Medicare Advantage plans lacking in doctor diversity
Seniors of color who sign up for Medicare Advantage may find it difficult to find a doctor who shares their race or ethnicity, new research in Health Affairs shows.
Published Jan. 6, the study found Black and Hispanic physicians were less likely to be part of a Medicare Advantage network at the county level than white physicians. As of 2019, about 41% of U.S. counties had no Black physicians that participated in Medicare Advantage, while 47% lacked participating Hispanic physicians.
On average, Black and Hispanic patients covered by Medicare Advantage had access to only five doctors in their county who shared their race or ethnicity. Twenty percent of Black patients had no access to a Black physician at all through the program, while 20% of Hispanic patients had access to only one Hispanic doctor.
The findings are important because research shows that Black and Hispanic patients who see doctors that share their race or ethnicity may receive better or more culturally appropriate care. A 2019 study, for example, found Black patients who received primary care from physicians who share their race were more likely to receive recommended preventive care.
More than 32.8 million older adults in the U.S. participate in Medicare Advantage plans, which disproportionately cover Black and Hispanic patients. The plans, which are administered through private companies, generally offer low or no monthly premiums, but often come with a limited network of hospitals, higher out-of-pocket costs and up-front payments for treatment.
Disparities in race and ethnicity between patients and doctors varied by Medicare Advantage companies: UnitedHealth Group tended to have more diverse networks of physicians compared with Centene, Humana, CVS and Elevance, the study said.
As Medicare Advantage companies tend to avoid physicians who treat higher rates of medically complex patients, the insurers may be unintentionally excluding Black and Hispanic physician from networks. Black and Hispanic physicians overall are more likely to serve Black and Hispanic patients, who often have increased health care needs.
Microplastics common in seafood
Tiny pieces of plastic from bottles, clothing and other products are finding their way into seafood consumed by humans, a new study shows.
Researchers at Portland State University examined tissue samples from six kinds of sea animals — Chinook salmon, Pacific herring, Pacific lamprey, pink shrimp, black rockfish and lingcod — finding microplastics in all of them. Shrimp, which use filters to feed near the surface of water, had the highest concentrations of the plastic particles in their edible tissues, while Chinook salmon had the lowest concentration, according to the study in Frontiers in Toxicology.
More than 1,800 microplastic particles were found in the 180 seafood samples. Microplastic fibers — which are shed by synthetic textiles such as clothing, rugs and blankets during washing and production — accounted for most of the particles, followed by fragments and films.
Microplastics are plastic particles that are smaller than 5 millimeters. They have been linked to digestive cancer, respiratory disorders and blockages in arteries that lead to the heart, among other health risks.
The researchers recommended greater use of catchment filters in laundry machines to help prevent microfiber pollution from entering waterways.
PFAS in drinking water linked to prescription drugs
Millions of Americans may be regularly exposed to “forever chemicals” from pharmaceuticals that have entered their drinking water, new research estimates.
Published Jan. 6 in the Proceedings of the National Academy of Sciences, the study examined samples of water processed by treatment plants for extractable organic fluorine, a compound that can serve as an indicator for per- and polyfluoroalkyl substances, also known as PFAS.
Researchers cross-referenced their findings with six types of PFAS regulated by the Environmental Protection Agency, including perfluorooctanoic acid and perfluorooctane sulfonate, two common pollutants better known as PFOS and PFOA.
They found the EPA-regulated contaminants accounted for only about 8% of the organic fluorine in wastewater released by treatment plants. Instead, contaminants from prescription drugs made up 62%. Pharmaceuticals can enter water supplies through human waste, improper drug disposal and agricultural use.
During normal river conditions, about 15 million Americans receive drinking water containing levels of the compounds that exceed regulatory limits, the study researchers estimated. And during drought conditions, which are become more frequent in the U.S. because of climate change, that number can rise to 23 million people.
PFAS are referred to as forever chemicals because of their inability to break down in the human body or environment. They have been linked to health risks such as thyroid disease, liver and immune system damage and reproductive health problems.
Other recent public health news of note includes:
• New research in Nature Medicine says large floods fueled by climate change led to a 25% higher death rate from major causes in the U.S. over the past two decades. Severe rain-related floods were linked to increased deaths from infectious diseases, injuries and cardiovascular disease.
• Slight, unintentional acts of discrimination — also known as microaggressions — can cause blood pressure to spike among Asian, Black and Hispanic women who have recently given birth, a study in Hypertension finds. More than a third of women in the study said they had experienced at least one racial microaggression during their obstetrical care.
• A new study in the American Journal of Industrial Medicine finds job strain among middle-age workers is linked to long-lasting sleep problems, which can lead to poorer health.
• Climate change and extreme weather are associated with worse HIV prevention and care, including increased HIV exposure and poorer health outcomes for people with the infection, according to a new study in Current Opinion in Infectious Diseases.
• Suicidal behavior is more common among men working in construction than in other occupations, according to a new study in BMC Public Health. Researchers found suicide rates were higher overall among men working in jobs with low educational requirements.
• The Environmental Protection Agency added nine new types of per- and polyfluoroalkyl substances — also known as PFAS — to the list of chemicals covered by its Toxics Release Inventory. The change means industries will be required to report when they release the chemicals into the environment.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.