Publications by authors named "Steffie Woolhandler"

Background: Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people affect disparities in such problems.

Objective: To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.

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  • Drug prices significantly impact government budgets through direct spending on public programs like Medicare and Medicaid, and indirect costs via private insurance subsidies for public employees.
  • The Senate parliamentarian's ruling prevents extending price controls from the Inflation Reduction Act to private insurers, arguing their costs don't affect the federal budget.
  • In 2019, direct government spending on outpatient retail prescription drugs reached $154.85 billion, with indirect spending through private insurers totaling $53.59 billion, highlighting the substantial financial burden of drug costs on government entities.
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  • Early-life exposures can increase asthma risk, but their role in racial and socioeconomic disparities in asthma is not fully understood.
  • The study analyzes data from three surveys to assess how asthma prevalence, diagnosis age, and hospitalization rates differ based on race, ethnicity, and socioeconomic status among US children.
  • Results indicate that Black children experience higher asthma prevalence and hospitalization rates early in life compared to White children, though disparities in prevalence decrease as children age, particularly in adolescence.
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Importance: Decades-old data indicate that people imprisoned in the US have poor access to health care despite their constitutional right to care. Most prisons impose co-payments for at least some medical visits. No recent national studies have assessed access to care or whether co-pays are associated with worse access.

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For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use).

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Background: The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.

Objective: To explore the distribution of physical hospital resources-that is, capital assets-in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.

Research Design: We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020-2021 Area Health Resource File; 2016-2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER.

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Importance: Health care administrative overhead is greater in the US than some other nations but has not been assessed in the Veterans Health Administration (VHA).

Objective: To compare administrative staffing patterns in the VHA and private (non-VHA) sectors.

Design, Setting, And Participants: This cross-sectional study was conducted using US employment data from 2019, prior to pandemic-related disruptions in health care staffing, and was carried out between January 14 and August 10, 2023.

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Importance: Social Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described.

Objective: To evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US.

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Background: Previous studies have identified reductions in exacerbations of chronic lung disease in many locales after onset of the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To evaluate the population-level impacts of COVID-19 on asthma and chronic obstructive pulmonary disease (COPD) exacerbations-with a focus on disadvantaged communities-in the United States.

Methods: We analyzed 2016 to 2020 county-level data on asthma and COPD acute care use, with myocardial infarction hospitalizations as a comparator condition.

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We assessed how many US deaths would have been averted each year, 1933-2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as "missing Americans." The United States had lower mortality rates than peer countries in the 1930s-1950s and similar mortality in the 1960s and 1970s.

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Importance: Several recent US Supreme Court rulings have drawn criticism from the medical community, but their health consequences have not been quantitatively evaluated.

Objective: To model health outcomes associated with 3 Supreme Court rulings in 2022 that invalidated workplace COVID-19 vaccine or mask-and-test requirements, voided state handgun-carry restrictions, and revoked the constitutional right to abortion.

Design, Setting, And Participants: This decision analytical modeling study estimated outcomes associated with 3 Supreme Court rulings in 2022: (1) National Federation of Independent Business v Department of Labor, Occupational Safety and Health Administration (OSHA), which invalidated COVID-19 workplace protections; (2) New York State Rifle and Pistol Association Inc v Bruen, Superintendent of New York State Police (Bruen), which voided state laws restricting handgun carry; and (3) Dobbs v Jackson Women's Health Organization (Dobbs), which revoked the constitutional right to abortion.

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Unlabelled: Policy Points Over the past century, the tax-financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance. For-profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees.

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To assess the risk of COVID-19 by occupation and industry in the United States. Using the 2020-2021 National Health Interview Survey, we estimated the risk of having had a diagnosis of COVID-19 by workers' industry and occupation, with and without adjustment for confounders. We also examined COVID-19 period prevalence by the number of workers in a household.

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Over the past two centuries, progressive scholars have highlighted the health-harming effects of oppressive living and working conditions. Early studies delineated the roots of inequities in these social determinants of health in capitalist exploitation. Analyses in the 1970s and 1980s that adopted the social determinants of health framework emphasized the deleterious effects of poverty but rarely explored its origins in capitalist exploitation.

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Booster vaccination offers vital protection against COVID-19, particularly for communities in which many people have chronic conditions. Although vaccination has been widely and freely available, people who have experienced barriers to care might be deterred from being vaccinated. We examined the relationship between COVID-19 booster uptake and small area-level demographics, chronic disease prevalence, and measures of health care access in 462 Massachusetts communities during the period September 2021-April 2022.

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Article Synopsis
  • Adults with children suffering from chronic illnesses like asthma and diabetes tend to experience higher financial strain and are more likely to delay or forego their own medical care compared to those without such children.
  • The study analyzed data from the National Health Interview Survey, focusing on 93,264 adult-child dyads, and found significant associations between a child's chronic illness and the adult's access to healthcare.
  • Recommendations include reducing out-of-pocket healthcare costs and improving health coverage to help alleviate the financial burdens on families managing chronic childhood illnesses.
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