Posts Tagged "mortality"

Medicaid Expansion has Saved Lives

The recent rise in Americans’ death rates is a crisis for the lowest-earning men. They are dying about 15 years younger than the highest-earners due to everything from obesity to opioids. Women with the lowest earnings are living 10 years less.

But healthcare policy is doing what it’s supposed to in the states that expanded their Medicaid coverage to more low-income people under the Affordable Care Act (ACA): helping to stem the tide by making low-income people healthier.

An analysis by the Center for Poverty Research at the University of California, Davis, found that death rates have declined in the states that chose to expand Medicaid coverage. The study focused on people between ages 55 and 64 – not quite old enough to enroll in Medicare.

Graph of number of lives saved Medicaid has “saved lives in the states where [expansion] occurred,” UC-Davis researchers found. They estimated that 15,600 more lives would have been saved nationwide if every state had covered more of their low-income residents.

This is one of many studies that takes advantage of the ability to compare what is happening to residents’ well-being in states that expanded their Medicaid programs with the states that did not.  Progress has come on many fronts.

In expansion states, rural hospitals, which are struggling nationwide, have had more success in keeping their doors open. By covering more adults, more low-income children have been brought into the program, which one study found reduces their applications for federal disability benefits as adults. And low-income residents’ precarious finances improved in states where Medicaid expansion reduced their healthcare costs. …Learn More

What’s Driving the Longevity Gap

The decline in U.S. life expectancy is unlike anything we’ve seen  

Bombshell headlines like this popped up in major news outlets last November after the government reported that life expectancy in 2017 fell for the third year in a row.

This is a troubling break from the steady improvements in lifespans since 1900, which were powered by a combination of medical breakthroughs and healthcare policy. Early in the 20th century, antibiotics dramatically increased infant lifespans. Later, new treatments like statins and stents, as well as expanded access to healthcare through Medicare and Medicaid, increased life expectancy across the age range.

But there’s another story behind this story: life expectancy very much depends on where one falls on the economic ladder.

Between 1979 and 2011 – prior to the very recent fall in longevity – the increase in lifespans was much larger for more educated, higher-earning Americans than the gains for people with less education and lower incomes, according to a study by the Center for Retirement Research (CRR).

Smoking is an important factor in this socioeconomic divide. The decline in smoking and cardiovascular disease greatly contributed to rising longevity in the latter half of the 20th century. But while all Americans are smoking less today, those in lower socioeconomic groups still smoke much more. Today, one in four of them is a smoker, compared with just one smoker for every 10 people who attended college, the CRR found.

Looking ahead, education will remain a clear dividing line, and life expectancy will continue to depend crucially on the future prevalence and impact of smoking, as well as obesity, CRR predicted. …Learn More

Photo of an older white man

Why are White Americans’ Deaths Rising?

Rarely does academic research make a splash with the general public like this did. A grim 2015 study, prominently displayed in The New York Times, showed death rates increasing among middle-aged white Americans and blamed so-called “deaths of despair” like opioid addiction, suicide, and liver disease.

Rising mortality, especially for white people with low levels of education, ran counter to the falling death rates the researchers found for Hispanic and black Americans. The husband and wife team who did the study proposed that “economic insecurity” might be an avenue for research into the root cause of white Americans’ deaths of despair.

A 2018 study took up where they left off and found a connection between economic conditions and some types of deaths. Researchers from the University of Michigan, Claremont Graduate University, and the Urban Institute said poor economic conditions – in the form of local employment losses – have played a role in the rising deaths since 1990 from chronic health problems like cardiovascular disease, particularly among 45 to 54 year olds with a high school education or less. However, they could not establish a connection to the rise in deaths of despair.

In a 2019 study in the Journal of Health and Social Behavior, these same researchers instead focused on what is driving the growing educational disparity in life expectancy trends among whites: life expectancy is rising for those with more education but stagnating or falling for less-educated whites.

As for the health reasons behind this, they found that chronic conditions like cardiovascular disease and even cancer are critical to explaining less-educated whites’ life expectancy, and they warned against putting too much emphasis on deaths of despair. In the medical literature, they noted, cardiovascular disease, and some cancers are consistently linked to the “wear and tear” on the body’s systems due to the stress that disadvantaged Americans experience over decades, because they earn less and face adversities ranging from a lack of opportunities and inadequate medical care to substandard living environments. …Learn More