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The survival of the city : living and thriving in an age of isolation
\"In Survival of the City, an urbanist and a public health expert join forces to explain where cities are right now and provide a prescription for a healthy future for them\"-- Provided by publisher.
Book
An algorithmic approach to reducing unexplained pain disparities in underserved populations
Underserved populations experience higher levels of pain. These disparities persist even after controlling for the objective severity of diseases like osteoarthritis, as graded by human physicians using medical images, raising the possibility that underserved patients’ pain stems from factors external to the knee, such as stress. Here we use a deep learning approach to measure the severity of osteoarthritis, by using knee X-rays to predict patients’ experienced pain. We show that this approach dramatically reduces unexplained racial disparities in pain. Relative to standard measures of severity graded by radiologists, which accounted for only 9% (95% confidence interval (CI), 3–16%) of racial disparities in pain, algorithmic predictions accounted for 43% of disparities, or 4.7× more (95% CI, 3.2–11.8×), with similar results for lower-income and less-educated patients. This suggests that much of underserved patients’ pain stems from factors within the knee not reflected in standard radiographic measures of severity. We show that the algorithm’s ability to reduce unexplained disparities is rooted in the racial and socioeconomic diversity of the training set. Because algorithmic severity measures better capture underserved patients’ pain, and severity measures influence treatment decisions, algorithmic predictions could potentially redress disparities in access to treatments like arthroplasty.
An algorithmic, machine-learning approach to measuring severe pain from osteoarthritis applied to X-ray images of knees suggests that reported disparities in knee pain in underserved populations can be reduced by comparison with use of standard radiographic measures of disease severity.
Journal Article
Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform
As many as half of all patients do not adhere faithfully to their prescription-medication requirements, and the result is more than $100 billion spent each year on avoidable hospitalizations. David Cutler and Wendy Everett discuss how to improve medication adherence.
Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Data show that as many as half of all patients do not adhere faithfully to their prescription-medication regimens — and the result is more than $100 billion spent each year on avoidable hospitalizations.
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Nonadherence to medication regimens also affects the quality and length of life; for example, it has been estimated that better adherence to antihypertensive treatment alone could prevent 89,000 premature deaths in the United States annually.
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What is less clear is why adherence to the 3.8 billion prescriptions written . . .
Journal Article
Reexamining the Contribution of Public Health Efforts to the Decline in Urban Mortality
We address points raised by Anderson, Charles, and Rees (2022b), which comments on our prior work. After correcting unambiguous data mistakes, our revised estimates suggest that municipal water disinfection (filtration) explains 38 percent of the total mortality rate decline in our sample cities and years—a result not very different from our original estimate of 43 percent. However, effects on infant mortality rates are smaller than in our original analysis. Much of the difference between their analyses and ours is due to the coding of partial intervention years and to differences in population denominators, for which ideal data are difficult to find.
Journal Article
Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy
Using data from U.S. national surveys, the authors forecast that the adverse effect of increases in obesity on the nation's health over the next decade will exceed the benefits of declines in smoking. They estimate that the elimination of smoking and obesity by 2020 would increase the average life expectancy at the age of 18 by almost 4 years.
The authors forecast that the adverse effect of increases in obesity on the nation's health over the next decade will exceed the benefits of declines in smoking.
Trends in behavioral risk factors can have a profound effect on population health.
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Estimates suggest that obesity accounts for 5 to 15% of deaths each year in the United States
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and smoking for 18%.
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Eliminating smoking could increase population life expectancy by as much as 1 to 2 years.
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In contrast, if obesity rates continue to grow as they have historically, a leveling off, or even a reversal, of past life expectancy trends has been predicted.
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In addition to their effect on mortality, obesity and smoking affect quality of life.
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Smoking is a major risk factor . . .
Journal Article
Surgeon specialization and operative mortality in United States: retrospective analysis
Objective To measure the association between a surgeon’s degree of specialization in a specific procedure and patient mortality.Design Retrospective analysis of Medicare data.Setting US patients aged 66 or older enrolled in traditional fee for service Medicare.Participants 25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13.Main outcome measure Relative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures).Results For all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure.Conclusion For several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon’s procedure specific volume as well as the degree to which a surgeon specializes in that procedure.
Journal Article
Early death after discharge from emergency departments: analysis of national US insurance claims data
Objective To measure incidence of early death after discharge from emergency departments, and explore potential sources of variation in risk by measurable aspects of hospitals and patients.Design Retrospective cohort study.Setting Claims data from the US Medicare program, covering visits to an emergency department, 2007-12.Participants Nationally representative 20% sample of Medicare fee for service beneficiaries. As the focus was on generally healthy people living in the community, patients in nursing facilities, aged ≥90, receiving palliative or hospice care, or with a diagnosis of a life limiting illnesses, either during emergency department visits (for example, myocardial infarction) or in the year before (for example, malignancy) were excluded.Main outcome measure Death within seven days after discharge from the emergency department, excluding patients transferred or admitted as inpatients.Results Among discharged patients, 0.12% (12 375/10 093 678, in the 20% sample over 2007-12) died within seven days, or 10 093 per year nationally. Mean age at death was 69. Leading causes of death on death certificates were atherosclerotic heart disease (13.6%), myocardial infarction (10.3%), and chronic obstructive pulmonary disease (9.6%). Some 2.3% died of narcotic overdose, largely after visits for musculoskeletal problems. Hospitals in the lowest fifth of rates of inpatient admission from the emergency department had the highest rates of early death (0.27%)—3.4 times higher than hospitals in the highest fifth (0.08%)—despite the fact that hospitals with low admission rates served healthier populations, as measured by overall seven day mortality among all comers to the emergency department. Small increases in admission rate were linked to large decreases in risk. In multivariate analysis, emergency departments that saw higher volumes of patients (odds ratio 0.84, 95% confidence interval 0.81 to 0.86) and those with higher charges for visits (0.75, 0.74 to 0.77) had significantly fewer deaths. Certain diagnoses were more common among early deaths compared with other emergency department visits: altered mental status (risk ratio 4.4, 95% confidence interval 3.8 to 5.1), dyspnea (3.1, 2.9 to 3.4), and malaise/fatigue (3.0, 2.9 to 3.7).Conclusions Every year, a substantial number of Medicare beneficiaries die soon after discharge from emergency departments, despite no diagnosis of a life limiting illnesses recorded in their claims. Further research is needed to explore whether these deaths were preventable.
Journal Article
The Value of Medical Spending in the United States, 1960–2000
This study compared the increases in spending on medical care and the gains in life expectancy from 1960 through 2000. The authors estimate that increased spending on health care resulted in a cost of about $20,000 per year of life gained and conclude that the additional spending has been worthwhile.
This study compared the increases in spending on medical care and the gains in life expectancy from 1960 through 2000. Increased spending on health care resulted in a cost of about $20,000 per year of life gained.
Advances in medical care have led to sustained increases in medical spending over time. Adjusted for inflation, annual medical spending per person has increased from approximately $700 in 1960 to more than $6,000 today, tripling as a share of the gross domestic product (GDP).
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At least half this increase is a result of more care, not higher prices for existing care.
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An evaluation of whether increased medical spending is useful requires the valuation of the increase in care. The enormous growth in spending has led many to argue that the increasing costs are excessive.
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Others, however, suggest that spending more . . .
Journal Article