Tag Archives: disparities

Fall in life expectancy for white Americans

Newly released 2014 data from the National Center for Health Statistics on life expectancy showed a worrisome decline in life expectancy for whites in the US, to 78.8 years in 2014 from 78.9 in 2013.

The good news is that, in contrast, life expectancy increased by 0.2 years for the Hispanic population (from 81.6 to 81.8 years) and by 0.1 years for the non-Hispanic black population (from 75.1 to 75.2). This continues a trend of a decreasing gap in life expectancy between black and white populations, with improving black life expectancies attributed to decreases in death rates due to heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions.db218_fig1

Life expectancy rates had steadily for decades, then flattened in 2010-2013. joi150117f1The decline in life expectancy is driven by increased death rates among young and middle-aged whites (mid 20’s to mid 50’s), especially among those with no more than a high school education.  A recent study attributed the rise in mortality in this group  to rising rates of suicide, liver disease and drug overdoses.

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Life expectancy has dipped before–most recently in 2005, the year of a severe influenza epidemic.

 

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Social determinants of health and pay-for-performance readmissions measures

In an article released by JAMA Pediatrics today, my co-authors and I show that social determinants of health (patient factors such as health insurance, poverty and other sociodemographic measures) are risk factors for readmissions-related penalties for children’s hospitals. Without adjusting pay-for-performance (P4P) measures for social determinants of health (SDH), hospitals may receive penalties partially related to patient SDH factors beyond the quality of hospital care.

Risk adjustment for SDH may reduce penalizing hospitals for patient factors beyond their control. When we calculated hospital rates on a readmissions-based  P4P measure, we found that risk adjusting the readmissions measure for SDH changed the penalty status of 7.0% and 11.6% of hospitals using 15-day and 30-day readmission windows, respectively.Screen Shot 2016-02-15 at 2.32.48 PM

For more on readmissions-related research and policy, see my recent post. A great post on readmissions risk-adjustment is here.

Readmissions revisited

I am reposting  a post by Garret Johnson and Zoe Lyon, both research assistants for Dr. Ashish Jha at the Harvard T.H. Chan School of Public Health (who also has a great post on risk-adjustment for readmissions.  The post eloquently explores an issue I’ve visited in a recent post: the importance of understanding the diverse factors that drive the health outcomes that have become performance metrics.  Performance metrics–in this case, hospital readmissions–are intended to reward or penalize providers (hospitals) for the quality of care they deliver.  However, these measures are often strongly driven by factors beyond the hospital’s care–patient factors often called “social determinants of health”.  The authors state “there is now substantial evidence that high readmission rates — especially for medical conditions, as opposed to surgical ones — are driven more by patient factors outside of hospitals’ control (e.g. poverty, lack of social supports) than by hospitals’ quality of care and discharge planning.”

Source: Readmissions revisited