the individual level are limited by the ecological nature of the study, and the generalizability of the findings outside of California are unknown.”
COVID and Vaccination, Again . . .
From The Los Angeles Times (here): “The vaccines and boosters currently available in the U.S. were designed with a particular strain of SARS-CoV-2 in mind — one that left China way back in January 2020. Since then, the World Health Organization has recognized five major variants of concern and eight additional variants of interest. According to the Centers for Disease Control and Prevention, all of the coronaviruses now circulating in the United States are some version of the Omicron variant. In other words, the coronavirus has changed, but our shots haven’t.”
“Dr. Peter Marks, the FDA’s vaccine chief, told the panel that all options entail some degree of risk. If the agency decided to update the formula, the new shots would become available without being subjected to the extensive clinical trials used to vet the original vaccines. The agency decided long ago that modifications to COVID-19 vaccines it had already authorized or approved would be evaluated using a streamlined process. In the unlikely event that an update created a safety problem, it would be up to the FDA’s surveillance systems to detect it in a timely manner. On the other hand, Marks warned, if no changes are made, Americans who are fully vaccinated and boosted could find themselves with significantly less protection than they have had in years past. One study found that three doses of mRNA vaccine offered half as much protection against Omicron as they did against Delta, the variant that preceded it.
COVID Doubles in England
News in the BMJ (here): “Some areas of England have seen the number of patients in hospital who have tested positive for covid-19 more than double in the past two weeks, latest figures show . . . Similar rises have been seen in Scotland which reported a 40% increase in patients in hospital with covid in the fortnight up to 6 July, with Wales reporting an 86% increase.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Pressure on Physicians: On-Line Physician Ratings, Administrative Malpractice, IT Dysfunction, Privatization
A study in JAMA Internal Medicine (here) found that “online physician ratings were, on average, 5.30 years old. In 41.54% of cases, physician ratings based on the most recent 3 years were meaningfully different from the displayed rating based on all available years.”
A comment in The New England Journal of Medicine (here) discusses “More than a decade ago, Chang and Liang described a ‘quiet epidemic’ of potentially harmful administrative decisions that were burdening clinicians and patients. Their essay focused on the interpositions of administrative employees at insurance and pharmaceutical companies. ‘Administrative malpractice’ was their term for these external impediments to patients receiving clinically indicated medications such as colchicine or undergoing testing such as magnetic resonance Imaging.” The author hypothesizes that “At the bedside, clinicians could only improvise workarounds and apologize to patients for the breaches in care. I am convinced that such embedded conflicts between a clinician’s professional obligations to a patient and a hospital’s impersonal administrative imperatives represent a major source of the moral injury pervading modern medical practice.”
The British Medical Association (in BMJ, here) found that “The BMA has calculated that 13.5 million hours of doctors’ hours are lost to the NHS every year—the equivalent of 8000 full time equivalent doctors—owing to IT systems that have failed, are slow, or are not up to date.”
A report in The Lancet (via The Financial Times, here) finds “The privatisation of NHS services in England over the past seven years has been linked to a decline in the quality of patient care, a study in the Lancet medical journal suggested on Wednesday. The report by researchers at the University of Oxford found that increased outsourcing of health services between 2013 and 2020 was linked to ‘higher rates of treatable mortality’, or deaths considered avoidable with effective healthcare.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
KaufmanHall reports (here) that hospital finances have, in general, still to recover from the pandemic. “Nearly half way through 2022, margins are cumulatively negative.”
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
September 13, 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org