Chronic disease management

Heart disease, diabetes, other leading causes of death up in 2020, federal data shows

The U.S. saw remarkable increases in the death rates for heart disease, diabetes and some other common killers in 2020, and experts believe a big reason may be that people stayed away from the hospital for fear of catching COVID-19 (Source: “US deaths from heart disease and diabetes climbed amid COVID,” Associated Press, June 9).

The death rates — posted online this week by federal health authorities — add to the growing body of evidence that the number of lives lost directly or indirectly to the coronavirus in the U.S. is far greater than the officially reported COVID-19 death toll of nearly 600,000 in 2020-21.

Earlier this year, the Centers for Disease Control and Prevention reported that nearly 3.4 million Americans died in 2020, an all-time record. Of those deaths, more than 345,000 were directly attributed to COVID-19. The CDC also provided the numbers of deaths for some of the leading causes of mortality, including the nation’s top two killers, heart disease and cancer.

Earlier research done by demographer Kenneth Johnson at the University of New Hampshire found that an unprecedented 25 states, including Ohio, saw more deaths than births overall last year (most states typically have more births than deaths).


Study: Death rates from chronic conditions rising in rural America

In rural America, more people die from chronic health conditions and substance abuse than in suburbs and cities, and the gap is widening.

A new study has found that the difference in rural and urban death rates tripled over the past 20 years mostly due to deaths among middle-aged white men and women (Source: “Study: Death rates from chronic conditions, 'deaths of despair' rising in rural U.S.,” United Press International, June 9).

This gap is partly due to access to care, but other factors also contribute, said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital in Boston and the VA Boston Healthcare System. In terms of access, rural areas have seen a wave of hospital closures driven largely by economics, especially during the COVID-19 pandemic, he said.

"But it's hard to disconnect health from other factors in our societies," Warraich said. "I think it's linked to the overall economic outlook of rural America as well, and also, health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, substance use, etc."

For the study, which was published in the Journal of the American Medical Association, Warraich and his colleagues used federal government health data for 1999 through 2019. They found that age-adjusted death rates dropped in both rural and urban areas over that period. But the gap widened dramatically as death rates rose among white rural residents between 25 and 64.

Over the study period, rural death rates increased 12% for that group. Although death rates dropped among rural Black residents, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.


Study: 4 in 10 Americans live in cities with unhealthy air

More than 40% of Americans live with unhealthy air, with certain cities and types of Americans far more prone to be affected, according to a new national study (Source: “More than 40% in U.S. live in cities with unhealthy air, study says,” United Press International, April 21).

The American Lung Association's annual "State of the Air" report, which was released this week, found that people of color are 61% more likely to live in a county with unhealthy air than are white people and three times more likely to live in a county with failing air-quality grades across the board.

Moreover, the report says climate change continues to worsen air pollution in much of the country. Research also shows that air pollution can make COVID-19 worse, the authors pointed out.


Concern grows over reduction in cancer screenings amid pandemic

Experts are expressing concern that a reduction in cancer screenings over the past year will soon result in an increase in advanced cases (Source: “Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings,” New York Times, March 17).

Months of lockdowns and waves of surging COVID-19 cases throughout last year shuttered or reduced hours at clinics and cancer-testing labs, resulting in steep declines in the number of screenings, including for breast and colorectal cancers, experts have said.

Numerous studies showed that the number of patients screened or given a diagnosis of cancer fell during the early months of the pandemic. By mid-June, the rate of screenings for breast, colon and cervical cancers were still 29% to 36% lower than their prepandemic levels, according to an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease.

“There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,” said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. 


Ohio Medicaid to pay for earlier hepatitis C treatment

The Ohio Department of Medicaid on Wednesday announced that it will begin paying for the treatment of patients with hepatitis C at an earlier stage of the disease (Source: “Ohio Department of Medicaid to treat those with Hepatitis C earlier,” Cleveland Plain Dealer, Oct. 31, 2018).

Starting Jan. 1, 2019, the department will cover care for individuals when they first develop the disease instead of waiting until it progresses further.

Cases of hepatitis C have seen a resurgence in Ohio in recent years due to the opioid epidemic. The number of cases in the state climbed 38 percent from 2014 to 2017, according to statistics from the Ohio Department of Health. In 2014, there were 15,806 new cases and by 2017, there were 21,882 new cases. Nationwide, more than 3 million people have chronic hepatitis C, according to the CDC.

“Individuals with opioid use disorder are the fastest growing population impacted by hepatitis C,” Tom Betti, press secretary for the Ohio Department of Medicaid, said in a prepared statement. “In an effort to mitigate the harm caused by the opioid epidemic, the Ohio Department of Medicaid is changing policy to begin earlier therapy for individuals with chronic hepatitis C. We have been studying this issue for some time and believe this action is the next appropriate step as part of Ohio’s response to the opioid crisis.”


Medicare diabetes prevention program struggles at launch

The rollout of the Medicare Diabetes Prevention Program, a major new benefit that could help millions of people, is getting off to a rocky start, according to interviews with nearly a dozen experts (Source: “New Medicare Perk For Diabetes Prevention Stumbles At Rollout,” Kaiser Health News, April 19, 2018).

Several weeks ago Medicare launched an initiative to prevent seniors and people with serious disabilities from developing Type 2 diabetes, one of the most common and costly medical conditions in the U.S.

In all but a few locations, experts said, Medicare’s new prevention program — a yearlong series of classes about healthy eating, physical activity and behavioral change for people at high risk of developing diabetes — isn’t up and running yet. And there’s no easy way (no phone number or website) to learn where it’s available.

In a first for Medicare, community organizations such as YMCAs and senior centers will run the program, not doctors and hospitals. But many sites are struggling with Medicare’s contracting requirements and are hesitant to assume demanding administrative responsibilities, said Brenda Schmidt, acting president of the Council for Diabetes Prevention and chief executive officer of Solera Health, a company that assembles provider networks.