Actuarial Outpost
 
Go Back   Actuarial Outpost > Actuarial Discussion Forum > Life
FlashChat Actuarial Discussion Preliminary Exams CAS/SOA Exams Cyberchat Around the World Suggestions

2017 ACTUARIAL SALARY SURVEYS
Contact DW Simpson for a Personalized Salary Survey

Reply
 
Thread Tools Search this Thread Display Modes
  #221  
Old 05-09-2017, 11:28 AM
campbell's Avatar
campbell campbell is offline
Mary Pat Campbell
SOA AAA
 
Join Date: Nov 2003
Location: NY
Studying for duolingo and coursera
Favorite beer: Murphy's Irish Stout
Posts: 85,000
Blog Entries: 6
Default

https://www.washingtonpost.com/news/...l_draw2&wpmm=1

Quote:
U.S. life expectancy varies by more than 20 years from county to county

Life expectancy is rising overall in the United States, but in some areas, death rates are going conspicuously in the other direction. These geographical disparities are widening, according to a report published Monday in JAMA Internal Medicine.

Life expectancy is greatest in the high country of central Colorado, but in many pockets of the United States, life expectancy is more than 20 years lower, according to the report from the University of Washington’s Institute for Health Metrics and Evaluation.

Spoiler:




Quote:
“Life expectancy in many places in this country is declining. It’s going backward instead of forward,” said Ali Mokdad, a co-author of the report and a professor at the university. “These disparities are widening, so this gap is increasing.”

People are less likely to live longer if they are poor, get little exercise and lack access to health care, the researchers found. Mokdad said the quality and availability of that health care — for example, access to screening for signs of cancer — has a significant effect on health outcomes. The United States, he said, needs to rethink how it delivers medical care, with a much greater investment in prevention, and a more holistic approach to creating healthy communities.

Andrew Cherlin, a professor of sociology and public policy at Johns Hopkins University, said that the increasing inequality in death rates at the county level is troubling. “But it’s unclear from this study what has caused it,” said Cherlin, who was not part of the research team. "It’s hard to separate out the consequences of lower incomes, unhealthy conditions such as obesity, less access to health care providers, and of healthier people moving out of some counties.”

The new research echoes other findings in recent years that show that the United States is failing to keep up with improvements in longevity seen in other affluent nations. In 2013, researchers described what they called a “health disadvantage” in the United States when compared to peer countries. More recent research has focused on “diseases of despair” that have contributed to a dramatic spike in death rates among midlife working-class whites.

Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said.

“We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.”

The Institute for Health Metrics and Evaluation researchers looked at death certificates from 1980 through 2014. Among the places with sharply increased life expectancy and lower deaths over that period are the District of Columbia and Loudoun County, Va. — where life expectancy is up 12.8 and 12.4 percent, respectively. Fairfax County has the lowest all-cause death rate in the metropolitan Washington region, significantly lower than the national average.
Spoiler:




Quote:
Of the 10 counties where life expectancy has dropped the most since 1980, eight are in Kentucky. The other two are in Oklahoma and Alabama. The report includes an interactive map of death rates county by county (and sometimes by city, when a city is not part of a county). The areas with the worst mortality metrics include central Appalachia, the Mississippi Delta and areas in the Dakotas with large Native American populations.



https://vizhub.healthdata.org/subnational/usa
__________________
It's STUMP

LinkedIn Profile
Reply With Quote
  #222  
Old 05-12-2017, 04:20 PM
campbell's Avatar
campbell campbell is offline
Mary Pat Campbell
SOA AAA
 
Join Date: Nov 2003
Location: NY
Studying for duolingo and coursera
Favorite beer: Murphy's Irish Stout
Posts: 85,000
Blog Entries: 6
Default

MATERNAL MORTALITY

https://www.propublica.org/article/d...m_medium=email

Quote:
The Last Person You’d Expect to Die in Childbirth
The U.S. has the worst rate of maternal deaths in the developed world, and 60 percent are preventable. The death of Lauren Bloomstein, a neonatal nurse, in the hospital where she worked illustrates a profound disparity: the health care system focuses on babies but often ignores their mothers.

.....
HE ABILITY TO PROTECT THE HEALTH OF MOTHERS AND BABIES in childbirth is a basic measure of a society’s development. Yet every year in the U.S., 700 to 900 women die from pregnancy or childbirth-related causes, and some 65,000 nearly die — by many measures, the worst record in the developed world.

American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that “a man is more likely to die while his partner is pregnant than she is.” But in the U.S., maternal deaths increased from 2000 to 2014. In a recent analysis by the CDC Foundation, nearly 60 percent of such deaths were preventable.

While maternal mortality is significantly more common among African Americans, low-income women and in rural areas, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, in every part of the U.S. ProPublica and NPR spent the last several months scouring social media and other sources, ultimately identifying more than 450 expectant and new mothers who have died since 2011. The list includes teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, a co-founder of the YouTube channel WhatsUpMoms, and more than a dozen doctors and nurses like Lauren Bloomstein. They died from cardiomyopathy and other heart problems, massive hemorrhage, blood clots, infections and pregnancy-induced hypertension (preeclampsia) as well as rarer causes. Many died days or weeks after leaving the hospital. Maternal mortality is commonplace enough that three new mothers who died, including Lauren, were cared for by the same OB-GYN.

The reasons for higher maternal mortality in the U.S. are manifold. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don’t address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

Yet the worsening U.S. maternal mortality numbers contrast sharply with the impressive progress in saving babies’ lives. Infant mortality has fallen to its lowest point in history, the CDC reports, reflecting 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth and improve outcomes for very premature infants. The number of babies who die annually in the U.S. — about 23,000 in 2014 — still greatly exceeds the number of expectant and new mothers who die, but the ratio is narrowing.
The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica’s and NPR’s reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.

.....
In regular maternity wards, too, babies are monitored more closely than mothers during and after birth, maternal health advocates told ProPublica and NPR. Newborns in the slightest danger are whisked off to neonatal intensive care units like the one Lauren Bloomstein worked at, staffed by highly trained specialists ready for the worst, while their mothers are tended by nurses and doctors who expect things to be fine and are often unprepared when they aren’t.
When women are discharged, they routinely receive information about how to breastfeed and what to do if their newborn is sick but not necessarily how to tell if they need medical attention themselves. “It was only when I had my own child that I realized, ‘Oh my goodness. That was completely insufficient information,’” said Elizabeth Howell, professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. “The way that we’ve been trained, we do not give women enough information for them to manage their health postpartum. The focus had always been on babies and not on mothers.”

.....
The fact that Lauren gave birth over the weekend may also have worked against her. Hospitals may be staffed differently on weekends, adding to the challenges of managing a crisis. A new Baylor College of Medicine analysis of 45 million pregnancies in the U.S. from 2004 to 2014 found mothers who deliver on Saturday or Sunday have nearly 50 percent higher mortality rates as well as more blood transfusions and more perineal tearing. The “weekend effect” has also been associated with higher fatality rates from heart attacks, strokes and head trauma.
.....
EARLIER THIS YEAR, an analysis by the CDC Foundation of maternal mortality data from four states identified more than 20 “critical factors” that contributed to pregnancy-related deaths. Among the ones involving providers: lack of standardized policies, inadequate clinical skills, failure to consult specialists and poor coordination of care. The average maternal death had 3.7 critical factors.
“It’s never just one thing,” said Roberta Gold, a member of the Council on Patient Safety in Women’s Health Care, whose daughter and unborn grandson died from a pregnancy-related blood clot in 2010. “It’s always a cascading combination of things. It’s a slow-motion train wreck.”

.....

AS THE MATERNAL DEATH RATE has mounted around the U.S., a small cadre of reformers has mobilized. Some of the earliest and most important work has come in California, where more babies are born than in any other state — 500,000 a year, one-eighth of the U.S. total.
Modeled on the U.K. process, the California Maternal Quality Care Collaborative is informed by the experiences of founder Elliott Main, a professor of obstetrics and gynecology at Stanford and the University of California-San Francisco, who for many years ran the OB-GYN department at a San Francisco hospital. “One of my saddest moments as an obstetrician was a woman with severe preeclampsia that we thought we had done everything correct, who still had a major stroke and we could not save her,” he said recently. That loss has weighed on him for 20 years. “When you’ve had a maternal death, you remember it for the rest of your life. All the details.”
Launched a decade ago, CMQCC aims to reduce not only mortality, but also life-threatening complications and racial disparities in obstetric care. It began by analyzing maternal deaths in the state over several years; in almost every case, it discovered, there was “at least some chance to alter the outcome.” The most preventable deaths were from hemorrhage (70 percent) and preeclampsia (60 percent).

http://www.thelancet.com/pdfs/journa...16)31470-2.pdf

Quote:
Summary
Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is
imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success,
remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world
by underlying cause and age from 1990 to 2015.
Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages
10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and
territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal
death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIVrelated
maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of
drivers of trends, including the relation between maternal mortality and coverage of specifi c reproductive health-care
services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic
Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.
Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical
disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than
400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the
dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI
quintile improved the most from 1990 to 2015, but also has the most complicated causal profi le. Maternal mortality in
the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion,
ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage
of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled
birth attendance.
Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should
establish or renew systems for collection and timely dissemination of health data; expand coverage and improve
quality of family planning services, including access to contraception and safe abortion to address high adolescent
fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of
more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and
reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine
their own performance with respect to their SDI level, using that information to formulate strategies to improve
performance and ensure optimum reproductive health of their population.
https://www.cdcfoundation.org/sites/...MRIAReport.pdf

Quote:
REPORT FROM MATERNAL MORTALITY
REVIEW COMMITTEES:
A VIEW INTO THEIR
CRITICAL ROLE

.....
Overall, the leading causes of pregnancy-related death include seven causes accounting for 72.2% of all
pregnancy-related deaths (Figure 4).

Figure 4. Leading Underlying Causes of Pregnancy-Related Deaths

Hemorrhage 12.7
Cardiovascular & Coronary Conditions 12.7
Cardiomyopathy 11.4
Infection 9.5
Embolism 9.5
Mental Health Conditions 8.9
Preeclampsia & Eclampsia 7.6




__________________
It's STUMP

LinkedIn Profile
Reply With Quote
  #223  
Old 05-22-2017, 10:42 PM
campbell's Avatar
campbell campbell is offline
Mary Pat Campbell
SOA AAA
 
Join Date: Nov 2003
Location: NY
Studying for duolingo and coursera
Favorite beer: Murphy's Irish Stout
Posts: 85,000
Blog Entries: 6
Default

https://www.citylab.com/politics/201...m_medium=email

Quote:
Where Life Expectancy Is Dipping Across America
In 13 counties, residents can expect to die younger than their parents.

In 13 counties across the U.S., Americans can now expect to die younger than their parents did. And the eight counties with the largest declines in life expectancy since 1980 are all in the state of Kentucky.

That’s according to a new study out Monday in the journal JAMA: Internal Medicine, for which researchers examined geographic changes and inequality in life expectancy across the U.S.

The authors, who are from the Institute for Health Metrics and Evaluation, at the University of Washington, and Erasmus University, in the Netherlands, found that although life expectancy at birth for Americans increased from 73.8 years in 1980 to 79.1 years in 2014, there is a 20-year gap in life expectancy between the shortest- and longest-living counties. This inequality in life expectancy has grown since 1980, they found. Other studies have found that nationally, life expectancy has ticked down slightly since 2014, the final year of the JAMA study.



__________________
It's STUMP

LinkedIn Profile
Reply With Quote
  #224  
Old 05-23-2017, 09:28 AM
snikelfritz's Avatar
snikelfritz snikelfritz is offline
Member
 
Join Date: Jun 2011
Location: Yep
Studying for Nope
Favorite beer: Yep
Posts: 27,409
Default

Aren't counties pretty small?

I doubt every county in Kentucky has enough deaths per year to form credible data.....
__________________
The universe is a cruel uncaring void, the key to being happy isn't the search for meaning, it's to just keep yourself busy with unimportant nonsense and eventually, you'll be dead.
Reply With Quote
  #225  
Old 05-23-2017, 09:29 AM
snikelfritz's Avatar
snikelfritz snikelfritz is offline
Member
 
Join Date: Jun 2011
Location: Yep
Studying for Nope
Favorite beer: Yep
Posts: 27,409
Default

And hey, if you measure mortality by house, some houses have life expectancies like 60 years different from others!
__________________
The universe is a cruel uncaring void, the key to being happy isn't the search for meaning, it's to just keep yourself busy with unimportant nonsense and eventually, you'll be dead.
Reply With Quote
  #226  
Old 05-23-2017, 09:32 AM
snikelfritz's Avatar
snikelfritz snikelfritz is offline
Member
 
Join Date: Jun 2011
Location: Yep
Studying for Nope
Favorite beer: Yep
Posts: 27,409
Default

Robertson county Kentucky, population, 2,282 - everyone would have to die in a year for it to be credible.....

https://en.wikipedia.org/wiki/County...sely_populated
__________________
The universe is a cruel uncaring void, the key to being happy isn't the search for meaning, it's to just keep yourself busy with unimportant nonsense and eventually, you'll be dead.
Reply With Quote
  #227  
Old 05-23-2017, 09:40 AM
E's Avatar
E E is offline
Eddie Smith
SOA AAA
 
Join Date: May 2003
College: UGA
Posts: 9,167
Default

Quote:
Originally Posted by snikelfritz View Post
Robertson county Kentucky, population, 2,282 - everyone would have to die in a year for it to be credible.....

https://en.wikipedia.org/wiki/County...sely_populated
Hopefully they'll have an open bourbon bar at the town hall meeting where they announce that.
__________________


Learn how FSA exams are different from the prelims

We have your exam covered:

LP | LFV-U | LFV-C | LRM | ERM | QFI Quant | QFI Adv | QFI IRM | G&H Core | G&H Adv | G&H Sp

Check out our Technical Skills Course and our new R Course!

Connect on Twitter, Facebook, & LinkedIn
Reply With Quote
  #228  
Old 05-23-2017, 11:06 AM
campbell's Avatar
campbell campbell is offline
Mary Pat Campbell
SOA AAA
 
Join Date: Nov 2003
Location: NY
Studying for duolingo and coursera
Favorite beer: Murphy's Irish Stout
Posts: 85,000
Blog Entries: 6
Default

Quote:
Originally Posted by snikelfritz View Post
Aren't counties pretty small?

I doubt every county in Kentucky has enough deaths per year to form credible data.....

They do some smoothing -- but I agree, it's a bit silly for counties where there's almost nobody there.
__________________
It's STUMP

LinkedIn Profile
Reply With Quote
  #229  
Old 05-23-2017, 12:02 PM
Actuary321 Actuary321 is offline
Member
 
Join Date: Sep 2001
Posts: 27,760
Default

Quote:
Originally Posted by snikelfritz View Post
Aren't counties pretty small?

I doubt every county in Kentucky has enough deaths per year to form credible data.....
Utah counties are huge. There are only 29 in the entire state. But most are small population wise. I was looking at voting recently and some of the counties had less than 1000 votes cast for president and they had pretty decent turnout. So they could also suffer from the same issue of few deaths and few births to make things credible.
Reply With Quote
  #230  
Old 05-23-2017, 01:11 PM
A Student A Student is offline
Member
Non-Actuary
 
Join Date: Dec 2001
Posts: 3,751
Default

On the maternal mortality article - overall a disturbing trend in the US, but this quote made me chuckle a bit...

'in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that a man is more likely to die while his partner is pregnant than she is. '
Reply With Quote
Reply

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


All times are GMT -4. The time now is 12:19 PM.


Powered by vBulletin®
Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.
*PLEASE NOTE: Posts are not checked for accuracy, and do not
represent the views of the Actuarial Outpost or its sponsors.
Page generated in 1.49551 seconds with 9 queries