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Racial disparities persist in states with best health outcomes

April 18, 2024
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Morning Rounds Writer and Podcast Producer
Good morning! We were so excited to see STAT colleagues Casey Ross and Bob Herman (a duo we're calling Bob Ross) win the NIHCM award for Investigative and General Reporting for their excellent series, Denied by AI: Consequences for Sick and Vulnerable Americans. If you haven't read it, I urge you to do so!

health equity 

States with the best health outcomes still have deep racial disparities

April18-disparities

J. Emory Parker/STAT

A new analysis of health care performance shows that every state — even those considered the best when it comes to overall health outcomes — has deep racial and ethnic health disparities. The report, released today by the Commonwealth Fund, analyzed 25 indicators that track health outcomes, access, and quality of care for five different racial and ethnic groups. It also made clear that the health disparities experienced by different racial and ethnic groups were not universal, but differed by state, STAT's Usha McFarling reports.

Only six states had health outcomes for Black residents that were above the average performance for all states. In several states, Indigenous people had the highest premature death rates of any group, with deaths caused largely by conditions that were treatable.

"Health equity does not exist in any state," said David Radley, a co-author of the report. Read more from Usha on the state-by-state specifics.


Vaccines

New long-term data show the power of the CDC's preferred shingles vaccine

When GSK's shingles vaccine, Shingrix, hit the U.S. market in 2017, the expert panel that advises the Centers for Disease Control and Prevention on vaccination voted to endorse a rare "preferential recommendation," suggesting people 50 and older who were getting vaccinated to prevent painful bouts of shingles get Shingrix over the then-competition, Merck's Zostavax. Evidence suggested the protection generated by Zostavax quickly waned, whereas Shingrix's durability looked stronger. By 2020, Zostavax was no longer sold in the U.S.

Now GSK has released long-term follow-up data that underscores the wisdom of the preferential recommendation, STAT's Helen Branswell tells us. The company reported Wednesday that a study of 7,000 people in 18 countries showed that, 11 years after immunization, the vaccine's effectiveness in preventing shingles was 82% in adults 50 and older. For people 70 and older, the effectiveness was 73% between years six and 11. The study's principal investigator, Javier Díez-Domingo, said in a statement that the finding is "a remarkable advancement in our understanding of what can be achieved long-term for effective protection against shingles." 

The findings will be presented at the European Society of Clinical Microbiology and Infectious Diseases meeting in Barcelona at the end of the month.


artificial intelligence

Microsoft is helping set the standards for the AI it sells in health care

For a company moving as quickly as possible to build artificial intelligence into everything — including health care — Microsoft spends a lot of time talking about how to regulate it. The tech giant has helped organize four separate coalitions in the last two years to devise guidelines and technical standards for AI in health care and has supplied these groups with top executives to serve on steering committees and more. 

The company's full-throated advocacy of responsible AI, in turn, gives it something even more precious: the opportunity to influence testing standards and regulations that will determine how thoroughly its own technology is vetted in health care. This isn't unusual in the development of health technology, but some experts have misgivings about the depth of Microsoft's involvement and the potential for the company to bend the rules in its favor. Read more from STAT's Casey Ross and Brittany Trang on those concerns.



first opinion

Medicaid should cover donor breast milk

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Gregory Bull/AP

Each day, more than 1,000 babies are born prematurely in America. These infants are at greater risk for a suite of serious health problems, including necrotizing enterocolitis. This inflammatory gut disease can kill up to 40% of the smallest, most vulnerable babies.

The best way to prevent the disease is simply to give babies human breast milk. Exclusively feeding preterm infants human milk rather than formula reduces their risk of necrotizing enterocolitis by 77%. But a mother's own milk supply often isn't enough. This is when donor milk becomes essential, STAT contributors Sionika Thayagabalu and Dominick Lemas write in a new First Opinion.

Their own research has shown that expanding Medicaid coverage of donor milk is one of the most effective ways to provide this treatment to more children. Read more on how Congress could expand Medicaid coverage and which states have already taken action.


research

More risks than previously thought with antipsychotics for dementia, per study

Doctors are prescribing antipsychotics to people with dementia at higher rates — especially since the pandemic — despite these drugs coming with a known increased risk for stroke and death. But there may be even more risks than previously thought. A new study in the British Medical Journal found that the use of antipsychotics by people over 50 with dementia increased risk for stroke, blood clot, heart attack, heart failure, fracture, pneumonia, and acute kidney injury. Risk was highest in the first few months after starting the medication.

The findings are based on data from almost 174,000 people in England who were diagnosed with dementia between 1998-2018, more than 35,000 of whom were prescribed antipsychotics for the first time. The authors write that the findings show how important it is to consider both the need for antipsychotics among those with dementia and the potential risks, and they add that these medications should only be tried after non-pharmacological treatments.


public health

Next-generation mosquito nets prevented 13 million malaria cases in three years

Bed nets are an essential frontline weapon in the fight against malaria. But traditional nets first introduced two decades ago are no longer as effective because mosquitos have developed insecticide resistance. Nets treated with two insecticides were introduced a few years ago, and newly released results from several pilot programs found them much more effective, STAT's Nalis Merelli tells us. In three years, 56 million second-generation nets in several sub-Saharan countries prevented 13 million cases, and close to 25,000 deaths. Researchers found that the additional costs of these nets were outweighed by their public health benefits.

But eventually, even these nets are bound to fail and malaria prevention experts will need to find new solutions. "We're going to reach the limits of what's achievable with the bed nets, how effective the bed nets are at killing mosquitoes," said Joe Wagman, a senior public health entomologist at PATH, a charity focused on global health equity. Read more.


More around STAT
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What we're reading

  • The next frontier in data privacy? Your brain, STAT

  • Long-acting drugs may revolutionize HIV prevention and treatment, New York Times
  • Eli Lilly's Zepbound eases obstructive sleep apnea in trials, STAT 
  • Brushing with bacteria: the debate over a GMO tooth microbe, Undark

Thanks for reading! More tomorrow,


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