Monthly Archives: May 2013

Are we making progress or falling behind?

Posted by on May 27, 2013 Comments Off on Are we making progress or falling behind?

In health care we don’t need to look far for bad news. In the past week, I have read:

  1. The prevalence of diabetes has increases 75 percent from the early nineties to the late naughts. A more extensive discussion (may require free Medscape subscription registration) is at New Statistics Shed Light on ‘Worrisome’ Diabetes Epidemic
  2. Leapfrog Hospital Safety Scores ‘Depressing’
  3. Study finds jump in ER-related admissions

And certainly we could include partisan bickering in Washington among politicians more focused on the next election than any meaningful policy debate or measures.

However, the simple fact is that none of this matters. We have no choice. If we do not adequately address our health care needs, then we will no survive as individuals or as a society.

If that premise, the premise of this blog, is correct, then we must assure access to healthcare for everyone. We must get the public health epidemics of obesity, diabetes, and gun violence, among others, under control.

On this Memorial Day, as we reflect on how many Americans have given up their lives at a young age to protect the American experiment, let us consider our debt to them: we owe it to them to insure that our society does not fail and that individuals not on battlefields do not give up their lives at a young age because they ate too much or someone bought a gun out of fear.

We are Americans: we do not accept failure in ourselves. The rest is trivial distraction.

How researchers confuse the public

Posted by on May 20, 2013 Comments Off on How researchers confuse the public

A nursing professor once told me how a graduate student came to her all excited. There was a population cohort dying from an epidemic of cardiac disease that had been ignored in the literature: women above age 85.

Now, while we can chuckle together about the naivete of the observation, consider it for a moment from the graduate student’s perspective:

1. Clearly the phenomenon was real as a high percentage of women over age 85 may well be dying of cardiac disease.
2. The red flag of gender bias stood out–it was women who were being victimized by this scourge.
3. A literature search turned up no one acknowledging the problem.

What was missing was the larger context: the twin facts that no one lives forever, and everyone eventually dies of something.

Sometimes more experienced researchers fail to provide the needed context. The following study came to my attention this week. Truth be known, I have not read the entire study, just the abstract and the accounts of those who have, so I will admit up front that this discussion may be unfair to the researchers.

The Canadian study is The long arm of parental addictions: The association with adult children’s depression in a population-based study.

It came to my attention in Trouble Coping with Parental Addiction

I am going to quote the abstract in full:

Parental addictions have been associated with adult children’s depression in several clinical and population-based studies. However, these studies have not examined if gender differences exist nor have they controlled for a range of potential explanatory factors. Using a regionally representative sample of 6268 adults from the 2005 Canadian Community Health Survey (response rate=83%), we investigated the association between parental addictions and adulthood depression controlling for four clusters of variables: adverse childhood experiences, adult health behaviors, adult socioeconomic status and other stressors. After controlling for all factors, adults exposed to parental addiction had 69% higher odds of depression compared to their peers with non-addicted parents (OR=1.69; 95% CI, 1.25–2.28). The relationship between parental addictions and depression did not vary by gender. These findings underscore the intergenerational consequences of drug and alcohol addiction and reinforce the need to develop interventions that support healthy childhood development.

The authors suggest that previous studies have not directly looked at gender differences of children of addicted parents. If so, then that is a clear contribution to the literature. But, the abstract and the descriptive article that I cited above go further: there is the clear implication that beyond a correlation or “relationship,” depression is the consequence of parental addiction.

Let’s consider two scenarios:

First, parents engage in substance abuse. The substance abuse causes them to act out, to neglect their children’s physical and emotional needs. The children grow up insecure and prone to depression. That is the clear implication of the abstract.

Second, a small but measurable percentage of the population inherit a tendency to mental illnesses (bi-polar, uni-polar depression, anxiety disorder, etc.) They self-medicate with both legal and illegal substances. They have children, whom they raise while self-medicating. A high percentage of their children inherit the tendency to mental illness, including uni-polar depression, and depressive cycles of bi-polar, showing a higher tendency toward those illnesses in the general population.

I find the second scenario more compelling. Indeed, attributing the problems of children to their parents because children follow their parents temporally is to my mind a classic case of the post hoc, ergo propter hoc logical fallacy in which one concludes that events following another event were caused by the previous event due to their proximity.

Runny noses do not cause colds, nor does “catching a chill,” whatever that means. Scientific studies are confusing enough to the general public, particularly through the filter of news media that do not look past the headline. We need researchers to be more cautious and guarded in their conclusions.

When we read that President Harry Truman wanted some “one-handed economists,” we can be sure that the economists were doing their job in informing him. We need the same of healthcare researchers.

Are we doing ourselves in faster than we think?

Posted by on May 6, 2013 Comments Off on Are we doing ourselves in faster than we think?

We know that our health is adversely affected by obesity, a sedentary lifestyle and fat consumption, not to mention tobacco and lack of access to healthcare. These factors are holding down what should otherwise be continued gains in life expectancy. They also adversely affect those who survive: the strains of obesity on the skeletal structure, emphysema from tobacco consumption, chronic heart disease, cancer that takes over lives, etc.

Recent studies indicate that not only are we experiencing indirect and long-term impacts on our lives and health, but the rate of suicide is increasing, surpassing deaths by motor vehicles in 2009. What adverse lifestyles are not doing to us in the long-term, we are doing directly to ourselves in the now.

The recent CDC study Suicide Among Adults Aged 35–64 Years — United States, 1999–2010 showed that the largest increase in the suicide rate was among whites between ages 45 and 64, in contrast to the common concern about teen and geriatric suicide.

In general, the suicide rate is related to stressors and the availability of means. The following chart, with data from the National Vital Statistics system, is from that CDC study:

Suicide by Sex and Means 1999-2010

Noteworthy are the increased use of firearms, which account for about half of all suicides among men, and suffocation (euphemism for hanging). The study lists the rates of suicide by state as well as the rate of increase from 1999 to 2010. I wondered about the ownership of firearms in those states.

I found that the study, “Association of suicide rates, gun ownership, conservatism and individual suicide risk,” was published online in the journal Social Psychiatry & Psychiatric Epidemiology in February.

The title a bit provocative, but if the availability of firearms reflects the political views of a population, and if the availability of firearms is related to the suicide rate, then it is possible to find statistical correlations among the three, without implying that a particular political view is suicidal or causes suicide any more than suicide causes a political view.

The study by researchers at the University of California, Riverside presented the following map of suicide rates by state:

Suicide_2000_2006

The map seems to show higher rates in states where one might expect more gun ownership, but, being a data person, I did a little experiment of my own.

I ran a couple of regressions, down and dirty, not up to publishable, academic standards. I used MS Excel, probably acceptable for this purpose but not a tool I would use for a publishable regression analysis.

My data sets were gun ownership from the Behavioral Risk Factor Surveillance System for 2001 and Median Income from the US Census Bureau for 2006. First, regressing gun ownership by state on income found that income was a significant factor, inversely related to gun ownership, and explaining 35 percent of the unexplained variation. This is not surprising as rural states are generally poorer and are more likely to have traditions of gun ownership for protection as well as for hunting.

It also meant that the cross correlation of income and firearms ownership might cloud the findings when I looked at the suicide rate from the latest CDC report and its separate relationships to the two factors. Those figures were for only 39 states, so that is how I handled it. My informal findings were that gun ownership rates were strongly correlated with the suicide rate, p=.00025 with R squared =.308, accounting for 30.8% of the unexplained variation. Income was inversely related to suicide and was much weaker, with p=.045 and R squared = .104.

Now, you might say, “Oh, suicide is related to economic factors. With recent economic challenges, of course suicide is rising.” You would be correct. Researchers from Rutgers have provided a graph of the relationship between suicide and unemployment.

Suicide and Unemployment
Source: Social Fact: The Great Depressions?

That is not, however, the public health issue, as there will always be stressors causing suicide. We need to find a way to block access to guns in the same way that we block access to bridges for suicidal people. Of course, there are a lot more guns than bridges. In the United States we ban automatic weapons from private ownership, so the issue is not whether the right to bear arms can be restricted: the entire debate is how extensive those restrictions should or should not be. The data on suicide suggests that greater restrictions on access would have a positive public health impact.