Disparities in maternal mortality.

Maternal mortality rates in the USA remain high, with persistent racial and socioeconomic disparities. We identified 207,016 hospital admissions for pregnant women in Maryland, from 2017 to 2019. Logistic regression was used to identity factors associated with maternal death. The health outcome for black women was more prone to give rise to maternal mortality than for white women. Our study revealed numerous racial and age discrepancies in gestational health outcomes, which opioid use disorder exacerbated. Our findings elaborate on the importance of identifying the drivers of adverse pregnancy outcomes, to help inform policy, and resource allocations.

Social determinants of health, substance use, and drug overdose prevention.

BACKGROUND: Fatal drug overdoses, now primarily driven by illicit opioids like fentanyl, continue to increase in the United States, reflecting a growing need for prevention and treatment strategies. Preventive interventions have primarily focused on curbing opioid prescribing, and treatment strategies target individuals. However, little is known about the broader social context surrounding these individuals. OBJECTIVE: This study examines the association between drug overdose mortality and social determinants of health (SDOH) across different levels of influence in the social-ecological model. METHODS: Data on drug overdose death and SDOH were collected at the county level for most mid-Atlantic states in 2019. Association between each characteristic and drug overdose mortality was measured through a bivariate analysis. Furthermore, a multivariate analysis was performed to detect risk factors of drug overdose death while adjusting for multiple comparisons. All statistical analyses were performed with SAS version 9.4. RESULTS: SDOH, including violent crime (P < 0.001), access to the Internet (P < 0.001), per capita income (P < 0.001), social vulnerability index (P = 0.001), and access to health care (P < 0.001), demonstrated a statistically significant positive association with drug overdose death. In contrast, vacancy rate was negatively associated with drug overdose mortality (P < 0.001). The association between drug overdose deaths and opioid prescription rates was not statistically significant (P = 0.412). CONCLUSION: Factors such as violent crime and social vulnerability demonstrated a statistically significant impact on drug overdose mortality. To address drug overdose crisis, health care system, community leaders, and policy makers' strategies should focus on socially vulnerable populations.

COVID-19 pandemic and telemental health policy reforms.

Many patients with mental disorders lack access to care mainly due to provider shortages. Coronavirus disease 2019 (COVID-19) pandemic significantly raised the prevalence of anxiety, depression, substance use disorder and suicidal thoughts among people. Mandated social distancing, and higher incidence of mental disorders increased the demand for Telemental Health (TMH). TMH expands access to care and can be an effective alternative to the costly conventional mental health care. However, there are barriers to the adoption of TMH such as reimbursement challenges, and licensure restrictions. During the COVID-19 pandemic, some policies and regulations changed to address the increase in TMH demand. The federal government increased funding for the new telehealth initiatives and more states legalized the interstate practice for psychologists. Medicare waived telehealth co-payments, reimbursed audio-only visits, and required payment parities between virtual and in-person visits. Nevertheless, Medicare maintained in-person visit prerequisite within the six months prior to the first time only for mental health treatments which can act as a hindrance. Additionally, four more states required telehealth coverage, 33 states required Medicaid plans, and 21 states required private insurers to cover TMH services. Ten states mandated payment parity for private insurers, and four states eliminated cost-sharing for telehealth services. Currently, 21 states are implementing payment parity on a permanent basis. During the pandemic, 78% of Mental health providers integrated TMH services into their practice. Despite the decline in use of telehealth for other health conditions after the pandemic peak, TMH use has remained strong representing 36% of outpatient visits. TMH is beneficial to patients in terms of cost and time saving; thus, the beneficiary regulatory changes should be sustained. Further well-designed studies are needed on the cost-effectiveness of telehealth interventions, and policymakers need to collect more data to decide whether and how to keep these changes permanently for TMH.

Trends in Medicaid spending on inhalers in the United States, 2012-2018.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common respiratory diseases that impose a significant economic burden on Medicaid. Inhalers are the mainstay treatment for relieving symptoms and improving outcomes for COPD and asthma patients. OBJECTIVE: To describe the total spending and trends of Medicaid expenditures on inhalers between 2012 and 2018 in the United States. METHODS: We analyzed the deidentified data from the Medicaid Drug Spending Dashboard and utilization datasets from 2012 to 2018. We identified 9 classes of inhalers and described the Medicaid total spending on and relative annual changes for those inhalers. We also described the spending on available generic inhalers and compared the Medicaid spending by manufacturers during this time frame. RESULTS: Medicaid spent $26.2 billion on inhalers from 2012 to 2018. This spending increased by $2.5 billion (120%) over this time frame. During this specified period, the highest Medicaid spending was on the group of inhaled corticosteroid (ICS)-containing inhalers ($14.9 billion). Within this group, the inhaler class of ICS/long-acting beta-2 adrenoceptor agonists contributed to the highest Medicaid spending (53%), with a growth of 607% between 2012 and 2018. Of the $26.2 billion that Medicaid spent on inhalers, $35.5 million (less than 0.01%) was spent on 2 generic inhalers: fluticasone propionate with salmeterol and levalbuterol tartrate hydrofluoroalkane. CONCLUSIONS: Between 2012 and 2018, on average, $3.5 billion per year was spent by Medicaid on inhalers. Decreasing the price of inhalers by introducing more generic inhalers in the market can potentially reduce the cost burden on Medicaid. DISCLOSURES: This study was funded by the American Foundation for Pharmaceutical Education (AFPE). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest.