Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic.

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.

Health insurance coverage and health outcomes among transgender adults in the United States.

This study provides evidence of health and insurance coverage disparities between the cisgender and transgender US populations using repeated cross sections from the 2014-2020 Behavioral Risk Factors Surveillance Systems. The analysis tests whether increasing the incidence of insurance coverage among transgender people could alleviate the health disparity. The empirical approach uses a fuzzy regression discontinuity design that leverages breaks in government health assistance eligibility by age. Results indicate that, for transgender recipients only, insurance coverage meaningfully improves mental health; for cisgender recipients only, insurance coverage reduces difficulties with concentration and memory; and for both the transgender and cisgender populations, insurance coverage contributes to important improvements in physical health, overall health, and healthcare access.

Membrane curvature based lipid sorting using a nanoparticle patterned substrate.

Cellular membranes contain a variety of shapes that likely act as motifs for sorting lipids and proteins. To understand the sorting that takes place within cells, a continuous, fluid bilayer with regions of membrane curvature was designed and characterized using confocal fluorescence and total internal reflection fluorescence microscopy techniques. A supported lipid bilayer was formed over fluorescently labelled nanoparticles deposited on a glass surface. The lipid composition and membrane shape are separately controlled and the nanoparticle dimensions (d = 40-200 nm) determine the extent of curvature. The bulk membrane is fluid as demonstrated by fluorescence recovery after photobleaching (FRAP) using dye labelled lipids. In bilayers that contain fluorescently labelled, single-tailed lipids, accumulation is observed at regions of curvature, yet the molecules retain fluidity. Using single particle imaging methods, lipids are observed to visit regions of curvature and exchange with the surrounding flat membrane. The nanoparticle patterned substrate described here allows for quantitative measurement of the transient interactions between fluorescently labelled biomolecules and regions of membrane curvature.

Mental Health of Transgender Youth Following Gender Identity Milestones by Level of Family Support.

Importance: Transgender youth are at an elevated risk for adverse mental health outcomes compared with their cisgender peers. Identifying opportunities for intervention is a priority. Objective: To estimate differences in the association between gender identity milestones and mental health outcomes among transgender youth, stratified by level of family support. Design, Settings, and Participants: This retrospective cohort study compares changes in mental health outcomes among transgender youth who initiate gender identity milestones compared with those who initiate the same milestones 1 year later, stratified by level of family support, using the 2015 US Transgender Survey. The analytic samples included 18 303 transgender adults aged 18 and older who had initiated at least 1 gender identity milestone between ages 4 and 18 years. Exposure: Four gender identity milestones: feeling one's gender was different, thinking of oneself as transgender, telling another that one is transgender, and living full-time in one's gender identity, stratified by 3 levels of family support: supportive, neutral, and adverse. Main Outcomes: Age at first suicide attempt and at running away. Results: Study participants included 18 303 transgender adults (10 288 [56.2%] assigned female at birth; 14 777 [80.7%] White). Initiating a gender identity milestone was associated with a higher risk of suicide attempt and running away from home among transgender youth. This finding was driven by children who live in unsupportive families. For example, thinking of oneself as transgender was associated with a meaningful increase in the overall probability of attempting suicide among those in either adverse families (estimate = 1.75 percentage points; 95% CI, 0.47-3.03) or neutral families (estimate = 1.39 percentage points; 95% CI, 0.72-2.05). Among youth living with supportive families, there were no statistically significant associations between gender identity milestones and adverse mental health outcomes and 95% CIs generally ruled out any meaningful associations. Conclusion: These results demonstrate that without a supportive family environment, gender identity development increases the risk of transgender youth attempting suicide or running away from home. Social services and community resources to establish supportive relationships between transgender children and their parents are essential.

Conversion therapy, suicidality, and running away: An analysis of transgender youth in the U.S.

This study analyzes the relationship between conversion therapy and mental health and wellbeing of transgender youth in the U.S. We create a retrospective panel of transgender youth using the 2015 U.S. Transgender Survey to test how exposure to conversion therapy affects the likelihood of attempting suicide and running away from home. The empirical approach employs a difference-in-differences design. Results indicate that exposure to conversion therapy substantially increases the likelihood a transgender adolescent will attempt suicide and run away. The average treatment effect on treated (ATT) of conversion therapy on having attempted suicide is an increase of 17 percentage points, which amounts to a 55% increase in the risk of attempting suicide, and the ATT on the risk of running away is an increase of 7.8 percentage points, more than doubling the risk of running away. These effects are largest when exposure to conversion therapy occurs at a young age (11-14).

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study.

Background: Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance. Methods: We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion. Findings: Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis. Interpretation: Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

Alignment Between Resident Medical Condition Regard Scale Scores and Desire to Treat Patients With Opioid Use Disorder.

OBJECTIVES: To (1) evaluate attitudes of resident physicians towards patients with opioid use disorder (OUD) and (2) identify characteristics associated with residents' desire to treat patients with OUD. METHODS: We administered the validated medical condition regard scale (MCRS), a question regarding desire to treat patients with OUD, and a demographic questionnaire to residents in multiple specialties at the University of New Mexico (family medicine, psychiatry, emergency medicine, internal medicine, anesthesiology, general surgery, obstetrics/gynecology). RESULTS: One hundred sixty-three of 307 residents (53%) responded to the survey; 146 provided complete responses to the "desire" and MCRS questions. Response rates, MCRS, and desire to care for patients with OUD varied between specialties ( P < 0.001); family medicine had highest MCRS and desire to care scores; surgery, anesthesiology had low scores. MCRS and resident "desire" scores were highly correlated on univariate analysis ( r = 0.73, P < 0.001); resident demographics were not. On logistic regression, resident desire to care for OUD increased with MCRS scores ( P < 0.001). The predicated probability of desire to care for OUD was ≥80% with MCRS >57; MCRS classification skill on receiver operator curve analysis was excellent (area under curve = 0.81 [95% confidence interval 0.74, 0.88], and specialty-adjusted MCRS area under curve = 0.85 [95% confidence interval 0.79, 0.91]). CONCLUSIONS: High resident regard for patients with OUD on MCRS was directly related to resident's desire to provide OUD care. MCRS may offer a tool to alter or individualize OUD education, potentially influencing the OUD workforce of the future.