RISE looks at recent headlines concerning social determinants of health (SDoH), including issues that prevent seniors from accessing care, an increase in Medicare enrollees who struggle with opioid abuse, a study on racial, ethnic disparities in maternal health complications, federal funding to address Black youth mental health, and new draft guidelines for screening adults for anxiety.
Survey explores issues preventing seniors from accessing care
Economic instability, loneliness and food insecurity are the top three social barriers that impact seniors’ access to comprehensive, affordable, high-quality health care, according to the 2022 Social Threats to Aging Well in America survey.
The survey, released by Alignment Healthcare, asked 2,601 adults aged 65 and older across the United States about their biggest obstacles to health care and the support they need to overcome those challenges. The online study was conducted from July 24 to August 13 and focused on social determinants of health (SDoH), such as income and access to reliable transportation, and healthy foods. Among the key findings:
- One in five U.S. seniors lists the inability to pay as their top barrier to health care in the next year
- One in 10 says they do not have the resources and support to cover medical bills
- Nearly one in six carries medical debt and of those with medical debt, more than a quarter owe amounts equal to three months or more in living expenses
- Twenty-one percent of seniors rank loneliness and isolation as top factors causing stress and mental health issues
- One in five seniors says they are lonelier now than they were a year ago, and the same number says they won’t have consistent companionship or in-home support in the next year.
- Fifteen percent of seniors anticipate struggling to put healthy food on their table in the next year.
- One in seven says they will not have consistent transportation to medical care in the next year
- Seniors see easier access to care (e.g., telehealth visits, transportation to medical appointments) as a benefit that could reduce stress while improving overall health
- One in 10 seniors says their lack of access to reliable technology—or difficulties using it—will be an obstacle to health and medical care in the next year.
OIG: Medicare enrollees continue to struggle with opioid abuse
An Office of Inspector General (OIG) report found that 50,400 Part D beneficiaries experienced an opioid overdose from prescription opioids, illicit opioids, or both during 2021. But the number may be higher because more beneficiaries may have overdosed but not received care that was billed to Medicare, or their claims might not have yet been submitted to Medicare.
The data brief examines opioid use and access to treatment for Medicare beneficiaries with opioid use disorder and access to the opioid overdose-reversal drug naxolone. The report contains a mix of good and unwelcome news:
- The number of Medicare Part D beneficiaries who received opioids in 2021 dropped to a quarter of beneficiaries
- Fewer Part D beneficiaries received high amounts of opioids or at serious risk
- The number of prescribers ordering opioids for large numbers of beneficiaries at serious risk was steady
- More than one million Medicare beneficiaries had a diagnosis of opioid use disorder in 2021 but fewer than 1 in 5 of them received medication to treat their disorder
- However, at the same time, the number of Part D beneficiaries receiving naloxone increased
“There is clearly still cause for concern and vigilance, even as some positive trends emerge,” the OIG concludes. “Monitoring opioid use and access to medications for the treatment of opioid use disorder as well as to naloxone are critical to addressing the opioid crisis.”
The OIG recommended in a December 2021 report that the Centers for Medicare & Medicaid Services (CMS) take steps to improve access to medications for the treatment of opioid use disorder and other support services. The latest report reiterated the importance of implementing the recommendations.
Meanwhile, the Department of Health and Human Services announced it has awarded $1.6 billion in funds for communities addressing addiction and overdose crises. The awards for state, tribal and rural opioid response and technical assistance will fund a spectrum of prevention, harm reduction, treatment, and recovery supports for people in need.
HHS awards $3M for initiative to promote Black youth mental health
The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) has announced more than $3 million in grants to eight organizations for a new initiative to demonstrate policy effectiveness to promote Black youth mental health (BYMH). This three-year initiative will help identify health and wellness policies that are successful in improving BYMH, including suicide prevention.
“Over the past decade, Black children under age 13 years are twice as likely to die by suicide compared to their white peers,” Felicia Collins, M.D., Deputy Assistant Secretary for Minority Health, said in the grant announcement. “With this new initiative, we intend to identify specific policies that exhibit a meaningful impact on mental health for Black youth and to spread the word about these effective policy efforts.”
Awardees will use a policy assessment framework to identify existing policies that they expect to promote mental health in Black youth. They will subsequently test the impact of these policies on Black youth mental health in varied settings, such as schools, faith-based organizations, community centers, health centers, or other community agency settings.
In October 2020, HHS released a report to Congress on African American Youth Suicide. The report analyzed National Violent Death Reporting System data between 2014–2017, to examine the risk and precipitating factors in non-Hispanic Black children and non-Hispanic white children aged 10 to 17, who died by suicide. The report also examined youth suicide demographics and epidemiology, risk factors associated with higher suicide rates among Black compared to white youth, and evidence-based interventions to prevent youth suicide ideation and behavior.
The eight new BYMH awardees will conduct their projects across eight states, including Arizona, California, Georgia, Louisiana, Minnesota, Nevada, Ohio, and Rhode Island. The project period for the Demonstrating Policy Effectiveness to Promote Black Youth Mental Health initiative begins on September 30. Click here to see the full list of grant recipients.
Study: Racial, ethnic disparities in maternal health complications rose during pandemic
Pregnancy-related complications have worsened nine percent since 2018, with marked increase during the COVID-19 pandemic, with some women of color at nearly 70 percent higher risk of pregnancy-related complications than white women, according to a new report released by the Blue Cross Blue Shield Association (BCBSA).
“When it comes to racial disparities in childbirth complications, the pandemic has only sent us further in the wrong direction—and we were in a bad place to begin with,” Kim Keck, president and CEO of BCBSA, said in the study announcement. “We have a bold goal of reducing racial disparities in maternal health by 50 percent in five years, and BCBS companies are taking action through advocacy, partnerships, and local programs to support mothers at every stage of their pregnancy. Every mother deserves to have a healthy pregnancy, deliver a healthy baby, and live a healthy postpartum life. We invite everyone to join us in making this a reality.”
The study, Racial and Ethnic Disparities in Maternal Health, examined the rate of childbirth complications in nearly 11 million U.S. births to women with either commercial insurance or Medicaid as measured by the CDC’s Severe Maternal Morbidity Measure (SMM). The analysis found Black, Latina and Asian women have higher rates of SMM than white women, regardless of age or type of health insurance. Preexisting health conditions, such as hypertension, diabetes or asthma going into delivery, strongly correlate with higher SMM and worse pregnancy complications, increasing the likelihood of a risky delivery or challenges postpartum.
While across all populations women ages 35-44 were identified as most likely to have an SMM event, Black women in this age range have a 66 percent higher rate of SMM and are more likely to suffer pregnancy-related complications than white women.
“One’s race or ethnicity should not determine how likely you are to suffer from pregnancy-related complications. We must address deep-rooted issues like implicit bias and systemic racism that cause these disparities in the first place,” said Adam Myers, M.D., senior vice president and chief clinical transformation officer for BCBSA. “To achieve better outcomes, we need to make sure care before pregnancy is easily accessible and equitable for all women, in addition to robust prenatal care, and ongoing postpartum care to ensure the safety of future pregnancies.”
Federal task force issues draft recommendations for screening adults for anxiety
The U.S. Preventive Services Task Force has published draft recommendations for screening for anxiety in adults. This is the first time the task force has recommended screening adults younger than 65 for anxiety.
“To address the critical need for supporting the mental health of adults in primary care, the task force reviewed the evidence on screening for anxiety, depression, and suicide risk,” Task Force Member Lori Pbert, Ph.D., said in an announcement. “The good news is that screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety can help identify these conditions early so people can be connected to care.”
For most adults, screening and follow-up care can reduce symptoms of anxiety and depression. However, there is limited evidence on the benefits and harms of screening adults 65 or older for anxiety, the task force noted. More research is also needed on the role of screening for suicide risk. Although suicide is tragically a leading cause of death among adults, there is not enough evidence on whether screening those without recognized signs or symptoms helps prevent suicide,
Screening is only the first step in helping adults with anxiety and depression, according to the task force. People who screen positive need further evaluation to determine if they have anxiety or depression. After diagnosis, people should participate in shared decision-making with their health care professionals to identify the treatment or combination of treatments that are right for them, and then be monitored on an ongoing basis to ensure that the chosen treatment is effective.
Public comment on the task force’s draft recommendation statements and evidence review will be accepted through October 17.