Embargoed AJPH Research on Hepatitis C and Opioids, Medicaid Expansion and Cancer Diagnoses, ACA and Breastfeeding, Osteoarthritis Increases

EMBARGOED UNTIL December 21, 2017 4p.m. EST (links to the below articles will go live once the embargo lifts)

American Journal of Public Health February issue research highlights:

Increases in hepatitis C infections linked to opioid epidemic

Newswise — Findings from this study strongly suggest that the national increase in acute hepatitis C infection is related to the country’s opioid epidemic and associated increases in injection drug use.

Researchers found the annual incidence rate of acute hepatitis C infection increased more than twofold from 2004 to 2014, with significant increases among select demographic subgroups. Admissions for substance use disorder attributed to injection of heroin and prescription opioid analgesics increased significantly, with an almost fourfold increase in prescription opioid analgesic injection. Significant increases in opioid injection mirrored those for reported cases of acute hepatitis C infection among demographic subgroups.

Authors also suggest some public health interventions that may help to slow the spread of hepatitis C as the opioid epidemic continues.

["Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014." Contact: Alice Asher, Epidemiology, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA].

Medicaid expansion increased early-stage cancer diagnoses

Researchers found that counties that participated in Medicaid expansion in 2014 saw a 3.4 percent increase in overall cancer diagnoses (13.8 per 100,000 population) and a 6.4 percent increase in the number of early stage cancer diagnoses. (15.4 per 100,000 population).

The study compared Surveillance, Epidemiology, and End Results Cancer Registry data from 2010 to 2014. It looked at changes in county-level diagnosis rates in US states that expanded Medicaid in 2014 with those that did not expand Medicaid. The analysis included 611 counties total.

Researchers concluded that expanding public health insurance may be an avenue for improving cancer detection, which is associated with improved patient outcomes, including reduced mortality.

["Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses." Contact: Aparna Soni, MA, Indiana University, Bloomington, IN].

Affordable Care Act policies increased breastfeeding

Research found that Affordable Care Act policy changes were associated with an increase in breastfeeding duration by 10 percent (0.57 months) and duration of exclusive breastfeeding by 21 percent (0.74 months) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding. Researchers used data from the US National Immunization Survey from 2008 to 2014.

Researchers concluded that reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding—particularly the duration of breastfeeding and the amount of time before formula supplementation.

ACA policies impacting breastfeeding included requiring large employers to provide reasonable break time and a private place for expressing breastmilk. Others included mandating insurance coverage of lactation-support services and equipment without cost-sharing for new health insurance policies beginning on or after August 1, 2012.

["Effect of the Affordable Care Act on Breastfeeding Outcomes." Contact: Kandice Kapinos, RAND Corporation, Arlington, VA].

Osteoarthritis prevalence doubled between 1999 and 2014

This study found that, between 1999 and 2014, the rate of osteoarthritis doubled. During that time, nearly one quarter of American adults reported arthritis.

The research found that age-adjusted prevalence of arthritis was 24.7 percent. The prevalence of osteoarthritis specifically increased from 6.6 to 14.3 percent, while rheumatoid arthritis prevalence decreased from 5.9 to 3.8 percent. An increase in osteoarthritis prevalence was significant in both men and women; in non-Hispanic Whites, non-Hispanic Blacks and Hispanics; and in people with high socioeconomic status. A decrease in rheumatoid arthritis prevalence was more pronounced in men, non-Hispanic Blacks and participants with low income or obesity.

[“Various Types of Arthritis in the United States: Prevalence and Age-Related Trends From 1999 to 2014.” Contact: Juyoung Park, PhD, Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL].

Impact of dual use of Department of Veterans Affairs and Medicare Part D Drug Benefits on potentially unsafe opioid use

This study concluded that, among veterans dually enrolled in VA and Medicare Part D, dual use of opioids was associated with more than 2 to 3 times the risk of high-dose opioid exposure.

135,643 (25.1 percent) of veterans received opioids from VA only, 332,630 (61.7 percent) from Part D only and 71,200 (13.2 percent) from both. The dual-use group was more likely than the VA-only group to receive greater than 100MME for one or more days, to have more days with greater than 100 MME and to receive greater than 120 MME for 90 consecutive days.

[“Impact of Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits on Potentially Unsafe Opioid Use.” Contact: Walid F. Gellad, MD, MPH, VA Pittsburgh Healthcare System, Pittsburgh, PA].

Find a full list of AJPH research papers published online below:

• Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004-2014                
• Effect of the Affordable Care Act on breastfeeding outcomes
• Elevated blood lead levels by length of time from resettlement to health screening in Kentucky refugee children
• Trends in illicit cigarette use in Brazil estimated from legal sales, 2012 to 2016
• Social impact bonds as a funding method for health and social programs: potential areas of concern
• Legal and administrative feasibility of a federal junk food and sugar-sweetened beverage tax to improve diet
• Predicted impact of the US Food and Drug Administration's menu-labeling regulations on restaurants in four New Jersey cities
• Sustained reduction in chlamydia associated with school-based screening, Detroit, 2010 to 2015
• Hearing aid acquisition in Chinese older adults with hearing loss
• The Medicaid expansions of 2014 increased overall and early-stage cancer diagnoses
• Impact of dual use of VA and Medicare Part D drug benefits on potentially unsafe opioid use
• Cost-related medication nonadherence for older adults participating in SNAP, 2013 to 2015
• Prevalence and age-related trends of various types of arthritis in the US population from 1999 to 2014
• Completion of requirements in Iowa’s Medicaid expansion premium disincentive program, 2014 to 2015
• Arresting leprosy: therapeutic outcomes besides cure
• Inequality in utilization of dental services: a systematic review and meta-analysis
• Effects of alcohol interventions on other drug use in the Cherokee nation
• Mortality among confirmed Lassa fever cases during the 2015 to 2016 outbreaks in Nigeria
• No easy fix: to address the opioid crisis, address its structural determinants

The articles above will be published online December 21, 2017 at 4 p.m. EST by AJPH under “First Look.” “First Look” articles have undergone peer review, copyedit and approval by authors but have not yet been printed on paper or posted online by issue. AJPH is published by the American Public Health Association and is available at www.ajph.org.

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