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Texas team re-calculates maternal mortality rate
MacDorman findings from 2016 addressed, somewhat
Located in News
Article Reference Troff document (with manpage macros)The association between first abortion and first-time non-fatal suicide attempt: a longitudinal cohort study of Danish population registries
Background Suicidal ideation due to abortion has been used to justify restrictive US abortion policies. Much research examining abortion and mental health has relied on self-report, has had low participation rates, and did not consider confounding factors. In the present study, we used data that do not rely on self-report and are not affected by low participation rates to examine the association between abortion and non-fatal suicide attempts, adjusting for confounding factors. Methods In this longitudinal cohort study of Danish population registries, we linked data on a cohort of women born in Denmark between Jan 1, 1980, and Dec 30, 1998, who did not die or emigrate from Denmark before their 18th birthday or before study entry. Follow-up started on the woman's 18th birthday or Jan 1, 2000, whichever came last. Follow-up ended at the date of first suicide attempt, date of emigration from Denmark, date of death, or Dec 31, 2016, whichever came first. Women were between the ages of 18 and 36 years during the study period. We used a survival analysis to examine the risk of first suicide attempts or self-harm associated with a first abortion compared with no abortion, in the complete study cohort. To examine incidence rate ratios (IRRs) associated with abortion, we used Poisson regression with the logarithm of woman-years at risk as an offset. We also examined whether the risk of suicide attempts changed before and after the abortion, adjusting for age, calendar year, socioeconomic status, and history of childbirth, mental health, parental mental health, and physical health. Findings Data on 523 280 women were included in this study. Of these, 48 990 (9·4%) women had a record of at least one first-trimester abortion, and 10 216 (2·0%) had a suicide attempt during the study period. Among 48 990 women who had an abortion, 1402 (2·9%) had a first suicide attempt after the first abortion. In our fully-adjusted model which adjusted for all covariates, the risk of first-time non-fatal suicide attempts was similar in the year before an abortion (IRR 2·46 [95% CI 2·22–2·72]) and the year after an abortion (IRR 2·54 [2·29–2·81], p=0·509) compared with women who had not had an abortion, and decreased with increasing time since the abortion (1–5 years IRR 1·90 [1·75–2·06]; ≥5 years IRR 1·73 [1·53–1·96]). Interpretation We found that women who had abortions had a higher risk of non-fatal suicide attempts compared with women who did not have an abortion. However, because the increased risk was the same both the year before and after the abortion, it is not attributable to the abortion. Thus, policies based on the notion that abortion increases women's risk of suicide attempts are misinformed.
Located in MPRC People / Julia Steinberg, Ph.D. / Julia Steinberg Publications
Article Reference Troff document (with manpage macros)The association between interpregnancy interval and severe maternal morbidities using revised national birth certificate data: A probabilistic bias analysis
Severe maternal morbidity continues to be on the rise in the US. Short birth spacing is a modifiable risk factor associated with maternal morbidity, yet few studies have examined this association, possibly due to few available data sources to examine these rare events. To examine the association between interpregnancy interval (IPI) and severe maternal morbidity using near‐national birth certificate data and account for known under‐reporting using probabilistic bias analysis. We used revised 2014‐2017 birth certificate data, restricting to resident women with a non–first‐born singleton birth. We examined the following: (a) maternal blood transfusion, (b) admission to intensive care unit (ICU), (c) uterine rupture (among women with a prior caesarean delivery) and (d) third‐ or fourth‐degree perineal laceration (among vaginal deliveries) by IPI categories (<6, 6‐11, 12‐17, 18‐23, 24‐59 and 60+ months). Risk ratios and 95% confidence intervals were estimated using log‐binomial regression, adjusting for select maternal characteristics. Probabilistic bias analyses were performed. Compared with IPI 18 to 23 months, adjusted models revealed that the risk of maternal transfusion followed a U‐shaped curve with IPI, while risk of ICU admission and perineal laceration increased with longer IPI. Risk of uterine rupture was highest among IPI <6 months. With the exception of maternal transfusion, these findings persisted regardless of the extent or type of misclassification examined in bias analyses. Associations between IPI and maternal morbidity varied by outcome, even after adjusting for misclassification of SMM. Differences across maternal health outcomes should be considered when counselling and making recommendations regarding optimal birth spacing.
Located in MPRC People / Marie Thoma, Ph.D. / Marie Thoma Publications
The built environment and traffic collisions in the United States
Quynh Nguyen and Thu Nguyen examine how built environment features affect U.S. traffic collisions
Located in Research / Selected Research
Article Reference Troff document (with manpage macros)The consequences of foster care versus institutional care in early childhood on adolescent cardiometabolic and immune markers: Results from a randomized controlled trial
OBJECTIVE: Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence. METHODS: The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers. RESULTS: Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03). CONCLUSIONS: The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)The COVID-19 epidemic in rural U.S. counties
Having first reached epidemic proportions in coastal metropolitan areas, COVID-19 has spread 4 around the country. Reported case rates vary across counties from zero to 125 per thousand 5 population (around a state prison in the rural county of Trousdale, Tennessee). Overall, rural 6 counties are underrepresented relative to their share of the population, but a growing proportion 7 of all daily cases and deaths have been reported in rural counties. This analysis uses daily 8 reports for all counties to present the trends and distribution of COVID-19 cases and deaths in 9 rural counties, from late March to May 16, 2020. I describe the relationship between population 10 density and case rates in rural and non-rural counties. Then I focus on noteworthy outbreaks 11 linked to prisons, meat and poultry plants, and nursing homes, many of which are linked to 12 high concentrations of Hispanic, American Indian, and Black populations. The growing 13 epidemic in rural counties is apparently driven by outbreaks concentrated in these institutional 14 settings, which are conducive to transmission. The impact of the epidemic in rural areas may 15 be heightened due to their weaker health infrastructure and more vulnerable populations, 16 especially due to age, socioeconomic status, and health conditions. As a result, the epidemic 17 may contribute to the ongoing decline of health, economic, and social conditions in rural areas.
Located in MPRC People / Philip Cohen, Ph.D. / Philip Cohen Publications
The Effects of Changes in Medicaid Physician Fees on the Use of Preventative Care
Faculty Associate Karoline Mortensen to model effects of Affordable Care Act on Medicaid enrollees
Located in Research / Selected Research
Misc Reference Troff document (with manpage macros)The Effects of Non-Contributory Pensions on Material and Subjective Well Being
Public expenditures on non-contributory pensions are equivalent to at least 1 percent of GDP in several countries in Latin America and is expected to increase. We explore the effect of noncontributory pensions on the well-being of the beneficiary population by studying the Pension 65 program in Peru, which uses a poverty eligibility threshold. We find that the program reduced the average score of beneficiaries on the Geriatric Depression Scale by nine percent and reduced the proportion of older adults doing paid work by four percentage points. Moreover, households with a beneficiary increased their level of consumption by 40 percent. All these effects are consistent with the findings of Galiani, Gertler and Bando (2016) in their study on a non-contributory pension scheme in Mexico. Thus, we conclude that the effects of non-contributory pensions on well-being in rural Mexico can be largely generalized to Peru
Located in MPRC People / Sebastian Galiani, Ph.D. / Sebastian Galiani Publications
Article Reference Troff document (with manpage macros)The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
Objectives:  We examined changes in  health care access  and utilization associated with the Patient Protection and  Affordable Care Act  (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design:  Using 2003–2017 California Health Interview Survey data, we examined changes in 4  health care access  measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results:  After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions:  Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Article ReferenceThe Eighteen of 1918–1919: Black Nurses and the Great Flu Pandemic in the United States
This article examines the role of Black American nurses during the 1918–1919 influenza pandemic and the aftermath of World War I. The pandemic caused at least 50 million deaths worldwide and 675 000 in the United States. It occurred during a period of pervasive segregation and racial violence, in which Black Americans were routinely denied access to health, educational, and political institutions. We discuss how an unsuccessful campaign by Black leaders for admission of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during World War I eventually created opportunities for 18 Black nurses to serve in the army during the pandemic and the war’s aftermath. Analyzing archival sources, news reports, and published materials, we examine these events in the context of nursing and early civil rights history. This analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity. In 1918, Aileen Cole and Clara Rollins ached to become Red Cross war nurses. 1  Cole, aged 24 years, had recently passed her registration exams, and Rollins, 34, had years of nursing experience. 2  The two boarded with other nurses in a Washington, DC, brick row house near Freedmen’s Hospital, where they had all graduated from the rigorous nurse training school. The Red Cross had enrolled Cole and Rollins on paper, but had done nothing else: the US Army and Navy, for which the Red Cross served as the official recruiter, did not accept Black nurses. 3 In October, the influenza pandemic brought change. The Red Cross called up Cole, Rollins, and several other Black nurses for civilian duty, and sent them to West Virginia to battle pandemic influenza. 4  This 1918–1919 pandemic was responsible for at least 50 million deaths worldwide and 675 000 in the United States. 5  It also created opportunities for previously excluded Black nurses, including the first 18 to serve in the Army Nurse Corps (ANC) between December 1918 and August 1919. 6 Although Black nurses’ roles in World War I and the pandemic have been noted by numerous historians, this article represents the first effort to move these nurses from periphery to center, and to critically analyze their struggle to serve as a seminal episode in the long and ongoing movement for civil rights and racial health equity. 7  Using archival materials, news reports, census records, and published literature, we highlight how Black nurses fulfilled a critical need for skilled care during the pandemic and the war’s aftermath, but received little recognition. We also show how nurses and Black community leaders viewed this service as a political act. We present this story as a historical case study of nursing and racism in a public health emergency, while raising transhistorical questions: Do public health emergencies spur advancements in health equity? Or do they merely allow exploitation of already-marginalized persons? Although a single case study cannot offer definitive answers, it can provide valuable insights.
Located in Retired Persons / Marian Moser Jones, Ph.D. / Marion Moser Jones Publications