Study: Preventable deaths increased during pandemic in all states | Health News from the Healthiest Communities

A new report offers a grim picture of the state of the country’s health care system in the wake of the COVID-19 pandemic, with premature deaths on the rise in all states while disparities in access to reproductive care for women dug themselves.

Deaths directly attributable to COVID-19 led to a large increase in preventable mortality for every state between 2019 and 2021, according to the findings of a new analysis released Thursday by the Commonwealth Fund. The report also found a sharp rise after 2019 in “preventable” deaths, which were defined as those that occurred due to otherwise treatable chronic health conditions such as diabetes and heart disease. The report’s researchers suggest that the increase in deaths from these conditions was likely the result of their being left untreated because patients delayed getting preventive care due to service disruptions caused by the pandemic.

“The dashboard really gives a detailed view of how we’ve come out of the pandemic, and that’s ringing alarm bells,” Commonwealth Fund chairman Dr Joseph Betancourt said in a call with officials. journalists held on Wednesday. “We’ve rolled back on life expectancy, rolled back on preventable deaths – women’s health, mental health, substance use disorders are all critical issues that need urgent attention.”

Other notable contributors to the increase in premature deaths from 2019 to 2021 include a 51% increase in drug overdose deaths, which in 2021 reached an all-time high of over 106,000. alcohol increased by 39% during this period and firearm-related mortality increased by 23% in 2021 compared to 2019. Deaths from drug overdose, alcohol and suicide combined accounted for about 200,000 in 2021 for the first time, the report said, an increase of about 50,000 from 2019.

“Efforts to reduce drug overdose deaths would likely have the greatest impact on short-term preventable mortality,” says report co-author David Radley, lead scientist in monitoring health system performance at the Commonwealth. Fund, in response to questions from US News. “Policy makers could take steps to increase access to additional care, implement and expand harm reduction policies for faster impact. In the medium to long term, it will be important to work to integrate behavioral health into primary care and to strengthen the primary care workforce.

Arizona, Louisiana, Mississippi, New Mexico And Texas saw the largest increases in the rate of preventable deaths from 2019 to 2021, with each of these states seeing an increase of more than 35% during that time. Arizona saw the largest increase of any state, rising 45% from 249.3 deaths per 100,000 population in 2019 to 362.6 per 100,000 population in 2021.

In total, these deaths contributed to a decline in the United States life expectancy for two consecutive years.

The report ranks state and District of Columbia health system performance using 58 performance indicators grouped into seven dimensions, including health care access and affordability; prevention and treatment; avoidable hospital utilization and costs; a healthy life, which involves risky behaviors for health; income disparity; racial and ethnic equity; and reproductive care and women’s health. The analysis used publicly available data from government agencies, including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services and the US Census Bureau.

For the first time, the report includes rankings of state performance in reproductive care delivery and women’s health outcomes. The issue of reproductive care has garnered more attention in recent years due to both the disproportionate impact that COVID-19 has had on maternal health, as well as concerns that the US Supreme Court’s decision- United in 2022 to cancel abortion rights could lead to limited access to maternal health care services and poorer health outcomes.

The report’s co-author, Dr Laurie Zephyrin, senior vice president for promoting health equity for the Commonwealth Fund, said some of the worst outcomes in reproductive care and women’s health are happening in passing states and considering new restrictions on reproductive care, which she supports. will only make it more difficult for women to access these services.

“Right now, we’re seeing big state variations in women’s reproductive care and health outcomes,” Zephyrin said. “It really raises concerns about inequities in access and inequities in health outcomes.”

Nationally, maternal mortality jumped nearly 64%, from a rate of 20.1 deaths per 100,000 live births in 2019 to 32.9 per 100,000 in 2021, according to the report. Between 2019 and 2021, state maternal mortality rates ranged from a low of 9.6 per 100,000 in California to a maximum of 50.3 per 100,000 in Mississippi.

The Commonwealth Fund report found that the all-cause death rate among women of childbearing age (15-44) increased by 40%, from 89.4 deaths per 100,000 women in 2019 to 124, 2 per 100,000 in 2021, with a range of 78.9 per 100,000 in Hawaii at 238.6 per 100,000 in West Virginia.

Among the report’s recommendations to states to improve reproductive care and women’s health include expanding Medicaid coverage for postpartum care services from 60 days to 12 months. The enactment of the American Rescue Plan Act in 2021 granted states the ability to extend postpartum Medicaid coverage to 12 months for five years, which, so far, 36 did. Other recommendations include funding community organizations focused on maternal health outcomes and expanding and diversifying the maternal and reproductive health workforce.

The report found that states varied widely when it came to women’s access to early prenatal care. While only 11% of women in Vermont did not have access to prenatal care during their first trimester of pregnancy, states like Texas and Florida had the highest proportion of women without access, at almost 30%. “Antenatal care is essential to identify risk early and support people through pregnancy, and it can improve outcomes for mothers and babies,” the report says.

Overall, the report ranked Massachusetts as having the best-performing health care system in the United States, with the state leading in most categories, including health care access and affordability; prevention and treatment; racial and ethnic equity in health; and reproductive care and women’s health. Hawaii, New Hampshire, Rhode Island and Vermont.

Mississippi ranked last for health system performance, ranking near the bottom of nearly every category, including 50th for reproductive care and women’s health, and 50th for healthy living, while also ranking 49th for racial and ethnic equity in health. Besides Mississippi, other states that received poor ratings include West Virginia and Oklahomawho tied for 49th, followed by Texas and Arkansas.

Many of the issues outlined in the report underscore the need to expand access to health care, which the report authors say could be further complicated by the end of temporary federal policies put in place during the public health emergency to expand health insurance coverage, resulting in the United States reaching a record high rate of uninsured 8% last year.

Most notable is the potential loss of health care coverage as long as 15 million enrolled in Medicaid and Children’s Health Insurance Program as states begin the process of “unwinding” their continuing enrollment policies. During the public health emergency, states received federal funding to maintain Medicaid coverage for enrollees without renewal or redetermination of eligibility. As potentially millions more Americans become uninsured in the coming months, the report’s authors recommend that policymakers take steps to close these coverage gaps by addressing some of the administrative barriers to eligibility and at enrollment that may affect coverage for Medicaid enrollees.

“Federal and state policies are important,” Betancourt said. “The variations we see in this data do not happen by happenstance or happenstance – we truly hope that this report along with the moral courage of the leaders of all 50 states can lead us to meet these challenges both now and in the future. coming.”