Ohio Health Policy News

Last week, HPIO release a new data snapshot, “Updated Death Trends among Working-age Ohioans,” that found that the number of annual deaths among working-age Ohioans increased 32% from 2007 to 2022, from 25,885 to 34,146.

The analysis also found that unintentional injuries, including unintentional drug overdoses and motor vehicle crashes, increased the most from 2007 to 2022 among the leading causes of death, as illustrated above. Cancer is the only leading cause of death that decreased since 2007 for this age group.

“These mostly preventable deaths have a tremendous impact on Ohio families, communities and society,” according to the data snapshot. “In addition, the loss of a large number of working-age adults negatively affects Ohio’s economy and businesses.”

In a first-of-its-kind look at the link between drug overdose deaths and certain occupations, new CDC data shows that 1 out of every 5 people who died of an overdose in 2020 usually worked in construction or restaurants (Source: “The depressing relationship between your job and your odds of drug overdose,” Washington Post, Oct. 6).

According to the new CDC National Vital Statistics report, overdoses killed 163 of every 100,000 people who usually worked in construction and extraction in 2020, whether they were on the job or not, making it by far the most dangerous major occupation, drug-wise. Restaurant jobs were second at 118 deaths per 100,000, according to new data.

This is the first time the CDC has published such comprehensive and detailed numbers linking jobs and overdoses, which the authors separately wrote was made possible by “funeral directors across the country who take time to speak with decedents’ loved ones and record [industry and occupation] on the death certificate.”

The report found that the safest jobs in the country, in terms of likelihood of overdose deaths were education and computer work, where 6 and 9 people per 100,000 died, respectively.

“Occupations with the largest rates of overdoses are also generally ones that require a lot of physical mobility/strength,” University of Southern California health economist Rosalie Liccardo Pacula told the Washington Post. “Many workers in these positions develop chronic pain conditions. Chronic pain is the leading reason why people use opioids long-term, and those with long-term use are now facing greater hurdles maintaining access to their opioid prescriptions in light of changing medical recommendations … so they may be more likely to turn to the illegal market.”

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Updated analysis from the Health Policy Institute of Ohio found that working-age Ohioans are dying at a much higher rate than they were 15 years ago, despite a drop in deaths in 2022 as the state emerged from the pandemic.

The analysis, which is compiled in a new data snapshot, “Death Trends among Working-age Ohioans,” found that the number of deaths among working-age Ohioans increased 32% from 2007 to 2022, from 25,885 to 34,146, as illustrated above. If the annual number of deaths had remained constant since 2007, 66,637 fewer working-age Ohioans would have died.

“These mostly preventable deaths have a tremendous impact on Ohio families, communities and society,” according to the data snapshot. “In addition, the loss of a large number of working-age adults negatively affects Ohio’s economy and businesses.”

The leading cause of death for working-age adults remains unintentional injuries, which included unintentional drug overdoses and motor vehicle crashes.

“Unintentional drug overdose deaths continue to play a major role in Ohio’s increased death rate, accounting for 14% of all deaths among Ohioans ages 15-64 in 2022,” the analysis found.

The analysis concludes that “There are many effective strategies to address substance use, promote mental health and support access to healthy food and physical activity, all of which can help reduce deaths among working-age Ohioans… Public and private partners can work together to ensure more Ohio workers have the opportunity to live a healthy and productive life.”

A months-long investigation by the Washington Post concludes that decisions made by policymakers over the past several decades have led to poorer health outcomes and lower life expectancy for Ohioans compared to those in other states (Source: “How red-state politics are shaving years off American lives,” Washington Post, Oct. 3).

Many of those early deaths can be traced to decisions made years ago by local and state lawmakers over whether to implement cigarette taxes, invest in public health or tighten seat-belt regulations, among other policies, an examination by the Washington Post found.

“States’ politics — and their resulting policies — are shaving years off American lives,” according to the Post.

Ohio has plummeted nationally when it comes to life expectancy rates, moving from middle of the pack to the bottom fifth of states during the last 50 years, the Post found. Ohioans have a similar life expectancy to residents of Slovakia and Ecuador, relatively poor countries.

According to analysis from Jennifer Karas Montez, director of the Center for Aging and Policy Studies at Syracuse University, roughly 1 in 5 Ohioans will die before they turn 65.

HPIO’s 2023 Health Value Dashboard provides additional insight on how Ohio compares to other states and D.C. on a wide range of metrics.

A new federal report has found that more than half a million Medicaid recipients diagnosed with opioid use disorder did not receive medication to treat it in 2021 (Source: “A Third of Medicaid Recipients With Opioid Use Disorder Aren’t Getting Medication to Treat It,” New York Times, Sept. 29)

The report, released last week by the inspector general of the Department of Health and Human Services, examined the use of addiction treatments that almost all Medicaid programs are now required to cover, also found major disparities in medication rates across states, ages and racial groups. It said the Centers for Medicare & Medicaid Services, an agency of the Health and Human Services Department, should work to close the gaps.

“Medicaid is uniquely positioned to achieve these goals given that the program is estimated to cover almost 40% of nonelderly adults with opioid use disorder,” the report said.

The half-million people who did not receive treatment amounted to about one-third of all Medicaid recipients with opioid use disorder. The authors of the report expressed concern that, when a five-year mandatory coverage period issued by the federal government ends in September 2025, some states could again start restricting access.

The report also found that almost a quarter of Medicaid enrollees with opioid use disorder lived in New York, Ohio or Pennsylvania.

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Consistent with national research findings and previous HPIO work, new analysis from the Institute finds that Ohioans who reported experiencing more adverse childhood experiences (ACEs) were also more likely to report negative outcomes that contribute to poor health. For example, as illustrated above, the percent of Ohioans who were exposed to two or more ACEs were almost twice as likely to smoke (23%) as those exposed to no ACEs (13%). Similarly, the percent of Ohioans with depression who were exposed to two or more ACEs (34%) was more than three times higher than Ohioans with depression who reported no ACEs (11%).

Exposure to ACEs affects many children in Ohio and across the country. National data and analysis provide clear evidence that ACEs exposure is linked to poor health and well-being through adulthood, including disrupted neurodevelopment, social problems, disease, disability and premature death. In addition, ACEs exposure has severe long-term cost implications at the individual and societal levels, including increased medical, child welfare, criminal justice and special education expenditures. However, the negative effects of ACEs can be mitigated. HPIO has presented 12 key strategies to intervene early and prevent the poor health outcomes associated with ACEs.

Click here to learn more about HPIO’s Ohio ACEs Impact project

Gov. Mike DeWine this week announced a partnership with the RecoveryOhio initiative, the Ohio Department of Transportation and the Ohio Department of Health’s Project DAWN (Deaths Avoided With Naloxone) to install naloxone kits at rest areas across Ohio (Source: “Narcan, naloxone boxes being installed at highway rest stops,” Dayton Daily News, Sept. 25).

Naloxone kits known as NaloxBoxes will be installed at highway rest stops in order to expand access to medication that can reverse the symptoms of an opioid overdose.

Naloxone, commonly referred to by the name brand Narcan, is medication that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose, according to the U.S. Food and Drug Administration. The FDA has approved Narcan and another naloxone product, RiVive, for over-the-counter use.

Last year, unintentional drug overdoses in Ohio resulted in 4,915 deaths, according to the Ohio Department of Health. That is nearly four times greater than the 1,275 fatalities caused by motor vehicle crashes over the same period, the state said.

Earlier this summer, public health nonprofit the Truth Initiative released a new report on “Tobacco Nation,” the 12 contiguous states (including Ohio) that have smoking rates that are 50% higher than the national average. This list of states overlaps substantially with the states ranked in the bottom quartile for population health in HPIO's 2023 Health Value Dashboard. In fact, 11 of the 13 bottom quartile states are part of Tobacco Nation, as illustrated above.

Analysis from HPIO has found a strong link between smoking rates and overall population health and healthcare spending. Ohio reports higher rates of adult smoking than most other states (ranking near the bottom at 44th) and Dashboard analysis “found a strong correlation between adult smoking and health value, indicating that tobacco use is a leading driver of poor health and higher healthcare spending.” 

Previous analysis by HPIO also supports the link between tobacco use, population health and healthcare spending, “States with a lower adult smoking rate are more likely to have a better health value rank— meaning better population health outcomes and lower healthcare spending,” the analysis found.

All of HPIO’s work related to tobacco is available on the Institute’s website.

The number of prescription opioid pain pills shipped in the United States plummeted nearly 45% between 2011 and 2019, new federal data shows, even as fatal overdoses rose to record levels as users increasingly used heroin, and then illegal fentanyl (Source: “Overdoses soared even as prescription pain pills plunged,” Washington Post, Sept. 12).

The data confirms what’s long been known about the arc of the nation’s addiction crisis: Users first got hooked by pain pills saturating the nation, then turned to cheaper and more readily available street drugs after law enforcement crackdowns, public outcry and changes in how the medical community views prescribing opioids to treat pain.
 
The drug industry transaction data, collected by the Drug Enforcement Administration and released by attorneys involved in the massive litigation against opioid industry players, reveals that the number of prescription hydrocodone and oxycodone pills peaked in 2011 at 12.8 billion pills, and dropped to fewer than 7.1 billion by 2019. Shipments of potent 80-milligram oxycodone pills dropped 92% in 2019 from their peak a decade earlier.

Many of the counties with the highest fentanyl death rates — in hard-hit states such as West Virginia, Kentucky and Ohio — started out with alarmingly high doses of prescription pills per capita, according to a Washington Post analysis of the DEA data and federal death records.

Heat-related illness and deaths in the U.S. are on the rise, and an increase in drug use and homelessness is a significant part of the problem, according to public health officials and data from the Centers for Disease Control and Prevention (Source: “Heat-Related Deaths Are Up, and Not Just Because It’s Getting Hotter,” KFF Health News, Sept. 8).

Heat was the underlying or contributing cause of about 1,670 deaths nationwide in 2022, for a rate of about 5 deaths per million residents, according to provisional data from the CDC. That’s the highest heat-related death rate in at least two decades. The next-highest death rate was logged in 2021.

The simplest explanation for the increase is that it is getting hotter. The last eight years were the hottest on record, according to NASA figures dating to the late 1800s. But factors other than climate change also play a role.

Substance abuse, especially misuse of methamphetamines, has emerged as a major factor in heat-related illness. Methamphetamines can cause body temperature to increase to dangerous levels, and the combination of meth abuse, heat, and homelessness can be fatal.

“With any environmental crisis, people experiencing homelessness experience it first, they experience it worst, and they experience it longest,” said Katie League, behavioral health manager for the National Health Care for the Homeless Council.