A weekly roundup of public health news
Emergency departments threatened by low reimbursements, high demand
Long-festering problems within the nation’s emergency care system are increasing, putting both hospitals and patients at risk, a new report finds.
Released April 7 by the RAND research organization, the report said issues such as long emergency department wait times, patient boarding in emergency department beds and high levels of uncompensated care are expanding, threatening the viability of EDs within U.S. hospitals.
The findings come as visits to EDs have surged back to levels seen before the start of the COVID-19 pandemic, which deterred some people from seeking care at the facilities.
While the nation’s nearly 4,600 EDs provide emergency care to anyone that needs it, regardless of their ability to pay, reimbursements to ED physicians have not kept pace with growth. Payments for in-network insured patients dropped almost 11% from 2018 to 2022, and nearly 48% percent for out-of-network visits, the report said. Payments to ED physicians from Medicare and Medicaid fell 3.8% during the same time period.
ED staff also are managing more patients with complex medical and social needs, such as older adults, patients with mental illness and people who are homeless, researchers said. Without changes, some EDs may be forced to close and more clinicians may leave emergency care, worsening health care workforce shortages.
Hospitals that primarily serve Black patients have worse adverse health events
U.S. hospitals that predominantly serve Black communities fare worse on a range of preventable patient health problems, a new study in Nursing Research finds.
Researchers looked at indicators of patient health at more than 3,100 U.S hospitals, finding significantly higher rates of pressure ulcers, post-surgery deep vein thrombosis and post-surgery sepsis at Black-serving hospitals. Each of the conditions are considered to be largely preventable through adequate levels of skilled hospital nursing care.
Hospitals that disproportionately serve Black patients tend to have lower nurse staffing and higher death rates, previous research has found. Black-serving hospitals, which number about 575 nationwide, are also more likely to be located in urban areas, be owned by for-profit companies or governments and serve as teaching facilities.
Microplastics released into Texas bays can end up as ocean pollution
Plastic pollution released into Texas coastal waterways doesn’t always stay put along the shoreline, a new study in Environmental Science & Technology finds.
Researchers measured levels of microplastic pollution in several locations along the state’s 360-plus miles of coastline, finding the highest concentrations near river mouths. Plastic particles were just as prevalent in deep waters as shallow waters close to shore, suggesting that at least some particles are being transported out of bays, into the Gulf of Mexico and on to the open ocean, researchers said.
The Texas bay system, which is a series of interconnected estuaries along the Gulf Coast, has been the site of a number of plastic pollution incidents, including a spill of billions of plastic pellets by the Formosa Plastic Corporation in Point Comfort, Texas, in 2019.
At least 35 facilities in Texas produce micropellets, also known as nurdles, and other pre-production microplastics, Environment America found last year. Since 2018, volunteers have collected more than 2 million nurdles, which are used to create plastic products, along the Gulf Coast and beyond.
Researchers in the new study suggested high storm winds and the state’s shrimp and oyster fishing industry, which stirs up the bottom of bays and redistributes sediments, may play a role in how the microplastics are dispersed.
Other recent public health news of note includes:
• Two-thirds of U.S. adolescent girls are impacted by state abortion restrictions, new research in JAMA Pediatrics says. More than 7 million girls ages 13 to 17 live in states with abortion bans, restrictive gestational limits or requirements that parents be involved, according to the study.
• A recent study in JAMA Network Open shows children who are exposed to high levels of ozone in their first two years of life are at considerably increased risk of developing asthma or wheezing two to three years later. Another study, published this month in Environment International, finds kids who are exposed to high levels of air pollution in early and mid-childhood have weaker connections in regions of the brain that are responsible for functions such as thinking, perception and movement control.
• Heat waves have long been linked to elevated risks of heart attack and stroke. A new study published April 8 in the Journal of the American College of Cardiology finds deaths from heart attacks, heart failure and other cardiac-related causes increase significantly when heat wave temperatures are high both during the day and night.
• Death rates for ischemic strokes are on the rise in the U.S., particularly for Black Americans and people who live in rural areas, according to new research published April 9 in PLOS One. Ischemic strokes, which are the most common type of stroke, occur when blood flow to the brain is blocked. People who experience such strokes are increasingly dying at home, with the rate of at-home deaths jumping 71% over two decades, the study found.
• Access to cancer care can require significant travel for rural Americans. Recent research in JAMA Network Open that looked at data from rural Medicare users with cancer finds nearly 19% of patients traveled to other states for surgery, 17% for radiation therapy and 16% for chemotherapy. The treatments generally require multiple visits over many months, which could create barriers to care.
• Long-term exposure to high levels of air pollution can impede brain health for older adults, a new study in The Journals of Gerontology: Series A concludes. Researchers found people ages 65 and older who were exposed to high levels of nitrogen dioxide and fine-particle pollution performed worse on cognitive tests such as memory and language compared to people who lived in areas with average pollution levels.
• Recent findings in Social Science & Medicine link frequent exposure to gun violence to depression and suicidal thoughts. About, 12% of participants in the nationwide study said they had experienced five or more incidents of gun violence during their lives. More than a quarter said they had heard a gunshot within the past year.
• People exposed to fine-particle air pollution from wildfire smoke are more likely to visit emergency departments for mental health conditions, an April 4 study in JAMA Network Open reports. Researchers examined data on ED visits that occurred during severe wildfires in California in 2020, finding an uptick in visits for certain psychotic disorders, anxiety, depression and other mood-related conditions. Young children, people of color and women were at higher risk.
• Black women with breast cancer who live in disadvantaged neighborhoods are more likely to die from the disease than Black women who live elsewhere, new findings in in JAMA Network Open show. Researchers suggested chronic exposure to stressors, longer distance to treatment facilities and limited access to nutritious food could play a role in the disparities.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.