A weekly roundup of public health news
Heavy health costs common for Americans
Most Americans will struggle with burdensome health care costs at some point in their lives, a new study predicts.
Published in JAMA Internal Medicine, the analysis found that over a four-year period, nearly a quarter of people in the U.S. lived in families burdened by health costs. Those are defined as annual out-of-pocket medical costs that were greater than 10% of family income, or 5% for low-income families.
About 11% of Americans lived in families with “catastrophic” costs, where out-of-pocket spending took up a large share of the money they had left after paying for food. Overall, 12% of adults reported skipping needed medical care during the study period because they could not afford it.
Adults with low incomes, no insurance coverage, chronic disease and hospitalizations were more likely to experience cost-related problems. For example, researchers found that by the fourth year of the study, 33% of low-income adults experienced a cost burden, compared with 8% of high-income adults. Cost burdens also rose with each additional chronic condition: compared with adults reporting no chronic diseases at baseline, people with three or more had a 163% higher risk of being burdened.
For people who died during the study period, cost pressures intensified significantly in the years before their lives ended, the study found. More than half of those who died experienced cost burdens before their deaths and a third incurred catastrophic costs, “suggesting that eventually most U.S. individuals will face burdensome health care spending,” researchers said.
Inflammation may explain how ‘forever chemicals’ harm heart health
People who are exposed to a mix of “forever chemicals” are at higher risk for certain heart and metabolic health problems, and inflammation may be a key reason why, a new study in Eco-Environment & Health says.
Researchers measured levels of nine per- and polyfluoroalkyl substances, known as PFAS, in the blood of nearly 8,000 people. They linked high exposure to a mixture of PFAS chemicals to unhealthy cholesterol levels, high blood pressure and high uric acid.
As PFAS exposure increased, so did risks: People with higher levels of PFAS mixtures in their blood were also more likely to have high LDL cholesterol, hypertension and hyperuricemia, a condition that can lead to gout.
People with higher PFAS levels also had elevated levels of blood markers linked to inflammation. Those markers may explain much of the link between PFAS exposure and problems such as obesity and unhealthy cholesterol, researchers suggested.
When researchers examined individual chemicals, one especially stood out: Perfluorohexane sulfonate was linked to every major category of cardiometabolic disease studied. People with the highest level of the chemical, also known as PFHxS, were more likely to have Type 2 diabetes, high cholesterol, high blood pressure and high uric acid compared with those who had the lowest levels. While PFHxS has been phased out of production in the U.S., it is still used in imported products and remains in the environment.
PFAS, which do not break down in the human body or environment, are chemicals designed to resist heat, water, grease and stains. They have been used in products such as nonstick coatings, textiles and firefighting foam. Most people are exposed to more than one PFAS at once.
Rolling back Medicaid coverage reduced access to prescriptions
Medicaid coverage helped millions of people maintain access to essential prescriptions for chronic diseases during some of the worst years of the COVID-19 pandemic. But that access narrowed when coverage was later rolled back, new research shows.
Published in JAMA Health Forum, the study found that prescription drug use for chronic diseases increased after states suspended eligibility review for existing Medicaid users, which allowed people to automatically stay covered. When those protections ended and states began removing people from Medicaid rolls, millions lost coverage and prescription use fell.
Before COVID-19 was declared a U.S. public health emergency in January 2020, Medicaid covered about 71 million people and paid for roughly 183 million prescriptions per quarter. Enrollment rose steadily during the continuous enrollment period, peaking at nearly 94 million people in mid-2023. During that same period, the number of prescriptions reimbursed by Medicaid also increased, reaching more than 212 million per quarter, the study found.
After the continuous enrollment provision ended, Medicaid enrollment fell by nearly 5% per quarter in subsequent months. Prescriptions used to treat chronic conditions — including diabetes, cardiovascular disease and cancer — decreased alongside enrollment.
States that experienced the largest drops in Medicaid enrollment during unwinding also saw the biggest reductions in prescriptions for chronic disease medications, with use falling by more than 7% per quarter. In contrast, states that adopted policies designed to protect coverage — such as spreading out disenrollments or using other data sources to verify eligibility — saw smaller declines in enrollment and little reduction in chronic medication use, the study found.
Other recent public health news of note:
• People living in nursing homes that lack air conditioning are more likely to die during heat waves, a new study in JAMA Internal Medicine finds. Researchers examined more than 73,000 deaths among nursing home residents, finding that extreme heat was linked to a significantly higher risk of death in facilities without AC. Across the U.S., deaths linked to extreme heat more than doubled between 1999 and 2023, and nearly 40% of those deaths occurred among older adults.
• Men who are exposed to microplastics may pass on metabolic health risks to their daughters, a new study in the Journal of the Endocrine Society suggests. Researchers found that female mice whose fathers were exposed to microplastics were more likely to develop higher blood sugar, increased blood pressure and excess body fat than offspring of fathers who were not exposed.
• Colorectal cancer is more likely to be diagnosed at an advanced stage in people who live in U.S. counties marked by poverty and racial segregation, new research accepted by the American Journal of Epidemiology shows. Researchers found that residents of the most disadvantaged counties face higher odds of late-stage disease than those in more affluent areas. The association was strongest among younger people and populations of color.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.