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  #271  
Old 02-27-2018, 03:35 PM
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CHICAGO, ILLINOIS
MURDER RATE

https://www.citylab.com/equity/2018/...31c4df#new_tab

Quote:
The Bleeding of Chicago

America’s third-largest city has built one of the world’s best trauma care systems. But that success might be obscuring the true scale of its gun violence.


Spoiler:
Ask a cop, physician, or EMT in Chicago about July 4 of last year, and most, if not all, will have a story to tell.

The city has a history of violence over this holiday, and police worried that the extra-long weekend in the summer of 2017 would produce exceptionally bloody results. They weren’t wrong.

Over the five-day weekend, 101 Chicagoans were shot; of those, 15 were slain. The holiday drew national headlines and scorn from the Trump administration and others who saw the shooting spree as emblematic of a city intractably stained by violence.

In 2016, 771 people were killed in Chicago, its highest homicide tally since 1996 and the largest number of murder victims by volume of any U.S. city. Per capita, this wasn’t the highest rate in the nation—it ranked ninth among cities with a population of 250,000 or greater. St. Louis officially held the title of most murderous large city in the United States in that year. In 2017, Baltimore—recently declared the most dangerous in America by USA Today and the site of 343 homicides in 2017—is likely to top the FBI’s forthcoming list of most lethal American cities. Baltimore’s police chief was sacked in January due to the rising crime there.

But it’s Chicago that feels like America’s murder capital: The nation’s third-largest city ended 2017 with 650 killings, more than twice the toll in larger New York City or Los Angeles. That represents an improvement over 2016’s numbers, but the sheer scale of the Chicago-style carnage remains striking.

There’s something else that’s extraordinary about Chicago’s murder rate. Take that holiday weekend: While 15 people died, 86 were shot—but survived. They lived because the city’s first responders and emergency room staff have adapted to accommodate combat-zone conditions. Chicago boasts one of the oldest and largest urban emergency medicine networks in the world, with six certified Level 1 trauma centers within the city limits. Indeed, criminologist Arthur Lurigio of Loyola University Chicago credits the strength of this network, and recent improvements in trauma care, with the historic drop in the city’s homicide rate since its mid-1990s peak.

“I have often wondered how many homicides we’d have in Chicago if it wasn’t for the skilled physicians in our ERs,” Lurigio said. “We could very well have surpassed 700, 800, even 900 [murders] into the 2000s.”

The story of why that didn’t happen is a story about what Chicago’s murder statistics can and can’t say about the true scale of its gun violence.

The twist in the Chicago murder narrative
If you watch the seasonal ebb and flow of homicide numbers in Chicago since 1957, as the Chicago Tribune did recently, you see how violence flares in the summer, then retreats every winter. Pull further back and the six-decade saga—39,000 killings, by the paper’s count—seems to assume a three-act structure, dominated by a ferocious second-act stretch from 1969 to 1998 in which the annual toll topped 650, peaking in 1992 with 943 killings.

Then comes a slow decline during the 2000s and 2010s, with a low of 415 total homicides in 2014. The last two years form a troubling coda. As violence surged, sank, and spiked anew, law enforcement officials and local politicians were quick to claim the credit—and then get hammered with the blame.

But telling the story of gun violence in Chicago only through the rise and fall of the CPD’s homicide stats misses another narrative entirely. To see this, reporters from Chicago’s Data Reporting Lab looked at homicide and shooting data covering Cook County, which contains the city of Chicago. These figures from the Illinois Department of Health and official Chicago police statistics reveal not only the number of gun-related homicides but also the number of patients discharged from county hospitals with gunshot wounds from 1990 to 2015.

The narrative they tell is a slightly different one: As murders trended down overall, the number of shootings has been holding relatively steady—and even scaling up.


Cook County’s homicide numbers went up and down between 1995 and 2015, but the overall trend line (in red) went down. (Data Reporting Lab/CityLab)
Take 1995, when guns accounted for 73 percent of all homicides in Cook County. There were 995 total slayings. Fast forward to 2015, and there were 604 killings, with guns accounting for a larger proportion—84 percent—of them. The homicide toll during that 20-year span was lowest in 2013: 536 killings, with guns making up 80 percent of them, or 430 homicides.

But while homicides by firearms went down over that stretch—by 30 percent overall—shootings do not appear to follow the same pattern. The annual number of Chicago-area gunshot victims who survived and were discharged from the county’s hospitals bounced up and down, starting with 677 in 2005 and ending at 870 in 2015, according to hospital inpatient discharge records.


The black line shows the number of shooting victims discharged from Cook County hospitals from 1995 to 2015. The annual toll varied widely, but the red line shows a slight overall trend line upward. (Data Reporting Lab/CityLab)
In other words, the story of Chicago’s lower homicide rates during the 2000s and 2010s doesn’t seem to be intimately connected to law enforcement tactics, as city leaders and police officials often suggest.

During the years when homicide was in decline, police regularly touted new programs and legal strategies that were used to lop the head off the gangs that bloodied the streets of Chicago for generations. It was an easy sell: More community policing, hit the hotspots of drug dealing and gun trafficking, and use random stops to clear out cars of drugs and weapons. But that explanation came unglued after 2015.

The Chicago Police Department and the Mayor’s Office did not respond to requests for comment. But current Chicago Police Superintendent Eddie Johnson has cited new policing strategies and tactics as the chief reason the slayings dropped by more than 100 in 2017. “The fact that we’ve got it over 100 in terms of reduction is really room for encouragement and positive thinking going into 2018,” Johnson told the Tribune, which uses a different methodology for calculating homicides in Chicago: Their calculations bring the 2017 toll up to 670, which includes slayings on expressways (which are patrolled by state police).

It’s also worth noting the period covered in this analysis was a turbulent one for the Chicago Police Department, which saw a turnover of several superintendents and was the target of a scathing Department of Justice investigation in 2015. As crime surged in that year, Mayor Rahm Emanuel remarked that the department had gone “fetal” in their policing tactics in the aftermath of controversial police shootings, a comment that drew fierce opposition from officers and contributed to the national debate around the “Ferguson effect” and its possible role in explaining crime upticks in several U.S. cities.

“It’s sad that our paramedics are great at what they do. It’s sad that they should be getting that kind of experience on the streets of Chicago.”
Other first responders might be less surprised by the relationship between policing, shootings, and homicides.

“Everyone knows it’s the fire department that saves lives in Chicago,“ said one high-ranking Chicago Fire Department official who declined to be identified, “not the police.”

It’s a distinction that the city’s policymakers should heed. “It's not really the murder rate but the shootings that we ought to be looking at,” said Toni Preckwinkle, president of the Cook County Board of Commissioners and a former alderman representing the South Side’s Fourth Ward. “The world-class nature of our trauma care masks, to some extent, the problem. … Looking at the gun violence issue as simply a policing issue is a terrible mistake.”

“Shifting the spectrum”
In a way, there’s a remarkable medical success story buried in this data. “People that would have died are now surviving with disabilities, and people who would have survived with disabilities are now surviving with a full recovery,” said John Barrett, former director of the trauma unit at John H. Stroger, Jr. Hospital of Cook County. Trauma specialists “are shifting the spectrum backward. The end result is that less people are actually dying of those who were shot.”

But to Mary Sheridan, the city’s chief paramedic, this is an achievement laced with tragedy. “It’s sad that our paramedics are great at what they do,” she said. “Navy and Army medics are training at Rush [Medical Center], and they ride with us. It’s sad that they should be getting that kind of experience on the streets of Chicago.”

Chicago’s success as a national leader in trauma care also has a stark geographical limitation, one that community members have long sought to address. The vast majority of Chicago slayings—94 percent in 2017—occur in the city’s South and West sides, in places marked not only by poverty but, in some cases, a lack of swift access to medical care. The southeast corner of the city marks a perilous “trauma desert,” where shooting victims are often shuttled out of the city to suburban centers, or north to Stroger Hospital near downtown. It can be a deadly delay.


In this heat map of Chicago gun violence, based on data from the first part of 2017, the city’s West and South sides dominate. (Data Reporting Lab/CityLab)
That will soon change: 25 years after closing its trauma facility, the University of Chicago broke ground on a new trauma center in September 2016. The estimated $43 million facility is set to open in May, after years of protests and pressure from the South Side community. According to Sheridan, the UChicago trauma center is expected to have “a significant impact” on survival rates. “Our ambulances may have a 7- to 10-minute ride, versus 20 minutes. The times are going to fall by half or better.”

Those minutes can be critical. In emergency care, the concept of the “golden hour” following severe injury—a bedrock principle of the field since the 1970s—emphasizes the urgency of getting victims to hospital care. Transport time is particularly critical in cases of penetrating wounds like gunshots, where severe blood loss makes every moment count. But, according to research from Dr. Marie Crandall, a trauma surgeon and former Northwestern University Hospital associate professor of surgery, more than a quarter of shooting victims from parts of southeast Chicago experience transport times of 30 minutes and up. If you take a bullet in front of UChicago hospital today, you might have to take a ride north to Stroger before receiving hospital care, losing precious moments.

“Before, we’d see gunshot victims with maybe two or four gunshot wounds. Now we see victims with eight to ten.”
“For every mile away [that] a gunshot victim is from a trauma center, there’s an increase in the mortality rate,” said Crandall, now professor of surgery and director of research at the University of Florida College of Medicine Jacksonville. “We found that people shot more than five miles away from a trauma center door increased the risk of dying more than 23 percent.”

Besides time, the men and women trying to save Chicago’s shooting victims are racing another enemy: the growing lethality of modern weaponry. “There has been this drastic increase in the number of gunshot victims we’ve been seeing over the last two years—but also, we are seeing an increase in the number of wounds,” said Dr. Ponni Arunkumar, Cook County’s chief medical examiner. “Before we’d see gunshot victims with maybe two or four gunshot wounds. Now we see victims with eight to 10.”

Semiautomatic weapons like the AR-15—the rifle used in the Parkland, Florida, school shooting this month—are becoming a more common tool in the arsenal of some gangs in Chicago. Last year, an AR-15 was recovered after the shootings of two Chicago police officers. The rifles shoot high-velocity bullets that can be vastly more damaging than bullets fired from typical firearms. Arunkumar also cites the destructive nature of so-called R.I.P bullets (for “radically invasive projectile”), a type of hollow-point round designed to fragment inside a person’s body, in order to cause maximum trauma. Their manufacturer markets them as “the last bullet you’ll ever need.”

When shooting victims in Chicago started turning up with these wounds, “we didn’t know what we were dealing with,” said Arunkumar. “We had to look it up. Then we looked up the casing and the kind of projectiles and how they produce injury.” What they found was frightening. “Once it impacts the soft tissue, it fragments and goes in different directions. One surgeon described it to me as like little paper clips.”

Essentially, Chicago’s world-class trauma system is deadlocked in a kind of technological arms race, with first responders deploying the latest combat-proven gear and techniques against weaponry on the streets that has become more lethal. Given this escalation, the current survival rates of Chicago’s shooting victims stand as an even more impressive achievement. But it has come at a daunting cost—and it can’t be sustained indefinitely.

Stopping the bleeding
Start with the costs to the city of dispatching a fully loaded ambulance. Each new vehicle costs the city up to $400,000; to fully staff and equip it runs the bill to around $2 million, per ambulance, per year, according to city officials.

Then add the costs of surgery to repair (if possible) the victim’s wounds and the weeks and months of aftercare and rehabilitation. In Chicago alone, a study from the University of Chicago’s Crime Lab in 2009 estimated that the costs associated with shootings total $2.5 billion annually—a staggering figure that factors in “lost worker productivity, medical costs, mental health costs, and costs to the government vis-à-vis the criminal justice system,” the study authors wrote. The same study concluded that the national figure was $100 billion. In 2015, Mother Jones ran the gun violence bill for 2012 up to $229 billion; that figure included $169 billion worth of impact on victims’ quality of life and $49 billion in lost wages.

“We could put 50 more ambulances on the streets of Chicago, but if we’re not using them appropriately, it won’t make a bit of difference.”
But there’s considerable guesswork in such figures, as the issue has been only lightly researched, and estimates are all over the fiscal map. Consider: A Johns Hopkins study found last year that the yearly total for hospital costs associated with gun violence as just under $3 billion nationally. And a Chicago Tribune analysis last year showed Chicago-area hospitals and trauma centers got a $447 million bill covering the care of about 12,000 victims between 2009 and the middle of 2016.

Part of the explanation for the varying public health costs related to gun violence is that the Centers for Disease Control and Prevention—the very government entity charged with studying and tracking what ails Americans—has been effectively blocked from funding research on the topic since 1996, when the GOP-led Congress threatened to strip CDC funding over the issue. In the wake of the Parkland shooting, calls to reverse that have intensified recently.

To stanch this bleeding of dollars as well as blood, Sheridan advocates a model known as community paramedicine, which is currently being used in a few pilot areas in Chicago. That model integrates emergency response with primary care; it connects 911 dispatchers, social workers, nurses, EMTs, paramedics, surgeons, cops, firefighters and after-care specialists to provide a coordinated “continuum of care” throughout a longer period of time—and identify problem patients and hot spots earlier. “It’s a whole change of the healthcare system,” Sheridan said, “and a wild change to the billing system would have to take place. Because, as it is, the cost to the city is too huge.”

Especially in low-income neighborhoods, emergency responders now tend to function as an extremely costly form of primary care. Community paramedicine would allow first responders to intervene in troubled areas earlier, providing care on the spot instead of making unnecessary ER runs. “What do you say to the elderly woman who wakes up scared and lonely and calls 911?” Sheridan said. “We could put 50 more ambulances on the streets of Chicago, but if we’re not using them appropriately, it won’t make a bit of difference.”

The Chicago Fire Department has studied community paramedicine in Rockford, Illinois, and Minnesota, as well as several pilot areas of the city. Sheridan said the department and others are working to keep in closer contact with any victim or patient after release, to better keep tabs on their health and ward off re-victimization. “This is not just Chicago, but a national focus,” she said.

Not long ago, Sheridan and others went to Washington to lobby on behalf of this model. “I think we had everyone’s ear, but the changes from Obamacare to Trumpcare to whatever is coming has pushed it back months, if not years.”

Recommended

Reeling from a Murder Spike, Baltimore Grasps at a Gun Bill
RACHEL M. COHEN
SEP 22, 2017

What's Causing Chicago’s Homicide Spike?
MATT FORD
JAN 25, 2017

What Happened to Crime in Camden?
SARAH HOLDER
JAN 10, 2018
So, for now, Chicago’s first responders will keep running their race with gun violence, doing what they do to keep a lid on the city’s murder rate. There’s a limit, however, to what even the most well-equipped trauma centers and the most advanced emergency care technology can achieve without more social and political willpower. “We have not done anything to alter the root causes of violence in those communities,” said Loyola’s Lurigio. “We need to change the climate. Climate change takes a very long time.”

And in Chicago, that hasn’t happened yet. Winter here is often a time when harsh weather offers a respite from the killing; so far, 2018 has failed to provide much of a pause. In the first week of February, Cook County Board president Toni Preckwinkle checked the numbers.

“As of Monday of this week,” she said, “we’ve already seen 51 gunshot homicides in the [medical examiner’s] office.”

With additional reporting by Kevin Stark of the Data Reporting Lab.

This story is part of a collaboration between CityLab, The Data Reporting Lab, and Reveal, a podcast from The Center for Investigative Reporting and PRX. To listen to the full episode, go to revealnews.org/podcast.
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  #272  
Old 02-28-2018, 05:31 PM
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http://www.thinkadvisor.com/2018/02/...paign=02262018

Quote:
Alzheimer's Death Rate Continues to Rise: CDC
The overall 12-month death rate increased slightly

Spoiler:
The official age-adjusted U.S. death rate from Alzheimer's disease continues to creep up.

The Alzheimer's death rate for the 12-month period ending in the third quarter of 2017 increased to 30.9 per 100,000 people, up from 29.9 per 100,000 people for the comparable period in 2016.

Analysts at the National Center for Health Statistics, an arm of the U.S. Centers for Disease Control Prevention (CDC), have reported those figures in a selection of mortality data for the third quarter.

(Related: Nancy Reagan, U.S. Presidential Wife and Protector, Dies at 94)

RELATED

Americans Are Dying Younger, Saving Corporations Billions
Shorter lifespans help some pension sponsors cut obligation estimates.

CDC analysts have already posted data for some indicators, such as the overall death rate and the heart disease death rate, but they have not yet posted data for other indicators, such as the death rate from falls for people ages 65 and older.

Here are how some other age-adjusted 12-month death rates changed between the third quarter of 2016 and the third quarter of 2017:

The overall death rate: Increased to 730 per 100,000 lives, from 724.4 per 100,000 lives.

The heart disease death rate: Fell to 164.1 per 100,000 lives, from 164.8 per 100,000 lives.

The cancer death rate: Fell to 152.8 per 100,000 lives, from 156.2 per 100,000 lives.

For the analysts one challenge with analyzing the death rate data is random error. Another challenge is data collection and reporting problems. For September, for example, the analysts still have little mortality data for Arizona.

Another challenge may be that changes in diagnostic methods, and in physicians' way of thinking, could affect how causes of death are recorded.

A third challenge may be that the analysts' efforts to adjust death rates for changes in the age of the U.S. population could add new errors.

The crude, non-adjusted, overall 12-month death rate increased to 859.2 per 100,000 lives in the third quarter of 2017, from 842 per 100,000 lives in the year-earlier quarter.

The crude, non-adjusted, 12-month death rate for Alzheimer's disease increased to 37.1 per 100,000 lives, from 35.3 per 100,000 lives.
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Old 03-01-2018, 11:58 AM
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https://www.brookings.edu/blog/up-fr...ntent=61031052

Quote:
Why are Canada’s First Nations women dying at such an alarming rate?
Spoiler:
In Canada, Status First Nations persons—those listed in the country’s Indian Register—are significantly more likely than the average Canadian to meet an untimely death. When it comes to wellness outcomes, disparities along racial and ethnic lines are well documented across many metrics. What is often overlooked, however, is what those data look like at the intersection of race and gender.

In a new paper (PDF) “First People Lost: Determining the State of Status First Nations Mortality in Canada using Administrative Data” with Donna Feir, we combine data from Canada’s Indian Register and the Indigenous and Northern Affairs Canada (INAC) to identify both female and male mortality rates for the First Nations populations relative to the Canadian average. Our findings indicate that girls and women suffer from a disproportionately high rate of mortality as compared to their male and Canadian counterparts.

We show that the mortality rates comparing First Nations peoples to that of the Canadian average are consistently higher in all age groups. Starting in the early teenage years, however, there’s a spike in First Nations female mortality that persists until age 45. The rates approach 400 percent of the average Canadian mortality rate for females and 300 percent for males across these age groups.

First Nations people dying at higher rates than average Canadians
Mortality rate of status First Nations people where 100 percent represents the average Canadian mortality rate
Source: The Brookings Institution

Brookings Watermark
It turns out that geography matters as well for mortality rates. In the U.S., much attention is given to zip codes as determinants of wellness outcomes and optimism, though the neighborhood in which someone lives may have more to do with their chances of success than any other factor.

In Canada, the probability of early death is higher for Status First Nations person living on one of Canada’s First Nations Reserves than for those living off reserve. Adding location to the intersection of race and gender, we see staggering numbers that are hidden in data aggregated at larger geographic levels—the mortality rate of on-reserve Status girls between the ages of 15 and 19 is almost five times the national average. These results are often masked in provincial or regional data given that Reserves tend to be very small in terms of their individual populations.

On and Off Reserve Mortality Rates, Male
Mortality rate of status First Nations people where 100 percent represents the average Canadian mortality rate
Source: The Brookings Institution

Brookings Watermark
On and Off Reserve Mortality Rates, Female
Mortality rate of status First Nations people where 100 percent represents the average Canadian mortality rate
Note: The figures show the difference in mortality for women and men rates between Status First Nations and all Canadians with their 95 percent confidence intervals aver- aged over 2010 to 2013 using Data from the Indian Register on population size and death rates by age and gender and from Vital Statistics data from Health Canada. The label “on-reserve” indicates the figure that provides the relative mortality rates calculated for the population reported to be living on legally defined reserve land and the label “off-reserve” indicates the figure that provides the relative mortality rates calculated for the population reported to be living off legally defined reserves.

Source: The Brookings Institution

Brookings Watermark
Even more alarming, these differences in mortality across the First Nations female populations and the average Canadian is not new. We document in the paper that these rates have not improved substantially for First Nations girls living on reserves in nearly 30 years.

What are the causes of such high rates of mortality? It could be several things alone or in combination: lack of access to health care, domestic violence and abuse, or poverty. Activists and First Nations communities have been voicing these concerns for some time: the National Women’s Association of Canada’s Missing and Murdered Indigenous Women movement, Amnesty International’s No More Stolen Sisters campaign, and survivors of the Canadian Residential School system (Truth and Reconciliation Commission of Canada (TRC), 2015, p 161) have all focused on the disproportionate abuse and deaths of Indigenous women in Canada.

While we cannot perfectly identify the causes for these high rates of mortality, our research has shown that there is a strong relationship with economic conditions and poverty. Our future work will focus on uncovering the direction of causation to further inform the great work these organizations and others are doing.


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Old 03-19-2018, 04:14 PM
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https://www.ai-cio.com/news/dont-get...-expectancies/

Quote:
Don’t Get Too Excited over Lower Life Expectancies
Report says actuaries shouldn’t reverse mortality expectations despite recent data.
Spoiler:
Life expectancy at birth has fallen for the second straight year, according to data from the National Center for Health Statistics (NCHS). And while it’s unlikely anyone would want to celebrate that, this can often be seen as a boon for pensions because it typically means reduced costs.

However, Segal Consulting says that life expectancy is still improving for those who have reached retirement age, and that pension plan actuaries should not reverse expectations for mortality improvement.

By law, funding for single-employer pension plans is based on mandated Society of Actuaries (SOA) tables and projection scales that are based on mortality data for private sector workers. While lower life expectancies typically mean lower costs for pension plans, Segal says it’s not so cut and dry, as there are many nuances to consider.

“For professionals who study population statistics, like actuaries and demographers, there are subtle but significant differences between life expectancy, longevity, life span, and mortality,” said Segal’s report.

Life expectancy is the result of a calculation that estimates the average number of years until death at a specific age, while longevity and life span are less specific terms that refer to an estimate of how long an individual might live. Meanwhile, the mortality rate is a ratio of the actual number of deaths to the size of the total population for a specific age or age group.

“Despite these differences,” said the report, “the media tends to use the terms interchangeably to refer to the estimated number of years until death.”

However, between 2015 and 2016, death rates increased significantly for those under 45, while death rates decreased for those older than 65. Additionally, an analysis by the SOA confirmed that although the life expectancy for newborns decreased based on the NCHS study, the overall age-adjusted mortality rate in the US improved, albeit by less than 1%.

“The recent mortality rates observed for the retired population continue to support expected improvements in life expectancy for this group,” said the report. “Therefore, it is important for actuaries of multiemployer plans not to reverse their expectations for mortality improvement in response to the latest data.”

Segal also said while refinements may be necessary in the actuaries’ assumptions for pension plans, they should be based on longer-term trends.

“There has indeed been a trend of lower improvement over the last several years even at the older ages, but we should be cautious about setting long-term assumptions based on shorter-term trends—even when those trends last a decade,” said Segal. “It is too soon to tell whether longevity for the retired population will continue to improve at high rates.”


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Old 03-19-2018, 05:25 PM
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So is the decrease due to the opiod epidemic?
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Old 03-19-2018, 07:55 PM
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And suicides, I believe.
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And suicides, I believe.
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Old 04-04-2018, 01:42 PM
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Default Midlife 'wealth shock' may lead to death, study suggests

https://www.daytondailynews.com/busi...yEJ8AHQGsv13H/

https://jamanetwork.com/journals/jam...rticle/2677445
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Old 04-04-2018, 02:06 PM
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copying over the abstract for convenience:

Quote:
Key Points
Question Is a large, sudden loss of wealth in middle or older age associated with higher risk of all-cause mortality?

Findings In this prospective cohort study that included 8714 adults aged 51 to 61 years at study entry, participants who experienced a negative wealth shock during the 20-year follow-up compared with those with continuous positive wealth had a significantly increased risk of mortality (hazard ratio, 1.50).

Meaning Sudden loss of wealth in middle or older age may be a risk factor for all-cause mortality.

Abstract
Importance A sudden loss of wealth—a negative wealth shock—may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.

Objective To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.

Design, Setting, and Participants The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).

Exposures Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.

Main Outcomes and Measures Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.

Results There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).

Conclusions and Relevance Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.
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Old 04-11-2018, 02:09 PM
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https://www.theatlantic.com/health/a...m_medium=email

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The States Where People Die Young
A new study explores where and why Americans are dying early.
Spoiler:
We’ve known for some time now that Americans are increasingly dying younger, but the scale and nature of the problem has been a little bit murky. There was speculation that the downturn in American life expectancy was all thanks to “deaths of despair,” but some experts have said that might not be the full story, and that obesity and tobacco are still major factors in American mortality.

A new study out today in the Journal of the American Medical Association drills down into which states are showing increases in deaths among the young, and why. In doing so, it reveals a profound disparity among the states when it comes to both life expectancy and disability.

Most startlingly, since 1990, 21 states have seen an increase in the death rate among people aged 20 to 55. In five states—Kentucky, Oklahoma, New Mexico, West Virginia, and Wyoming—the probability of early death among young adults rose by more than 10 percent in that time frame. Meanwhile, in New York and California, young and middle-aged people became much less likely to die in the same time period. The authors note that opioids, alcoholism, suicide, and kidney disease—which can be brought on by diabetes and alcoholism—were the main factors leading to the increases in early deaths.

In 2016, the 10 states with the highest probability of premature death among 20- to 55-year-olds were West Virginia, Mississippi, Alabama, Oklahoma, Kentucky, Arkansas, New Mexico, Louisiana, Tennessee, and South Carolina.

Meanwhile, the 10 states with lowest probability of premature death among this age group were Minnesota, California, New York, Connecticut, New Jersey, Washington, Massachusetts, Vermont, New Hampshire, and Hawaii.

“Overall the nation and some of our states are falling behind other, less developed countries,” Ali Mokdad, a University of Washington epidemiologist who co-wrote the study, said in a statement. “The strain on America’s health resources is getting worse, and the need for prevention services and greater access to and quality of medical care is increasing.”

Though not an immediate cause of death, major depression increased by more than 27 percent across the country between 1990 and 2016, and anxiety rose by 31 percent.

Some of the findings track with the “diseases of despair” hypothesis—the idea that Americans are self-medicating their misery with alcohol and drugs—but it’s also clear that Americans’ poor diets are a major part of the problem. Between 1990 and 2016, Alzheimer’s disease and opioid abuse became more prominent causes of death and disability, but so did diabetes. A poor diet was the leading cause of death, followed by tobacco use and high blood pressure.

“To an increasing degree, overweight, obesity, and sugary diets are driving up health-care costs and are costing Americans years of healthy life,” said the University of Washington’s Chris Murray, who also authored the study, in a statement. “They are undermining progress toward better health.”
https://jamanetwork.com/journals/jam...rticle/2678018

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The State of US Health, 1990-2016
Burden of Diseases, Injuries, and Risk Factors Among US States
The US Burden of Disease Collaborators
Article Information
JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158
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US Burden of Diseases, Injuries, and Disease Risk Factors, 1990-2016
Key Points
Question How have the levels and trends of burden of diseases, injuries, and risk factors in the United States changed from 1990 to 2016 by state?

Findings This study, involving examination of 333 causes and 84 risk factors, demonstrated that health in the United States improved from 1990 to 2016, although the drivers of mortality and morbidity have changed in some states, with specific risk factors such as drug use disorders, high body mass index (BMI), and alcohol use disorders being associated with adverse outcomes. In 5 states, the probability of death between ages 20 and 55 years has increased more than 10% between 1990 and 2016.

Meaning Differences in health outcomes and drivers of morbidity and mortality at the state level indicate the need for greater investment in preventive and medical care across the life course. The intersection of risk, mortality, and morbidity in particular geographic areas needs to be further explored at the state level.

Abstract
Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.

Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.

Design and Setting A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.

Main Outcomes and Measures Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.

Results Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).

Conclusions and Relevance There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.
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