A weekly roundup of public health news
Chronic health conditions driving up health costs for Americans
More than half of Americans with private health insurance have at least one chronic condition, and their medical costs rise sharply with each additional diagnosis, according to a new analysis of insurance claims.
Nearly 58% of commercially insured patients had at least one chronic condition in 2024, a new white paper from Fair Health finds. Patients with chronic conditions cost insurers more than those without them, reflecting how ongoing illnesses drive much of the nation’s health care spending.
On average, patients with no chronic conditions had $1,590 in allowed medical costs during the year. For patients with just one chronic condition, that figure jumped to about $3,040. Costs continued to climb as conditions stacked up, reaching an average of $21,730 a year for patients with 10 or more chronic conditions — nearly 14 times higher than for patients with none.
High cholesterol was the most common chronic condition among the 44 types studied, affecting about 21% of commercially insured patients. Many people had more than one ongoing health issue. About 12% had two chronic conditions, while 9% had three.
Researchers also found wide differences in costs depending on the condition. Lung cancer was associated with the highest average annual spending among the studied issues, at nearly $22,740 per patient, while ADHD had the lowest, at about $4,200. Conditions such as heart attacks and dementia were linked to the highest number of concurrent illnesses.
Researchers also found ties between chronic disease and economic hardship. Clusters of conditions — including high blood pressure, diabetes, obesity, chronic kidney disease and high cholesterol — were more common in counties with higher poverty rates.
The findings come as national health care spending continues to climb. A study published Jan. 14 in Health Affairs found that U.S. health care spending rose 7.2% in 2024 to $5.3 trillion, driven largely by increased use of services. Hospital care, physician services and prescription drugs accounted for much of the growth.
Private health insurance, which covers more than 214 million people, remained the largest single payer, accounting for nearly one-third of all health care spending in 2024.
Air pollution tied to thousands of annual deaths in Pittsburgh region
Fine-particle air pollution is contributing to thousands of deaths each year in the Pittsburgh region, according to a new study.
Researchers estimated that nearly 13% of adult deaths in the Pittsburgh metropolitan area in 2019 were linked to exposure to fine-particle pollution, also known as PM2.5. The study, published Jan. 27 in the Annals of Global Health, analyzed air pollution levels and death records across eight counties in the region.
Of the nearly 27,200 adult deaths recorded in the Pittsburgh metro area that year, as many as 3,500 were attributable to PM2.5 pollution, according to study researchers, who were affiliated with Boston College’s Schiller Institute for Integrated Science and Society.
PM2.5 refers to tiny airborne particles that can be inhaled deep into the lungs and enter the bloodstream. Common sources include vehicle exhaust and wildfire smoke, though in the Pittsburgh area, they also include emissions from steel and coke manufacturing industries.
PM2.5 exposure during pregnancy was also linked to health harms. In 2019 alone, air pollution contributed to about 230 premature births, 175 low-weight births and 12 stillbirths in the Pittsburgh region, researchers calculated.
Children born in the Pittsburgh area may also experience lasting cognitive effects from the dirty air they breathe. Among the more than 24,600 children born in the region in 2019, PM2.5 exposure was associated with a total loss of more than 60,000 full-scale IQ points, according to the study.
The highest pollution levels and health impacts were concentrated in parts of Allegheny County, particularly areas south and east of Pittsburgh, where previous research has found high levels of black carbon and other hazardous air pollutants. Neighborhoods with higher levels of social disadvantage also tended to have higher PM2.5 concentrations than more affluent areas.
Many of the health effects reported in the study occurred at pollution levels below the U.S. Environmental Protection Agency’s current annual standard for PM2.5 exposure.
Rising pesticide toxicity puts reduction target at risk
The overall toxicity of pesticides used in agriculture is increasing worldwide, even as countries have pledged to cut pesticide use in half by the end of the decade, according to new research.
Published Feb. 5 in Science, the study found pesticides are becoming more harmful to living organisms across many countries, crops and ecosystems. The increase is driven both by the growing amount of pesticides that are applied and by the increasing toxicity of the chemicals themselves, particularly insecticides.
Researchers examined pesticide use between 2013 and 2019 and found that the total applied toxicity — a measure that accounts for both how much pesticide is used and how poisonous it is — increased for most groups of plants and animals studied. Growth was especially pronounced for insects, soil organisms and fish.
A small number of chemicals and crops were responsible for most of the harm. Fruits and vegetables, corn, soybeans, rice and other cereal crops accounted for roughly three-quarters or more of global pesticide toxicity.
Brazil, China, the U.S. and India together contributed more than half of the world’s total applied toxicity during the study period.
In 2022, nearly 200 nations agreed to reduce pesticide risks in agriculture by 50% by 2030 as part of global biodiversity commitments. Researchers said rising toxicity trends could undermine that target unless major changes are made.
Other recent public health news of note:
• More than one-quarter of physicians enrolled in Medicaid delivered no care to beneficiaries in 2021, a new study published in Health Affairs finds. Although most physicians in key specialties were enrolled in Medicaid, nearly 28% had no Medicaid claims in a given year. Participation varied widely by specialty, with more than 40% of psychiatrists classified as “ghost” physicians who saw no Medicaid patients. Primary care physicians were far more likely to be high-volume Medicaid providers.
• Wildfire smoke exposure may contribute to more than 24,000 deaths each year in the U.S., according to a new study published Feb. 4 in Science Advances. Researchers found that long-term exposure to wildfire-related fine-particle pollution was linked to higher death rates from nearly all causes studied. The strongest increase was seen in deaths from neurological diseases, with mortality rising as smoke exposure increased.
• Regulating sources of lead exposure sharply reduced Americans’ exposure to the toxin, a new study published in the Proceedings of the National Academy of Sciences finds. Researchers analyzed hair samples collected in Utah from 1916 to 2024, finding that as sources of exposure became increasingly regulated in the U.S., lead levels in hair samples declined from around 50 parts per million in the 1970s to 10 ppm in the 1990s. Average lead values have been less than 1 ppm since 2020. Before regulation by the U.S. Environmental Protection Agency, Americans were commonly exposed to lead through paint, gasoline, pipes and other products as well as through industrial emissions.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.