Sunday, November 05, 2023

Two million European households could abandon the electrical grid by 2050


Peer-Reviewed Publication

CELL PRESS

Evaluation of self-sufficiency potential for 41 million European homes 

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EVALUATION OF SELF-SUFFICIENCY POTENTIAL FOR 41 MILLION EUROPEAN HOMES

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CREDIT: JOULE/KLEINEBRAHM ET AL.




Researchers report that 53% of European freestanding homes could have supplied all their own energy needs in 2020 using only local rooftop solar radiation, and this technical feasibility could increase to 75% in 2050. Publishing November 2 in the journal Joule, the study shows that there is no economic advantage for individual households to be fully self-sufficient under current or future conditions, though in some cases the costs are on par with remaining on-grid. The researchers estimate that self-sufficiency will be economically feasible for 5% (two million) of Europe’s 41 million freestanding single-family homes in 2050, if households are willing to pay up to 50% more than the cost of remaining fully grid dependent.

“Our results show that even in 2050 going off-grid won’t be the most economic choice, but it could make sense to invest in these kinds of self-sufficient buildings if you are willing to pay more for self-sufficiency,” says lead author Max Kleinebrahm, an energy economics researcher at the Karlsruhe Institute of Technology in Germany.

Grid energy costs are rising while renewable energy technology is becoming more affordable. In pursuit of self-sufficiency, more and more households are showing interest in producing their own renewable energy supplies. Kleinebrahm’s team wanted to know how feasible it would be for individual residential buildings in different parts of Europe to become fully self-sufficient, and whether doing so would come with any financial benefits. Though the potential of converting Europe to 100% renewable energy has been considered at the continental, national, and regional scale, this study is the first analysis at the level of individual buildings.

To identify regions and building types that are more amenable to self-sufficiency, the researchers compiled a database of homes across Europe and identified 4,000 homes that were representative of different regions in terms of architecture, household electricity demand, climate conditions, and the local economic framework. Then, the researchers designed optimal energy systems for each representative home that would fully cover electrical and thermal energy needs while minimizing costs. These systems included measures such as rooftop solar panels, small wind turbines, different types of storage systems, heat pump installation, and retrofitting and insulation measures.

Next, the researchers scaled their results up to estimate the technical and economic feasibility of energy self-sufficiency for Europe’s 41 million freestanding single-family homes. Overall, they estimated that 53% of homes could have technically achieved energy self-sufficiency in 2020, and that this proportion could increase to 75% by 2050 with expected improvements in renewable energy and storage technologies. However, becoming fully self-sufficient was more expensive than remaining fully dependent on the grid, both in 2020 and 2050.

Homes in sunny European countries such as Cyprus, Malta, and Italy have more economic potential for self-sufficiency, while northern European countries such as Finland, Norway, and Sweden (where there is a large mismatch between high winter energy needs and solar radiation) have the lowest potential. Regions with larger rooftops, such as Denmark, Slovenia, the Netherlands, and France, also have greater potential for self-sufficiency. The researchers also noted that there is greater potential for self-sufficient buildings in countries with high on-grid electricity costs, such as Germany, since there is less financial incentive to remain on-grid.

Though becoming fully self-sufficient may not be economically advantageous, the researchers demonstrated that partial self-sufficiency—where a building remains connected to the electricity grid but also invests in a photovoltaic system, heat pump, and insulation—could lower household energy costs. The optimal degree of self-sufficiency varied for different buildings and regions, but for one representative building in Germany, the researchers estimated that it would have been cost-optimal to be 73% self-sufficient in 2020 and 78% self-sufficient in 2050.

The researchers note that high carrier costs make leaving the grid more appealing and say that policymakers and utility companies should encourage even fully self-sufficient households to remain connected to the grid. “At a macroeconomic scale it would be less efficient to have a large number of households abandoning the grid rather than supporting it,” says Kleinebrahm.

Since the costs of supporting the grid are shared amongst users, there is also the potential for grid costs to climb further as households choose to leave the grid. “From the social perspective, you have to consider the possibility that very rich households could go off grid, in which case the rest of the grid operation would have to be paid for by economically weaker households,” says Kleinebrahm.

This study is unable to answer questions about how the expanding number of self-sufficient homes would impact electricity demand and electricity markets, but the researchers plan to address those topics in future.

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This research was supported by the Helmholtz Association.

Joule, Kleinebrahm et al., “Two million European single-family homes could abandon the grid by 2050” https://www.cell.com/joule/fulltext/S2542-4351(23)00402-6

Joule (@Joule_CP), published monthly by Cell Press, is a new home for outstanding and insightful research, analysis, and ideas addressing the need for more sustainable energy. A sister journal to CellJoule spans all scales of energy research, from fundamental laboratory research into energy conversion and storage to impactful analysis at the global level. Visit http://www.cell.com/joule. To receive Cell Press media alerts, contact press@cell.com.

 

Jawless ‘bite’ from the past: Jurassic fossils shed light on lamprey evolution


Peer-Reviewed Publication

CHINESE ACADEMY OF SCIENCES HEADQUARTERS

Reconstruction of the Jurassic (ca. 160 million years ago) lampreys Yanliaomyzon from the Yanliao Biota, northern China 

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RECONSTRUCTION OF THE JURASSIC (CA. 160 MILLION YEARS AGO) LAMPREYS YANLIAOMYZON FROM THE YANLIAO BIOTA, NORTHERN CHINA

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CREDIT: NICE VISTUDIO



Researchers from the Institute of Vertebrate Paleontology and Paleoanthropology (IVPP) of the Chinese Academy of Sciences and their collaborators have reported two extremely rare fossil lampreys from the Jurassic of northern China and revised our understanding of lamprey evolution.

The study was published in Nature Communications on Oct. 31.

The precious specimens were discovered in the famed Lagerstätte Yanliao Biota from rocks dating back 158–163 million years. One of them, Yanliaomyzon occisor or "Yanliao sucker killer," is 642 mm long (about 25 inches) and is the largest fossil lamprey ever found.

Both fossils superbly preserve the lampreys' keratinous teeth. After carefully examining the fossils, the scientists reinterpreted lamprey evolution, particularly their feeding apparatus, life cycle, and historic biogeography.

The Jurassic fossils' feeding apparatus strikingly resembles that of the living pouched lamprey Geotria australis, a flesh-feeding species. "Our study resolved these Jurassic lampreys as the closest fossil relatives to extant lampreys," said WU Feixiang, lead author of the study.

"Contrary to conventional wisdom that modern lampreys' ancestors fed on blood, our study showed that these two Jurassic lampreys must be flesh eaters, which foreshadows the flesh-eating habit of the most recent common ancestor of modern lampreys," added WU.

The study also recognized the Jurassic as a watershed in lamprey evolutionary history.

During the earlier Paleozoic era, lampreys may not have been predacious like their living relatives. This is based on consideration of Paleozoic lampreys' dwarfed body size and weak, simply assembled teeth. Furthermore, most other contemporaneous ancient fishes were heavily armored—with hard scales and body covers that prevented these tiny lampreys from biting through. However, as the abundant emergence of the 'advanced' teleost fishes with thinned scales since the Early Jurassic—changes that increased food availability—lampreys also changed.

"The abundant emergence of advanced teleost fishes with thinned scales by the Early Jurassic might have provided an important evolutionary opportunity for lampreys," said WU. "With the enhanced feeding structures, Jurassic lampreys onward were able to grow sufficiently large to meet the energy requirement of the evolution of a 'prolonged' life cycle interposed by the metamorphosis stage and involved in dramatic environmental shifts."

A time-calibrated family tree is the basis of an evolutionary history narrative. Inference of the time tree for lamprey evolution was performed in a Bayesian total-evidence dating framework. "Compared with the parsimony method, Bayesian inference is able to integrate various sources of information in a probabilistic setting while accounting for the uncertainties of the parameters, thus avoiding ad-hoc determinations and partial use of the data," said ZHANG Chi, another corresponding author of the study.

This method also makes possible the inference of ancestral geographical areas for lampreys. The history of the anti-tropical distribution pattern of lampreys has baffled biogeographers due to the extremely thin fossil record of the group. With the calibrations of the Jurassic lampreys, the lineage of the pouched lamprey in the Southern Hemisphere was resolved as the earliest diverged lineage among living lampreys. Thus, the study estimates that modern lampreys originated in the Southern Hemisphere during the Late Cretaceous. This contradicts the conventional wisdom that lampreys originated in the Northern Hemisphere, where most extant lamprey species live.

"This discovery clearly indicates that the extant southern lampreys retain a feeding morphology that already arose in the Jurassic, and that modern lamprey phylogeny is now consistent with a Southern Hemisphere origin, combined with an adaptation to a carnivorous diet," said Prof. Philippe JANVIER of France's National Museum of Natural History, a co-author of the study.

Although large gaps in the long evolutionary history of lampreys still exist, the discovery of Jurassic lamprey fossils is expected to promote more research in the future.

Flesh-eating lampreys Yanliaomyzon from the Jurassic Yanliao Biota  

 

Expanding pharmacists’ role for patients with hypertension could prevent 15 million heart attacks and save $1.1 trillion over 30 years, VCU-led study finds


The study details how pharmacists’ ability to treat patients with hypertension could have a positive impact on both Americans’ quality of life and the U.S. health care system

Peer-Reviewed Publication

VIRGINIA COMMONWEALTH UNIVERSITY




RICHMOND, Va. (Nov. 3, 2023) — If pharmacists had a larger role in prescribing medications to control blood pressure, they could prevent more than 15 million heart attacks, nearly 8 million strokes and more than 4 million cases each of angina and heart failure in the U.S. over 30 years, according to a new Virginia Commonwealth University-led study.

The study, “Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States,” which published Friday in JAMA Network Open, details how pharmacists’ ability to treat patients with hypertension directly could have both a positive impact on Americans’ health and quality of life and a significant economic impact on the U.S. health care system. The study is among the first to explore the economics of pharmacist prescribing to improve blood pressure control.

The research team, led by corresponding author Dave Dixon, Pharm.D., of the VCU School of Pharmacy, found that the U.S. health care system could save more than $1.1 trillion over 30 years, a cost savings of $10,162 per patient. Moreover, the study’s authors found that over 30 years, patients could regain more than 30 million “quality-adjusted life years,” or years where their quality of life is significantly higher than it would have been if they were to have a health emergency.

Dixon, the Nancy L. and Ronald H. McFarlane Professor of Pharmacy and chair of the Department of Pharmacotherapy and Outcomes Science at the VCU School of Pharmacy, said these findings support measures that could increase access to care for millions across the country.

“Being that hypertension affects so many Americans – we’re talking about over 100 million people in the U.S. – I think the impact is tremendous because everybody knows somebody with high blood pressure,” said Dixon, who serves as a core faculty member and former director of the Center for Pharmacy Practice Innovation at the VCU School of Pharmacy. “It’s one of the leading causes of heart disease and kidney failure in the world.”

More than 95% of Americans live within 5 miles of a community pharmacy, a 2022 study in the Journal of the American Pharmacists Association found. And according to the Centers for Disease Control and Prevention, patients visit their community pharmacist 12 times more frequently than their primary care provider. As the U.S. faces a shortage of primary care professionals, Dixon said pharmacists could bridge that gap.

“Pharmacists’ role as health care providers tends to be underused in the community, and this is really about how pharmacists can provide for their communities in a way that improves access to care for hypertension,” said Dixon, who also serves as an affiliate professor of internal medicine in the Division of Cardiology at the VCU School of Medicine.

Most states currently give pharmacists prescribing privileges; however, current federal laws make it difficult for pharmacists to receive reimbursement for the clinical services they provide.

“Although pharmacists currently have some type of prescribing privileges in 49 states and Washington, D.C., they are not recognized as providers under the Social Security Act,” Dixon said. “This is one of the major barriers to implementing these life-saving – and cost-saving – measures for patients.”

The $1.1 trillion in health care savings over 30 years that Dixon and his team identified stem from preventive measures, such as educating patients on high blood pressure and prescribing antihypertensive medication, as well as from helping patients better manage their blood pressure. The ability to offer these services could mean a reduction in cardiovascular emergencies, which is crucial given the increasing mortality rates around hypertension. From 2010-19, there was a 23.1% increase in hypertension-related mortality, according to a 2022 study from the Journal of the American Heart Association.

It could also address poor outcomes for racial and ethnic minority groups, Dixon said. For individuals ages 35-64, Black patients had the highest rates of death due to hypertension of any racial or ethnic group in the U.S., according to a 2020 study in the journal Hypertension. As Dixon and his co-authors state in the study, “pharmacist-led interventions have been shown to significantly improve blood pressure control among Black individuals and individuals of racial and ethnic minoritized groups.”

The team of researchers who contributed to this study includes co-authors Karissa Johnston, Ph.D., of Broadstreet Health Economics and Outcomes Research in Canada; Julie Patterson, Pharm.D., Ph.D., of the National Pharmaceutical Council and formerly of the VCU School of Pharmacy; Carlo A. Marra, Pharm.D., Ph.D., of the School of Pharmacy at the University of Otago in New Zealand; and Ross T. Tsuyuki, Pharm.D., of the Faculty of Medicine and Dentistry at the University of Alberta in Canada.

 

E-cigarette use among adults

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The findings of this study of 414,000 respondents to the 2021 Behavioral Risk Factor Surveillance System survey suggest that e-cigarette use remained common during the COVID-19 pandemic, particularly among young adults ages 18 to 24 (18% prevalence). Notably, 71.5% of individuals ages 18 to 20 who reported current e-cigarette use had never used combustible cigarettes. These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults. 

Authors: Michael J. Blaha, M.D., M.P.H., of the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease in Baltimore, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.40859)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.40859?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110323

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

Higher parenting stress for dads working from home versus onsite during pandemic

Fathers who worked remotely were more than twice as likely to report higher parenting stress compared to fathers who worked onsite

Peer-Reviewed Publication

NORTHWESTERN UNIVERSITY

  • Findings revealed a gender difference
  • ‘Might be a reflection of societal expectations that men should prioritize work obligations over family needs’
  • Study authors offer tips for parents, employers to mitigate stress of remote work

CHICAGO --- Forty percent of parents who worked remotely during the COVID-19 pandemic reported higher parenting stress compared with only 27 percent of parents who worked onsite, reports a new survey from scientists at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago.

The study results revealed a gender difference: Fathers who worked from home were twice as likely to report that parenting was stressful all or most of the time compared to fathers who worked onsite. Parenting stress for mothers who worked at home was slightly higher, but it did not reach statistical significance. 

The study found no differences in mental or general health between parents who worked remotely or onsite.

“Our survey results show that teleworking during the pandemic was associated with more parenting stress, especially for fathers,” said lead author Dr. John James Parker, an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and a pediatrician at Lurie Children’s. “This might be a reflection of societal expectations that men should prioritize work obligations over family needs, which creates additional stress for fathers working from home.”

The study will be published Nov. 3 in JAMA Network Open.

What parents can do

The study authors recommend parents reflect on their family and work situation and try to find an arrangement that limits stress and promotes wellbeing. 

“This can be as simple as putting a noise-cancelling machine in the workspace, rearranging schedules to limit distractions and planning time for parents to step away from work to be fully engaged with their children,” said Parker, who also is an internist at Northwestern Medicine.

What employers can do

“Employers could provide support to fathers by offering more flexibility and recognizing that both parents need more work/life balance,” Parker said. “Employers also could encourage parents who work from home, especially men, to take advantage of employee assistance programs if they are experiencing high levels of stress. This is important, since parents’ stress is linked to negative parental health and child developmental outcomes.” 

The study is titled, “Teleworking, Parenting Stress, and the Health of Mothers and Fathers.” The survey included 1,060 parents from all 77 neighborhoods in Chicago. 

Other Northwestern authors include Dr. Craig Garfield, Clarissa Simon, Marie Heffernan, Dr. Matthew Davis and Dr. Kristin Kan. 

This study was supported by the Patrick M. Magoon Institute for Healthy Communities at Lurie Children’s Hospital for Voices of Child Health in Chicago; the Siragusa Family Foundation; Hazel Speck Berry Trust and the National Heart Lung and Blood Institute of the National Institutes of Health. 

JOURNAL

ARTICLE TITLE

ARTICLE PUBLICATION DATE

Higher parenting stress for dads working from home during pandemic


Fathers who worked remotely were more than twice as likely to report higher parenting stress compared to fathers who worked onsite

Peer-Reviewed Publication

ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO





A survey from Ann & Robert H. Lurie Children’s Hospital of Chicago found that 40 percent of parents who worked remotely during the pandemic reported higher parenting stress compared with only 27 percent of parents who worked onsite.

Results revealed a gender difference – fathers who worked from home were twice as likely to report that parenting was stressful all or most of the time compared to fathers who worked onsite. Parenting stress for mothers who worked at home was slightly higher, but it did not reach statistical significance.

The study found no differences in mental or general health between parents who worked remotely or onsite.

“Our survey results show that teleworking during the pandemic was associated with more parenting stress, especially for fathers,” said lead author John James Parker, MD, a pediatrician at Lurie Children’s, an internist at Northwestern Medicine and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “This might be a reflection of societal expectations that men should prioritize work obligations over family needs, which creates additional stress for fathers working from home. We recommend that parents reflect on their family and work situation and try to find an arrangement that limits stress and promotes wellbeing. This can be as simple as putting a noise cancelling machine in the workspace, rearranging schedules to limit distractions and planning time for parents to step away from work to be fully engaged with their children.

The survey included 1,060 parents from all 77 neighborhoods in Chicago. The study was published in JAMA Network Open.

“Employers could provide support to fathers by offering more flexibility and recognizing that both parents need more work/life balance. Employers also could encourage parents who work from home, especially men, to take advantage of employee assistance programs if they are experiencing high levels of stress,” added Dr. Parker. “This is important, since parents’ stress is linked to negative parental health and child developmental outcomes.”

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is a nonprofit organization committed to providing access to exceptional care for every child. It is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. Lurie Children’s is the pediatric training ground for Northwestern University Feinberg School of Medicine.

Disclaimer: AAAS and 

 

34,000 healthcare professionals surveyed indicate they have higher bias against transgender people

Peer-Reviewed Publication

CELL PRESS

A screenshot of the transgender IAT procedure 

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A SCREENSHOT OF THE TRANSGENDER IAT PROCEDURE

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CREDIT: HELIYON/DERBYSHIRE ET AL.

By analyzing data from the Harvard Implicit Association Test—a widely accepted measure of a person’s attitudes toward people based on characteristics like race, gender, and sexuality—researchers find that healthcare professionals, and in particular nurses, are more biased against transgender people than are people who are not healthcare professionals. A questionnaire administered before and after the test shows that healthcare professionals are less likely to know transgender people personally and that nurses are more likely to conflate sex and gender identity. These results are reported November 3 in the journal Heliyon.

The Implicit Association Test works by asking participants to categorize groups of people with “good” words like “nice” or “laughter” and “bad” words like “nasty” or “rotten.” Its results are collected by a team of scientists as a part of Project Implicit since 1998 and are made available for use by the public and other researchers.

To specifically assess the attitudes of healthcare professionals towards transgender people, the researchers focused on a subset of the respondents from 2020 to 2022, including 11,996 nursing healthcare professionals and 22,443 non-nursing healthcare professionals. These responses were compared to 177,810 responses of non-healthcare professionals.

A person’s bias is reported as their “D-score,” which can range from -2 to 2, with higher scores indicating more anti-transgender views. The standard classification for this test lists values over 0.15 as “slightly biased,” and over 0.35 and 0.65 as “moderately” and “strongly” biased, respectively.

Non-healthcare professionals on average reported a D-score of 0.116, which is considered to mean that they have little to no bias. However, healthcare professionals (non-nursing), reported an elevated score of 0.149, which is on the edge of what is considered to be “slightly biased.” The average D-score for nursing healthcare professionals was 0.176, which falls clearly within the range of “slightly biased.”

The participants’ D-score assesses their implicit bias—their true beliefs which they may be too reluctant to share—but their explicit bias, or their self-reported views, were assessed by a questionnaire.

Nursing healthcare professionals were significantly more likely to agree with statements like “I believe a person can never change their gender” or “I think there is something wrong with a person who says they are neither a man nor a woman” compared to other healthcare professionals and non-healthcare professionals.

“Our finding that nurses have higher levels of implicit bias towards transgender people may be related to a tendency to conflate sex and gender identity, as shown by higher levels of agreement with transphobic statements that conflate these two distinct concepts,” write authors Daniel W. Derbyshire (@DWDerbyshire) of the University of Exeter and Tamsin Keay of Coventry University.

The questionnaire also asked about the participants’ relationships with transgender people in their daily lives. While healthcare professionals—including nurses and non-nurses—were more likely to have met a transgender person than non-healthcare professionals, they reported that they were less likely to have a transgender friend or family member.

“This suggests that healthcare professionals’ (both nurses and non-nurses) experience of interacting with transgender people may be largely confined to a work context,” write the authors.

The authors note that the participants in this test are limited to those who visited the Project Implicit website and chose to complete the test. “As such, the sample may be subject to sample selection bias in terms of the demographics and Implicit Association Test (IAT) results of participants,” write the authors. “However, it may be anticipated that people with particularly negative attitudes towards transgender people would avoid taking the Transgender IAT and the results presented here may therefore under-represent the extent of implicit bias towards transgender people.”

Images of transgender people used in the Implicit Association test 

Images of transgender people used in the Implicit Association test

Images of cisgender people used in the Implicit Association test 

Images of cisgender people used in the Implicit Association test

CREDIT

Heliyon/Derbyshire et al.

Heliyon, Derbyshire et al. “Nurses’ Implicit and Explicit Attitudes towards Transgender People and the need for Trans-Affirming Care” https://cell.com/heliyon/fulltext/S2405-8440(23)07970-7

Heliyon (@HeliyonJournal), part of the Cell Press family, is an open access journal publishing scientifically accurate and valuable research across life, physical, social, and medical sciences journal. Visit https://www.cell.com/heliyon. To receive Cell Press media alerts, contact press@cell.com.

 

Health care expenditures for black and white adults living under similar conditions


JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK



About The Study: In this study of a nationally representative sample of 7,062 non-Hispanic Black or white adults, health care spending for Black adults in the U.S. was equal to or less than that of white adults, but only in areas of racial and economic equity and equitable insurance access. The results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending. 

Authors: Lorraine T. Dean, Sc.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2023.3798)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Embed this link to provide your readers free access to the full-text article 

 https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2023.3798?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110323

About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

Black and white adults have similar health care expenditure levels in racially and economically integrated communities


In integrated communities, Black adults spent $79 less than whites on health expenditures per year; in non-integrated communities, Black adults spent $2,145 less on health care per year than whites


Peer-Reviewed Publication

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH




Differences in health care expenditures between Black and white adults vary substantially with the local level of racial and economic integration, and tend to be low or nonexistent in highly integrated communities, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

For their study, the researchers compared health care expenditures for a nationally representative sample of Black and white adults in census tracts across the United States. They found that, at the same level of health, health expenditures by Black adults were much lower than white adults’ in census tracts with the lowest levels of racial integration but were virtually the same in tracts where the level of integration was highest. The researchers also found that more-integrated areas also had signs of more equitable health access for Black and white adults.

Individuals’ health expenditures are indicators of people’s health needs and the types of health care they may or may not be able to access. The findings add to evidence that health disparities between Black and white adults are largely attributable to social factors that can be changed.

The study was published online November 3 in JAMA Health Forum.

“Fixing health care disparities may require both health care and non-health care solutions—making sure people have health insurance and that the resources they have based on where they live give them the best opportunities to be healthy,” says study lead author Lorraine Dean, ScD, an associate professor in the Bloomberg School’s Department of Epidemiology. “We already knew from previous research that health disparities mostly disappeared when Black and white adults lived in more equitable areas—now we know that extends to health care expenditures, too.”

Because of external factors—including different levels of exposure to poverty, economic opportunity, health care access, and neighborhood environments—life expectancy, disease risk, health outcomes, and other health care-related measures have long been known to differ between white and Black Americans. Black adults on average have shorter lives and higher rates of common ailments including diabetes, hypertension, and kidney disease.

A 2011 study, also by Bloomberg School researchers including a co-author of the new study, Darrell Gaskin, PhD, the William C. and Nancy F. Richardson Professor in the Bloomberg School’s Department of Health Policy and Management, described a racially and socioeconomically integrated area of Baltimore in which disparities in the rates of hypertension, diabetes, and other health measures were much lower than national averages, and for some measures disappeared entirely. The study used the term “place, not race” to capture the findings.

In the new study, Dean and colleagues addressed the closely related issue of whether health care expenditures vary with the level of racial and socioeconomic integration.

For their analysis, the researchers used data from a 2016 U.S. government survey called the Medical Expenditure Panel Survey (MEPS), which included data on race, socioeconomic status, health status, health care access, health care use, and health care expenditures (including insurer payments) for a nationally representative sample of Americans. The investigators also used data on each MEPS participant’s community levels of racial and socioeconomic integration, based on the U.S. Census Bureau’s American Community Survey (ACS) for 2013–17.

The analysis covered a total of 7,062 adult MEPS participants age 21 or older—one-third of them Black, two-thirds white—living in 2,238 census tracts where the population was at least five percent Black.

For each of these census tracts, the researchers used census data to calculate a measure of socioeconomic and Black/white integration called the Index of Concentration at the Extremes (ICE). They defined this as the number of non-Hispanic white adults in high-income (≥$100,000) households minus the number of non-Hispanic Black persons in low-income (<$20,000) households, divided by the total population with known income in that census tract.

The analysis, which adjusted for potential confounding factors such as age, sex, and education level, found that in communities where the ICE was highest—many high-income white adults, few low-income Black adults—racial disparities in health care expenditures were pronounced. In these relatively non-integrated communities, Black adults spent $2,145 less on health care per year compared to white adults. These differences could reflect undertreatment for Black adults or overuse of health care by white adults. By contrast, in communities where the ICE was in a medium range, indicating the highest level of racial and socioeconomic integration, these expenditure disparities mostly disappeared—the computed difference in overall annual expenditure being a mere $79.

In the least integrated communities, where Black adults had lower overall health care expenditures, they still had levels of physical health similar to white adults’. Their lower overall expenditures were driven mainly by lower doctor’s-office, prescription drug, and dental expenditures. But in highly integrated areas, differences in individual expenditure categories were minimized. The most integrated areas also had relatively equitable health care access, according to MEPS data.

On the whole, the researchers say, the findings suggest that reducing health care expenditure disparities between Blacks and whites is possible, though it might be much easier to achieve in areas where socioeconomic and health care access disparities are minimized.

“Health care expenditures for Black and White US Adults Living Under Similar Conditions” was co-authored by Lorraine Dean, Yuehan Zhang, Rachael McCleary, Rahel Dawit, Roland Thorpe, and Darrell Gaskin.

Funding for the study was provided by the National Institute on Minority Health and Health Disparities (U54MD000214) and the National Heart, Blood, and Lung Institute (R01HL164116).

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