PUBLIC HEALTH

U.S. Ranks Worst

The United States ranked worst among 19 leading industrialized nations in an analysis focusing on preventable deaths due to treatable conditions, says a January 8 report released in the journal Health Affairs. Researchers tracked preventable deaths among individuals under age 75 from conditions including diabetes, heart disease, stroke, certain cancers, bacterial infections and complications from common surgical procedures. France did best in the study period of 2002 and 2003—with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people. Japan had 71.2, and Australia, 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people. If the U.S. health-care system had performed as well as top-ranked countries, 101,000 fewer deaths would occur in the United States per year, according to researchers. They surmise that the large number of Americans who lack any type of health insurance—about 47 million—was likely a key factor in the poor showing of the United States. The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. All the countries made progress in reducing preventable deaths, with the exception of the United States, which fell from 15^th place to last place.

CHILDREN’S HEALTH

“Bubble-Boy” Testing

Beginning on January 1, Wisconsin became the first state in the nation to screen all infants for Severe Combined Immune Deficiency (SCID), colloquially known as “Bubble Boy Disease,” according to a press release from the Jeffrey Modell Foundation. Children with the disease have abnormalities in their immune systems which in turn reduces their ability to fight infections. Treatment generally involves a bone marrow transplant from a family member. The announcement builds on a pilot program to develop a testing procedure begun in 2006 as a collaborative effort among the Wisconsin State Laboratory of Hygiene at the University of Wisconsin-Madison, Children's Hospital of Wisconsin in Milwaukee and the Jeffrey Modell Foundation. Funding for the pilot comes from the Foundation and the Children’s Hospital and will continue through 2010, when an evaluation will be conducted. The Foundation also noted that Congress recently passed legislation that will fund states to set up pilot programs specifically for SCID testing in newborns.

DISPARITIES

Pain Management

Emergency department physicians are prescribing more narcotics to patients who say they have pain, but minority patients are less likely than whites to receive such drugs, according to a January 2 study published in the Journal of the American Medical Association. Researchers used data from a federal survey to analyze more than 150,000 ED visits for all types of pain at 500 city and rural U.S. hospitals from 1993 to 2005. According to the study, narcotic prescriptions by ED physicians increased from 23 percent in 1993 to 37 percent in 2005. The study found that opioid narcotics were prescribed in 31 percent of pain-related visits involving whites, 28 percent involving Asians, 24 percent involving Hispanics and 23 percent involving blacks. In addition, the study found that in more than 2,000 visits for kidney stones, whites received narcotics 72 percent of the time, Hispanic patients received the drugs 68 percent of the time, and Asian and black patients received the drugs 67 percent and 56 percent of the time, respectively. Minorities were slightly more likely than whites to receive aspirin, ibuprofen and similar pain medications. The study found racial disparities in ED narcotic prescriptions in both urban and rural hospitals. The study's authors posit that physicians might be less likely to see signs of pain medication abuse among white patients or might be undertreating pain in minorities. Patient behavior also might play a role, if minority patients are less likely to keep complaining about their pain or feel they deserve good pain control. An abstract of the study is available online.

HIV/AIDS

District to Fund Needle-Exchange

The District of Columbia will spend $650,000 in needle-exchange programs to help stem the spread of HIV-AIDS in the city. The decision comes after a new appropriations bill passed by Congress lifted a ban instituted in 1998 on the public funding of such programs. The city will provide $300,000 to PreventionWorks!, a needle-exchange program already in the city that until now has relied on private funding. The remaining funds will go towards establishing new programs around the city. City officials believe that the investment will pay off in the long run. “The cost of infection is immeasurably higher in terms of dollars and lives,” City Councilman David A. Catania told the Washington Post. The District currently has one of the highest HIV infection rates in the country, with one out of every 20 residents thought to have the virus.