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A Look at the End-of-Life Financial Situation in America

May 21, 2015 Comments off

A Look at the End-of-Life Financial Situation in America
Source: Employee Benefit Research Institute

  • This report takes a comprehensive look at the financial situation of older Americans at the end of their lives. In particular, it documents the percentage of households with a member who recently died with few or no assets. It also documents the income, debt, home-ownership rates, net home equity, and dependency on Social Security for households that experienced a recent death.
  • Significant findings include that among all those who died at ages 85 or above, 20.6 percent had no non-housing assets and 12.2 percent had no assets left. Among singles who died at or above age 85, 24.6 percent had no non-housing assets left and 16.7 percent had no assets left.
  • Data show those who died at earlier ages were generally worse off financially: 29.8 percent of households that lost a member between ages 50 and 64 had no assets left. Households with at least one member who died earlier also had significantly lower income than households with all surviving members.
  • The report shows that among singles who died at ages 85 or above, 9.1 percent had outstanding debt (other than mortgage debt) and the average debt amount for them was $6,368.
  • The report also shows that the importance of Social Security to older households cannot be overstated. For recently deceased singles, it provided at least two-thirds of their household income. Couple households above 75 with deceased members received more than 60 percent of their household income from Social Security.

High Interest GAO Report — Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence

April 29, 2015 Comments off

Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
Source: Government Accountability Office

Advance directives, such as living wills or health care powers of attorney, specify—consistent with applicable state law—how individuals want medical decisions to be made for them should they become unable to communicate their wishes. Many individuals receive medical care from Medicare and Medicaid funded providers during the last 6 months of life, and may benefit from having advance directives that specify treatment preferences. According to IOM, advance directives are most effective when part of a comprehensive approach to end-of-life care called advanced care planning.

GAO was asked to review information related to advance directives. This report examines (1) how CMS oversees providers’ implementation of the PSDA requirement; (2) what is known about the approaches providers use and challenges they face to inform individuals about advance directives; and (3) what is known about the prevalence of advance directives and how it varies across provider types and individuals’ demographic characteristics. To do this work, GAO reviewed CMS documents and survey data reported by state survey agencies into CMS’s Certification and Survey Provider Enhanced Reporting system about covered providers’ implementation of the PSDA requirement. GAO also conducted a literature review of peer reviewed articles and federal government reports. In addition, GAO interviewed CMS officials and stakeholders representing providers and individuals likely to benefit from advance directives.

Association between an Internet-Based Measure of Area Racism and Black Mortality

April 28, 2015 Comments off

Association between an Internet-Based Measure of Area Racism and Black Mortality
Source: PLoS ONE

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the “N-word” in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004–2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.

See: The most racist places in America, according to Google (Washington Post)

New topical fire report: Fire Risk in 2011

April 27, 2015 Comments off

New topical fire report: Fire Risk in 2011 (PDF)
Source: U.S. Fire Administration

The risk from fire is not the same for everyone. In 2011, 3,415 deaths and 17,500 injuries in the U.S. were caused by fires. These casualties were not equally distributed across the U.S. population and the resulting risk of death or injury from fire was more severe for some groups. This topical fire report explores why different segments of society are at a greater risk from fire.

Suicide Postvention in the Department of Defense

April 27, 2015 Comments off

Suicide Postvention in the Department of Defense
Source: RAND Corporation

The U.S. Department of Defense (DoD) has been struggling with increasing rates of suicide among military personnel for the past decade. As DoD continues to implement new programs and examine its policies in an effort to prevent military personnel from taking their own lives, it is important to assess its current responses to suicide and to identify opportunities to enhance these programs and policies. Unfortunately, there is little scientific evidence on how best to respond to suicides, how to ensure that surveillance activities are managed appropriately and that loss survivors are given sufficient support to grieve, how additional suicides can be prevented, and how to honor and respect the decedent and his or her loved ones. At the same time, there are many resource guides intended to provide recommendations for organizations (mostly schools) in responding to suicides. A review of the existing scientific evidence on postvention (responses to prevent additional suicides in the aftermath of a suicide) and guidance for other types of organizations provides potential insights for DoD, however. Complemented by the perspectives of those most intimately touched by military suicide — the family and friends of those who have died — these sources may help DoD formulate its guidance in a practical and sensitive way.

Drug-poisoning Deaths Involving Heroin: United States, 2000–2013

April 23, 2015 Comments off

Drug-poisoning Deaths Involving Heroin: United States, 2000–2013
Source: National Center for Health Statistics

Key findings
Data from the National Vital Statistics System (Mortality)

  • From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths involving heroin nearly quadrupled from 0.7 deaths per 100,000 in 2000 to 2.7 deaths per 100,000 in 2013. Most of the increase occurred after 2010.
  • The number of drug-poisoning deaths involving heroin was nearly four times higher for men (6,525 deaths) than women (1,732 deaths) in 2013.
  • In 2000, non-Hispanic black persons aged 45–64 had the highest rate for drug-poisoning deaths involving heroin (2.0 per 100,000). In 2013, non-Hispanic white persons aged 18–44 had the highest rate (7.0 per 100,000).
  • From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths involving heroin increased for all regions of the country, with the greatest increase seen in the Midwest.

Rail Safety Efforts Miss Leading Cause of Fatalities, CRS Insights (April 2, 2015)

April 21, 2015 Comments off

Rail Safety Efforts Miss Leading Cause of Fatalities, CRS Insights (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

As it debates reauthorization of the Rail Safety Improvement Act of 2008 (RSIA08; P.L. 110-432), Congress is focusing on steps to prevent train derailments and collisions. Such incidents often receive extensive publicity and cause harm to bystanders, such as the residents of Mount Carbon, WV, who were forced to evacuate after a train carrying crude oil derailed and burned on February 16, 2015.

Far less attention has been devoted to trespassing, although it is a much greater cause of rail-related fatalities than derailments and collisions combined. Since 2005, nearly three-fifths of deaths in rail incidents have been pedestrian trespassers (see Figure 1; note that the trespassing deaths in the figure do not include suicides).

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