African Americans face roadblocks to HIV therapy, untreated depression makes it worse
African Americans with HIV are much less likely to adhere to drug therapy than others with the disease, according to a U-M study.
Moreover, untreated depression may greatly hinder adherence to antiretroviral therapy (ART) for all low-income, HIV-infected patients, regardless of race.
The study is the first known to indicate a true racial disparity in antiretroviral therapy adherence, says Rajesh Balkrishnan, associate professor at the School of Public Health and the College of Pharmacy. Less than 30 percent of African-American HIV patients in the one-year study sustained optimal adherence to ART, compared to 40 percent of other HIV patients.
“Our results show an alarming disparity in the quality of pharmaceutical care provided to African-American Medicaid enrollees with HIV,” Balkrishnan says. “These enrollees have much lower adherence rates to ARTs and a 10 percent higher incidence of depression.”
More than 66 percent of the 7,034 HIV-infected patients in the study were African American and nearly half of them reported depression.
The good news is that antidepressant treatment nearly doubled the odds of optimal ART adherence among patients of all races who reported depression, Balkrishnan says. Anything greater than 90 percent adherence to therapy was considered optimal for purposes of the study. For antiretroviral drugs to be effective, patients should sustain 90-95 percent adherence to treatment.
Though depression was high among all HIV patients regardless of race, depression did not further enhance the already-existing racial disparity in adhering to drug therapy. However, Balkrishnan points out that this should be interpreted with caution, since evidence has shown that African Americans are less likely to be diagnosed and treated for depression than whites.
The study, “Association between race, depression, and antiretroviral therapy adherence in a low-income population with HIV infection,” appears in an advanced online publication of the Journal of General Internal Medicine.
— Laura Bailey, News Service
Retirement plans after the Great Recession: U-M study tracks the changes
New research shows that 40 percent of older Americans postponed retirement in the wake of the Great Recession.
The research, presented at the annual meeting of the Population Association of America, is the first to link actual data on household wealth just before and after the downturn to the retirement plans of a nationally representative sample of Americans age 50 and older.
“The typical household lost about 5 percent of its total wealth between the summers of 2008 and 2009,” says Brooke Helppie McFall, an economist at the Institute for Social Research (ISR). “The average person would need to work between 3.7 and 5 years longer than they planned in order to make up the money they lost.”
But people do not intend to work long enough to make up everything they lost, McFall says.
“In considering when to retire, people make trade-offs between their desire for more leisure and for more time to spend with friends and family, and their desire to be financially secure in retirement,” she says. “So the typical person we surveyed who planned to work longer because of the recession only planned to work about 1.6 years longer than they had originally planned. That isn’t long enough to make up what they lost, but they’re trading off time for money.”
In general, McFall — who used data from ISR’s the Health and Retirement Study and Cognitive Economics Study — found that people who decided to postpone retirement also expected to leave less for their heirs.
In future research, McFall plans to study whether Americans are opting for bridge jobs or other transitional work arrangements rather than moving directly from full-time work to full-time retirement.
— Diane Swanbrow, News Service
World Health Organization anti-smoking program could save millions of lives
Millions of smoking-related deaths could still be prevented by 2030 if the World Health Organization smoking reduction policy is applied immediately worldwide, U-M researchers say.
Further, the number of smokers could have been reduced by 34 percent had the WHO policy been implemented globally in 2010. Researchers developed two sets of projections predicting smoking outcomes from 2010 to 2020 and then again to 2030, with or without the implementation of the smoking reduction policy.
“While several countries have already implemented parts of the WHO voluntary tobacco control policy, called MPOWER, complete and global adoption of these tobacco control measures has not yet happened,” says David Mendez, associate professor of health management and policy at the School of Public Health.
Currently, 174 countries have committed to the program in principle by ratifying the Framework Convention on Tobacco Control, the world’s first global health treaty.
“Where adopted, the tobacco control policies embedded in MPOWER have had a substantial impact on smoking, creating one of the greatest public health success stories of recent decades,” says Kenneth Warner, professor of public health. “The tragedy is that the failure to adopt these policies will lead to literally millions of avoidable premature deaths.”
Estimated global smoking prevalence in 2010 was about 24 percent, or 794 million smokers, within the countries studied. However, if MPOWER polices had been applied and maintained globally starting in 2010, with a 100 percent increase in cigarette prices, smoking prevalence would be an estimated 15 percent by 2020, or 569 million smokers, and 13 percent by 2030, or 523 million smokers.
The study shows that doubling the price of cigarettes will have the biggest impact on tobacco use, Mendez says.
Without MPOWER policies and with the same starting and quitting rates, smoking prevalence is estimated at about 23 percent by 2020, or 838 million smokers (the larger number is reflected by population growth), and 22 percent by 2030, or 872 million smokers.
The study, “The potential impact of smoking control policies on future global smoking trends,” will be published online in the journal Tobacco Control.
— Laura Bailey, News Service
Most college-age students get help from parents to pay for expenses
More than 60 percent of young adults between the ages of 19 and 22 receive financial help from mom and dad, according to a new U-M study.
The average amount they receive — including help with college tuition, rent and transportation — is roughly $7,500 a year.
The study is the first to use nationally representative data to calculate parental assistance to young adults and to analyze how help varies by family and individual characteristics, and is based on data from the Panel Study of Income Dynamics Transition to Adulthood Study at the Institute for Social Research.
The analysis by Patrick Wightman and Robert Schoeni of the U-M National Poverty Center and Keith Robinson of the University of Texas was presented at the annual meeting of the Population Association of America in San Francisco.
“Young people in the U.S. are taking longer to leave home, finish their schooling, get stable jobs, get married and have children,” says Wightman, who is the MacArthur Network on Transitions to Adulthood research fellow at the Gerald R. Ford School of Public Policy. “And the slow transition to traditional adult roles has been accompanied by an increase in the financial support young adults receive from their parents.”
Interestingly, the researchers found that childhood characteristics had a significant impact on the likelihood parents would provide financial help to children when they were young adults. If parents reported that children age 12 and under were cheerful, self-reliant and got along well with others, they were more likely to give them financial gifts or loans when they were young adults.
Schoeni also is professor of public policy at the Ford School and professor of economics, LSA.
— Diane Swanbrow, News Service
UMHS approach to medical error & malpractice spreads beyond Michigan
For more than a decade, the U-M Health System has been a leader in demonstrating a new way to handle patient safety and malpractice concerns. The approach has simultaneously promoted safer care; helped patients, their families and clinical staff deal with unanticipated outcomes in a non-adversarial way; and saved UMHS money at the same time.
Now, just as seven major Massachusetts hospitals and their state medical society have announced they will emulate this approach, UMHS leaders are offering a manual for other hospitals to do the same.
In a new paper in Frontiers of Health Services Management, published by the American College of Healthcare Executives, the team lays out the basic principles of the Michigan Claims Management Model — and tips for implementing it.
The paper reviews the path that UMHS took in creating the honesty-based, patient safety-focused approach, identifies the essential practical components of the Michigan Model, offers suggestions for tailoring the approach to other settings, and presents some thoughts on the future of this approach.
The paper is co-authored by UMHS Chief Risk Officer Rick Boothman, Chief Medical Officer Darrell “Skip” Campbell Jr. and Sarah Imhoff, a UMHS administrative intern and Georgetown University law student.
The key principles, write the authors, are to compensate patients quickly and fairly when unreasonable medical care caused injury, to support caregivers and the organization vigorously if the care was reasonable or did not adversely affect the clinical outcome, and reduce patient injuries (and therefore claims) by learning through patients’ experiences.
The authors warn that the UMHS approach goes far beyond “apology” policies that have been advocated elsewhere, and replace the “deny and defend” approach still in place at most hospitals.
— Kara Gavin, UMHS Public Relations
