Health related social needs and whole person health: Relationship between unmet social needs, health outcomes, and healthcare spending among commercially insured adults.

Commercially-insured adults comprise a majority of health plan members but are least likely to be surveyed about their social needs. Little is known, consequently, about health-related social needs (HRSNs) in this population. The primary aim of this study was to assess the prevalence of HRSNs and health among commercially-insured adults and estimate their relationship with health outcomes and spending. This cross-sectional study used survey data from a representative sample of Elevance Health commercially insured members residing in Georgia and Indiana (U.S.) Adult members reported on HSRNs across nine different domains. Survey data were linked to medical claims data, and regression models were used to estimate the relationship between HRSNs and self-reported health, emergency department visits, three major health outcomes, and healthcare spending (medical and pharmaceutical). Of 1,160 commercially insured adults, 76 % indicated ≥ 1 HRSN, and 29 % reported > 3 HRSNs, (i.e., "high" HRSN). Each HRSN was associated with 2.2 (95 % CI, 1.84-2.55) additional unhealthy days per month, 3.0 percent (95 % CI 1.36 - 4.57) higher prevalence of anxiety/depression, 2.2 percent (95 % CI 0.88 - 3.50) higher prevalence of hypertension, 3.9 more ED visits per 1,000 member-months (95 % CI, 0.29-7.42), and $1,418 higher total healthcare spending (95 % CI, $614.67-$2,220.39) over a 12-month period. The widespread prevalence of HRSNs among commercially insured adults demonstrates the importance of screening all health plan members for HRSNs-not just Medicare and Medicaid members. Commercially insured members who experience high HRSN are at significantly higher risk for worse health, even after controlling for income and demographic characteristics.

Stroke-attributable death among older persons during the great recession.

Epidemiological evidence indicates an elevated risk for stroke among stressed persons, in general, and among individuals who have lost their job, in particular. We, therefore, tested the hypothesis that stroke accounted for a larger fraction of deaths during the Great Recession than expected from other deaths and from trends, cycles, and other forms of autocorrelation. Based on vital statistics death data from California spanning 132 months from January 2000 through December 2010, we found support for the hypothesis. These findings appear attributable to non-Hispanic white men, who experienced a 5% increase in their monthly odds of stroke-attributable death. Total mortality in this group, however, did not increase. Findings suggest that 879 deaths among older white men shifted from other causes to stroke during the 36 months following the start of the Great Recession. We infer the Great Recession may have affected social, biologic, and behavioral risk factors that altered the life histories of older white men in ways that shifted mortality risk toward stroke.

Do macroeconomic contractions induce or 'harvest' suicides? A test of competing hypotheses.

BACKGROUND: Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment-induction or displacement. METHODS: We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women. RESULTS: Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later. CONCLUSIONS: Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.

Twins less frequent than expected among male births in risk averse populations.

Male twin gestations exhibit higher incidence of fetal morbidity and mortality than singleton gestations. From an evolutionary perspective, the relatively high rates of infant and child mortality among male twins born into threatening environments reduce the fitness of these gestations, making them more vulnerable to fetal loss. Women do not perceive choosing to spontaneously abort gestations although the outcome may result from estimates, made without awareness, of the risks of continuing a pregnancy. Here, we examine whether the non-conscious decisional biology of gestation can be linked to conscious risk aversion. We test this speculation by measuring the association between household surveys in Sweden that gauge financial risk aversion in the population and the frequency of twins among live male births. We used time-series regression methods to estimate our suspected associations and Box-Jenkins modeling to ensure that autocorrelation did not confound the estimation or reduce its efficiency. We found, consistent with theory, that financial risk aversion in the population correlates inversely with the odds of a twin among Swedish males born two months later. The odds of a twin among males fell by approximately 3.5% two months after unexpectedly great risk aversion in the population. This work implies that shocks that affect population risk aversion carry implications for fetal loss in vulnerable twin pregnancies.