A weekly roundup of public health news
Health harms of wildfires felt long after flames go out
While the death count from this year’s devastating wildfires in Los Angeles officially numbers in the dozens, that total overlooks the hundreds of people who also died of related causes, new research says.
Fueled by drought and wind, 14 wildfires struck the Los Angeles area from Jan. 7 to 31, destroying more than 18,000 structures and directly causing the deaths of least 30 people. The new study, published Aug. 6 in the Journal of the American Medical Association, estimates that another 440 people died from related causes through Feb. 1 alone — nearly 15 times as many people who died directly from the fires. Researchers linked the deaths to causes such as lung or heart conditions that were worsened by smoke or stress as well as problems accessing health care because of the disaster.
Overall, deaths were 7% higher than expected in the Los Angeles area in the weeks after the wildfires began. Additional deaths may also have occurred in the months that followed, researchers suggested, though the study did not extend that far.
Suicide and drug overdose deaths can increase as well following wildfires, according to a second study in JAMA. Also released Aug. 6, the research found deaths from the two causes soared following the August 2023 wildfires in Maui, which directly killed at least 100 people and destroyed about 2,200 structures.
Researchers compared data on suicide and overdose death rates, finding a 97% increase in deaths from the two causes in Maui during the month of the fires. Deaths from the two causes also rose 46% in Hawaii’s other four counties, which researchers said may have been related to people who evacuated from the fires, or distress experienced by other residents. Previous research has found that calls to a federal suicide and crisis hotline spiked in Hawaii following the fires.
Suicide and overdose death rates in Hawaii and Maui returned to their usual levels in the months following the fires, researchers noted.
Maternal death rates improving, but still too high, brief finds
Maternal death rates are significantly higher in states that haven’t expanded Medicaid eligibility, according to an updated issue brief from the Commonwealth Fund.
In 2023, the most recent year federal data is available, pregnancy-related deaths were nearly 28% higher in the 10 states that hadn’t expanded eligibility for Medicaid. About 26.4 deaths per 100,000 live births occurred that year in states that had expanded access to the federal health insurance program for low-income people, compared to 33.7 per 100,000 in the non-expansion states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
Medicaid coverage saved lives during the height of the COVID-19 pandemic in 2021, when pregnant women in states without expansion had a 49% higher death rate, the brief said. With 41% of all U.S. births covered by Medicaid, the findings could offer insights into what’s ahead as federal and state policymakers pursue cuts to Medicaid.
Overall, during the five years before the pandemic, which began in March 2020, U.S. maternal death rates remained fairly stable nationwide, with 17.6 deaths per 100,000 live births in 2019, the brief found. That rate spiked to 24.9 per 100,000 in 2020 and 33.2 in 2021.
In 2023, the U.S. maternal death rate fell to 18.6 per 100,000 live births, equating to about 670 pregnancy-related deaths. While that rate was closer to pre-pandemic levels, the U.S. still trailed behind its high-income peers. As of 2023, the U.S. was one of only seven countries to report a significant jump in the rate of maternal deaths since 2000, according to the World Health Organization.
Pregnancy-related deaths remained higher for some women of color, with Black pregnant women dying at a rate of 50.3 per 100,000 live births in 2023. In comparison, white women died at a rate of 14.5 per 100,000; Hispanic women, 12.4; and Asian women, 10.7, according to the Centers for Disease Control and Prevention.
Longer wait for emergency services in some communities of color
Americans who live in historically redlined neighborhoods often have to wait longer for emergency medical services during a crisis, despite living in high-density areas.
New research published Aug. 5 in JAMA Network Open finds more than 2.2 million people lack rapid EMS access in formerly redlined neighborhoods, which tend to have higher proportions of people of color and residents with low incomes. Longer EMS response times can lower chances of survival for people suffering stroke, cardiac arrest and major trauma, among other conditions.
Redlining, which began in the U.S. in the 1930s, was a practice used to discriminate against people of color. Mortgage companies graded neighborhoods on a scale of A to D based on the proportion of minority residents, using their findings to deny loans to prospective homeowners. While the practice ended more than a half century ago, the effects linger.
Today, about 7% of people in neighborhoods that were once given a D grade — the lowest ranking — lack rapid EMS access, compared to about 4% of people in A-graded neighborhoods. Formerly D-graded neighborhoods were more likely to have a higher percentage of Black residents and to have greater population density.
Cities in the Eastern U.S. had the highest percentage of people living in formerly D-graded neighborhoods compared to other regions of the country.
Other recent public health news of note includes:
• Plastic is a growing and under-recognized danger to human health, according to a new review in The Lancet. Health-related economic losses from exposure to plastic chemicals and pollution costs the U.S. $1.5 trillion annually, with low-income people at high risk, researchers said. The review comes as international leaders undergo negotiations on a plastic treaty in Geneva this month.
• Workers in the stone benchtop industry report high rates of asthma, according to new research in Occupational & Environmental Medicine. Researchers said the findings suggest exposure to artificial stone dust may be linked to obstructive lung disease in addition to silicosis, a deadly lung disease that affects countertop workers.
• Onerous laws aimed at hindering care at abortion facilities are linked to OB-GYN shortages, a new study says. Targeted regulations of abortion providers, also known as TRAP laws, were associated with significant decreases in the density of OB-GYN health providers over three decades, particularly in nonmetropolitan counties, said the study in Health Affairs. TRAP laws, which are in place in 24 states, set cumbersome requirements such as room sizes or hallway widths.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.