Monday, September 22, 2025

 

More low-income adults reported having a usual source of care after the Affordable Care Act


Usual source of care among adults aged 18-64 years post-ACA, 2010-2017




American Academy of Family Physicians





Research Brief

More Low-Income Adults Reported Having a Usual Source of Care After the Affordable Care Act

Background and Goal: Before the Affordable Care Act (ACA), uninsured and low-income adults were less likely to have a usual source of care due to cost, coverage, and access barriers. This study evaluated changes in the prevalence of usual sources of care and the reasons for lacking one before and after ACA implementation.  

Study Approach: Researchers analyzed 2010 to 2017 data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC), a nationally representative survey of the U.S. civilian, noninstitutionalized population. The study sample included 36,738 adults ages 18 to 64 and was divided into pre-ACA (2010-2013) and post-ACA (2014-2017) implementation. The primary outcome was self-reported usual source of care status and, if none existed, the main reason why. 

Main Results:

  • The national usual source of care rose from 67% to 68% after the ACA, with the largest gains among low-income adults in both rural (+4.96 percentage points) and urban (+2.45 percentage points) areas. Reports by urban high-income adults declined slightly (-1.98 percentage points) while rural high-income adults showed no significant change.

  • After the ACA, reasons for lacking a usual source of care shifted in urban areas: affordability and insurance-related barriers decreased across income groups, accessibility increased across all income groups, and individual-preference reasons increased for low- and middle-income adults.

Why It Matters: The findings suggest that while low-income adults reported gains in usual sources of care, insurance expansion alone may not ensure consistent access to care, especially given persistent non-financial access challenges. 

Permanent link: Usual Source of Care Among Adults Aged 18-64 Years Post-ACA, 2010-2017

Sara Shahbazi, PhD, MSPH

Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

 

Current sexual orientation, gender identity, and differences of sex development measures in federal health surveys


Sexual orientation, gender identity, and differences of sex development measures in federal health surveys: implications for primary care research and practice



American Academy of Family Physicians





Methodology

Current Sexual Orientation, Gender Identity, and Differences of Sex Development Measures in Federal Health Surveys

Background and Goal: Federal health surveys are a key source for understanding health needs in the U.S., including the needs of people in LGBTQ+ community. This methodology paper characterized the current landscape of measures capturing sexual orientation, gender identity, and differences of sex development in federal health surveys, detailing when and how the information was collected.

Approach: Researchers scanned 10 large federal health surveys and did a content analysis of each survey’s materials. They recorded whether and when surveys included sexual orientation questions, whether gender identity was measured, how stable the items were over time, and whether any survey identified differences of sex development, or intersex status. They highlighted changes that occurred after 2022. The article was submitted in September, 2024.     

Main Results:

  • Sexual orientation questions were asked in nine out of 10 surveys. Several surveys began collecting sexual orientation in the mid-2010s. Unique standouts included the National Health and Nutrition Examination Survey (NHANES) and National Survey of Family Growth (NSFG), which had over 20 years of sexual orientation data collection.

  • Seven of the ten surveys ask about gender identity, with four adding those questions only within the last two years. Some include a separate sex-assigned-at-birth item, while others do not or ask only whether a person is transgender.

  • Differences of sex development questions are almost absent. Only one survey, All of Us, included a way to identify people with differences of sex development.  

Why It Matters: Having standard, sustained sexual orientation, gender identity, and differences of sex development measures in federal surveys would make it easier to identify and track disparities, plan studies, and evaluate interventions.

Permanent link: Sexual Orientation, Gender Identity, and Differences of Sex Development Measures in Federal Health Surveys: Implications for Primary Care Research and Practice 

Thomas M. Freitag, MPP 

Harvard Medical School, Boston, Massachusetts

Yalda Jabbarpour, MD

Robert Graham Center, Washington, DC

Georgetown University School of Medicine, Washington, DC

 

 

 

High educational debt and long work hours are associated with burnout symptoms in early-career family physicians



Relationships of educational debt with hours worked and burnout symptoms among early-career family physicians





American Academy of Family Physicians






Original Research

High Educational Debt and Long Work Hours Are Associated With Burnout Symptoms in Early-Career Family Physicians

Background and Goal: This study examined whether higher educational debt among physicians is associated with more hours worked per week and whether both are independently associated with burnout symptoms among early-career family physicians.

Study Approach: Researchers linked the American Board of Family Medicine Initial Certification Questionnaire (2017 to 2020) to its National Graduate Survey about three years later (2020 to 2023) to form a cohort of 4,905 U.S. early-career family physicians in outpatient continuity care. Educational debt at graduation was grouped as none, under $150,000, $150,000 to $250,000, $250,000 to $350,000, and over $350,000. Weekly work hours were grouped as under 40, 40 to 49, 50 to 59, and 60 or more. Respondents were classified as having symptoms of burnout by reporting at least weekly to either of two single-item questions. 

Main Results:

  • Out of 4,905 early-career family physicians, about 18% had no educational debt, and about 16% owed more than $350,000.

  • Physicians with higher debt tended to work more hours per week.

  • The more hours a physician worked, the more likely they were to report burnout symptoms.

  • In unadjusted analyses, burnout symptoms increased stepwise with debt. After adjustment analyses, physicians with $250,000–$350,000 and those with more than $350,000 had higher odds of reporting burnout symptoms compared with those with no debt.

  • Compared with working under 40 hours per week, working 60 or more hours a week was linked to nearly three times the odds of reporting burnout symptoms. 

Why It Matters: Finding ways to reduce educational debt burden on early-career family physicians may potentially reduce burnout symptoms. 

Permanent link: Relationships of Educational Debt With Hours Worked and Burnout Symptoms Among Early-Career Family Physicians 

Dean A. Seehusen, MD, MPH, et al

Medical College of Georgia, Augusta University, Augusta, Georgia

Pre-Embargo Link (temporary)

 

Over 62,700 deaths associated with record-breaking heat during the summer of 2024 in Europe



A study led by ISGlobal and published in Nature Medicine estimates that over 181,000 deaths were related to heat during the summers of 2022, 2023, and 2024




Barcelona Institute for Global Health (ISGlobal)




The year 2024 broke several temperature records: it was the hottest ever recorded, and its summer was also the warmest to date. A study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, has estimated that 62,775 heat-related deaths occurred in Europe between 1 June and 30 September of that year. These mortality figures are 23.6% higher than the approximately 50,800 estimated for the summer of 2023, and 8.1% lower than the nearly 67,900 estimated for the summer of 2022. These results have been published in Nature Medicine.

Italy and Spain, the countries with the highest number of deaths

The study focused on 654 regions in 32 European countries. The country with the highest number of heat-related deaths was Italy, with more than 19,000 estimated deaths in the summer of 2024. In the previous summers of 2023 and 2022, Italy was also the country with the highest heat-related mortality, with an estimated 13,800 and 18,800 deaths, respectively.

The country with the second highest estimated mortality in the summer of 2024 was Spain, with more than 6,700 deaths, followed by Germany (around 6,300), Greece (around 6,000) and Romania (more than 4,900). In the case of Spain, estimated deaths in 2024 were almost half those for 2022, due to lower summer temperatures than in the previous two years. In the case of Spain, estimated deaths in 2024 were almost half those for 2022, due to lower summer temperatures than in the previous two years.

Top 10 European countries with the highest estimated number of deaths

  

Estimated summer deaths (attributable number)

Country

 

2024

2023

2022

Italy

 

19,038

13,790

18,801

Spain

 

6,743

8,335

12,135

Germany

 

6,282

6,545

9,636

Greece

 

5,980

3,887

2,517

Romania

 

4,943

3,147

2,942

Bulgaria

 

3,414

2,082

1,445

Serbia

 

2,515

805

1,026

France

 

2,451

3,614

5,839

Poland

 

1,780

948

1,569

Hungary

 

1,443

555

1,013

Europe (total)

 

62,775

50,798

67,873

Data from the 32 countries, here.

Greece and Bulgaria, countries with the highest mortality rates

In terms of mortality incidence, the countries with the highest heat-related death rates for the same period were Greece (574 estimated deaths per million people)Bulgaria (530 deaths per million) and Serbia (379 deaths per million). These rates were significantly higher than those estimated for the two previous summers of the study, the highest of which was 373 deaths per million in Greece during 2023.

Overall, 15 of the 32 assessed countries experienced their highest heat-related mortality burden and rates during the summer of 2024.

Top 10 European countries with the highest estimated heat-related mortality rates

 

Attributable rate (summer deaths per million)

Country

2024

2023

2022

Greece

574

373

241

Bulgaria

530

323

223

Serbia

379

121

151

Croatia

326

133

187

Italy

323

234

318

Bosnia and Herzegovina

266

128

142

Romania

259

165

154

Cyprus

236

139

70

Montenegro

219

105

125

Hungary

150

58

105

Europe (average)

117

94

127

Data from the 32 countries, here.

Differences by sex and age

The number of heat-related deaths was higher among women and older people during the three summers studied (2022, 2023 and 2024). Specifically, it is estimated that in the summer of 2024, the number of heat-related deaths among women was 46.7% higher than among men. In people over 75, the estimated mortality rate was 323% higher than in all other age groups.

Most vulnerable regions

"Although the summer of 2024 was the hottest on record according to Copernicus, in the specific regions of our study, the summers of 2022 and 2023 were actually hotter. However, these regional differences in average temperature are not fully reflected in mortality, as the estimated deaths for 2024 were higher than those estimated for the summer of 2023 and only slightly lower than those for 2022. This is because in 2022 and 2024, the highest temperatures occurred in south-western and south-eastern Europe, respectively, both areas that are highly vulnerable to heat," explains Tomáš JanoÅ¡, ISGlobal and Recetox researcher and first author of the study.

“Europe is the continent that is warming most quickly, at twice the global average. And within Europe, the Mediterranean basin and south-eastern regions are emerging as major climate change hotspots, facing the greatest impacts on health and with a substantial rise in heat-related mortality projected during the 21st century”, adds JanoÅ¡.

Forecaster.health, an effective and reliable tool for emergency heat alerts

In total, the study suggests that there were more than 181,000 heat-related deaths in Europe during the three summers studied, two-thirds of which occurred in southern Europe. According to Joan Ballester Claramunt, principal investigator of the European Research Council (ERC) EARLY-ADAPT project, and senior author of the study, the magnitude of these figures highlights the need to “strengthen adaptation strategies, including the development and implementation of a new generation of continent-wide, impact-based heat-health early warning systems”.

For this reason, part of the study was devoted to evaluating Forecaster.health, a tool created within the ERC Proof-of-Concept Grants HHS-EWS and FORECAST-AIR, which uses epidemiological models to transform weather forecasts into daily operational heat-health alerts by region and for specific population groups. The analysis shows that the tool is highly reliable in issuing heat-health alerts at least one week in advance when conditions point to an exceptional mortality risk.

“In southern Europe, however, the early warning system continued to show relatively high reliability even beyond this seven-day horizon, which considering that this is the area with the highest heat-related mortality on the continent, represents an unexplored opportunity to save lives among the most vulnerable populations”, says Joan Ballester Claramunt.

Methodology

The team used daily regional temperature observations and mortality records for the period 2015-2019 to fit the epidemiological models. Once fitted, these were combined with daily temperature observations and forecasts and with weekly mortality series for the years 2022 to 2024 to calculate heat-related mortality in these three recent summers.

Re-estimation of heat-related mortality in the summers of 2023 and 2022

This study follows on from previous studies on estimated mortality for the summers of 2023 and 2022, respectively. After finding that the use of weekly mortality records to fit epidemiological models led to an underestimation of heat-related mortality of between 5% and 20%, the team this time used daily mortality series from the database of the EARLY-ADAPT project (www.early-adapt.eu) to fit the epidemiological models.

Using this improved methodology, the data for the summers of 2022 and 2023 were reprocessed, resulting in higher mortality estimates than in previous years' studies, which the researchers consider to be more accurate.

Reference

Tomáš JanoÅ¡, Marcos Quijal-Zamorano, Natalia Shartova, Elisa Gallo, Raúl Fernando Méndez Turrubiates, Nadia Denisse Beltrán Barrón, Fabien Peyrusse, Joan Ballester. Heat-related mortality in Europe during 2024 and health emergency forecasting to reduce preventable deaths. Nature Medicine, September 2025. doi: 10.1038/s41591-025-03954-7

 

About ISGlobal

 

The Barcelona Institute for Global Health, ISGlobal, is the fruit of an innovative alliance between the ”la Caixa” Foundation and academic and government institutions to contribute to the efforts undertaken by the international community to address the challenges in global health. ISGlobal is a consolidated hub of excellence in research that has grown out of work first started in the world of health care by the Hospital Clínic and the Hospital del Mar and in the academic sphere by the University of Barcelona and Pompeu Fabra University. Its working model is based on the generation of scientific knowledge through Research Programmes and Groups, and its translation through the areas of Training and Analysis and Global Development. ISGlobal has been named a Severo Ochoa Centre of Excellence and is a member of the CERCA system of the Generalitat de Catalunya.