Friday, July 17, 2026

 

Are survival rates for adults with congenital heart disease linked to specialized cardiac care access?



People with congenital heart disease living in states with lower average household incomes and higher percentages of uninsured residents had increased rates of death and disability, according to a new study in the Journal of the American Heart Association



American Heart Association

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Research Highlights:

  • In an analysis of the Global Burden of Disease Study compared with U.S. Census data from 1990-2021, researchers found that people with congenital heart disease living in states with lower average household incomes and fewer people with health insurance had higher rates of death and disability.

  • The research authors hypothesize that this difference may be due to easier access to specialized care and treatment from adult congenital heart disease cardiologists in communities with higher income levels and more residents with health insurance.

  •  Congenital heart disease requires lifelong, regular access to specialized cardiac care.

  • Expanding access to expert care, particularly in under-resourced regions of the U.S., could play a profound role in improving survival and quality of life for adult congenital heart disease patients.


DALLAS, July 15, 2026 — People with congenital heart disease living in states with low household incomes and limited access to health insurance and the specialized care they need may be more likely to become disabled or die from congenital heart disease, according to new, independent research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.

Over the past 30 years, more children with congenital heart disease have survived into adulthood due to better surgical and catheter-based treatments, as well as improvements in medical care. As these children grow into adults, they continue to require specialized cardiac care, as recommended by evidence-based American Heart Association/American College of Cardiology guidelines, to maintain lifelong health and well-being. 

This is one of the first studies to examine the connection between the health and survival of adults with congenital heart disease based on state-level data from the Global Burden of Disease Study along with income and insurance data from the U.S. Census, spanning from 1990 to 2021. Researchers examined the relationship among income levels, disability and death rates for nearly 300,000 adults with congenital heart disease aged 20 years and older.

“Understanding how social and economic factors can influence survival and outcomes is essential. Long-term outcomes and quality of life depend heavily on access to specialized, lifelong care for people with congenital heart disease,” said senior author Anitha John, M.D., Ph.D., medical director of the Washington Adult Congenital Heart Program at Children’s National in Washington, D.C. “Seeing how these factors affect patients long term allows us to better identify people at highest risk for complications. Then we can work toward improving access and reducing care gaps for people who have congenital heart disease.”

What are the key findings of the analysis?

  • As median household income increased in a state, the death rate for people with congenital heart disease decreased.
  • The relationship between death rate and individual income levels was stronger than the connection between death rates and the percentage of residents without insurance in each state. This suggests that simply having health insurance did not guarantee that people accessed the specialized care required for congenital heart disease. One reason for this might be differences in types of insurance coverage versus the overall presence of insurance.
  • Geography and access to resources (namely, specialized cardiac care) likely play a profound role in death and disability in adults with congenital heart disease in the U.S. More research is needed to understand these connections and their impact on the health, well-being and survival of people with congenital heart disease.  

“While having health insurance does matter, it does not explain the differences we found in terms of how long people with congenital heart disease live,” John said. “This indicates that insurance alone doesn’t guarantee access to care. People may still face barriers if their insurance doesn’t cover specialized heart care or if out-of-pocket costs are too high. In many cases, specialized care may not be available in their area at all. We need to make sure everyone with congenital heart disease has the same access to specialty care throughout their lifetime, regardless of where they live.”

“We also need more trained specialists in adult congenital heart conditions. These medical experts should be more evenly distributed across the country, particularly where congenital heart disease patients live and work. Additionally, we need better systems to help patients get referred to the right care throughout their lives,” she said. “Expanding telehealth and improving insurance networks may also help to improve access.”

Michelle Gurvitz, M.D., an American Heart Association volunteer expert and chair of the writing committee for the 2025 ACC/AHA/HRS/ISACHD/SCAI joint Guideline for the Management of Adults With Congenital Heart Disease, said, “The 2025 guideline outlines when to seek expert assistance and how specialists can work together with other healthcare providers to enhance access to care. Many patients stop receiving specialized care when they transition from pediatric to adult care. Additionally, this study shows that some patients cannot see specialists because of issues such as insurance or their location.” Gurvitz, who was not involved in this study, is also a cardiologist at Boston Children’s Hospital and an associate professor of pediatrics at Harvard Medical School.

According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, congenital heart defects (heart or blood vessel issues that are present at birth) are one of the most common birth defects around the world. Congenital heart disease is the leading cause of death in the U.S. from a condition present since birth.

What are the study details, background, design and limitations?

  • Researchers reviewed data on death rates and ”disability-adjusted life years“ – the number of healthy life years lost due to a condition.
  • Income levels, including household income and insurance status (considered uninsured if they lacked coverage for a full year), detailed by state were secured from the U.S. Census Bureau data.
  • The findings show associations among the data points such as income, but cannot be interpreted as cause and effect. The associations found in the analysis may be influenced by factors like access to care, which the researchers could not directly measure.

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

Journal

Journal of the American Heart Association

Article Title

Associations Between Socioeconomic Status and Adult Congenital Heart Disease Mortality in the U.S.: Insights from the Global Burden of Disease Study

Article Publication Date

15-Jul-2026

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Elephants communicate through ground vibrations thanks to large middle ear bones and a special muscle



Researchers may have uncovered the mechanisms behind elephants’ long-distance communication through ground vibrations: large and heavy ears and ear canals that can be sealed off at will




Frontiers

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Elephants can communicate with other elephants across distances of up to five kilometers by producing sounds that travel by air. However, they have a second way of sending signals: seismic waves traveling through the ground. These vibrations are transmitted from elephants’ feet through their legs and ultimately through the bones of their skull directly into the inner ear. They can be perceived across distances of 10 kilometers or more. This is called bone-conduction hearing.

Now, a Frontiers in Audiology and Otology study has found why bone-conduction hearing works so well for elephants: it may all come down to size and a special muscle.

“Ear canal listening devices such as AirPods can be annoying because we hear body-generated sounds louder than normal, for example, when we walk or chew,” said senior author Dr Sunil Puria, an associate professor at the Department of Otolaryngology at Harvard Medical School and at the Massachusetts Eye and Ear. “Elephants, however, may use the ability to close their ear canals to their advantage in long distance communication. We found that elephants’ bone-conduction hearing is significantly improved through their larger middle ear structures and possibly further enhanced by voluntarily closing the ear canal.”

Vibrating bones

For the study, published in the journal’s Auditory Science section, the scientists used temporal bones, a part of the skull that houses the middle and inner ear. Samples came from deceased elephants and human donors. The team attached the temporal bones to a device that creates vibrations mimicking sound traveling through the body into the skull. By shining a laser beam, it measured how much tiny reflective markers placed on the middle ear bones moved in response to vibrations generated by low- and high-frequency stimulation. The ear canal was closed with a soft foam plug for the experiment.

Elephant middle ear bones vibrated most effectively at a frequency of about 400 Hz, whereas human bones did so at around 1.2 kHz. Below these frequencies, elephants’ stapes, a small middle-ear bone that transmits vibrations to the inner ear, moved three to four times more than humans’ stapes. Greater movement doesn’t equal better hearing ability, but it means more vibrations are transmitted to the cochlea – the part of the ear where vibrations from sound waves are translated into neural signals.

Previous studies showed that elephants have better sensitivity to low-frequency hearing for air conduction, so it stands to reason that they would also hear low-frequency bone-conducted sounds better than humans, the team said.

“Although we suspected as much based on their behavior in the wild and responses to vibrational stimuli, it was very gratifying to show that elephants have excellent bone conduction hearing,” said first author Dr Caitlin O’Connell-Rodwell, formally an instructor in the Department of Otolaryngology at Harvard Medical School.

Sharp ears

The reason for elephants’ greater sensitivity to low-frequency sounds is likely anatomical. Their middle ear bones are nine times heavier and their eardrums seven times larger than those of humans. In most mammals, organ size scales with body size. This means an elephant’s middle ear isn’t specialized in its structure compared to a human one – it’s just bigger.

“Because of their ear size, elephants can better transmit lower frequency sounds to the cochlea. The specialization comes from the cochlea adapting to this greater input and generating neural responses that the brain can use and interpret for communication,” explained Puria.

Elephants’ ability to voluntarily close their ear canals – a capacity humans lack – could further improve their excellent low-frequency hearing. The authors hypothesized that when listening to low frequencies of around 200 Hz or lower, elephants may contract a muscle that closes the ear canal, achieving an effect similar to that of humans inserting earplugs or in-ear headphones.

“Elephants produce infrasonic vocalizations in the frequency range of 10 to 20 Hz,” O’Connell-Rodwell explained.

“Based on our estimates, elephants’ ability to close their ear canals could enhance their bone-conduction hearing by up to 30 times when listening to these infrasonic frequencies,” Puria elaborated. “However, the exact improvement in sensitivity would depend on the extent to which the ear canal volume is blocked by the muscle.”

This study opens avenues for further research in this intriguing field. For their experiments, the cochlea had been drained of fluids due to a lengthy procurement and preparation process, which may have led to an underestimation of the reported results, the team pointed out. Elephant tissue is scarce to obtain, which is why the number of samples available was limited.

“There are few creatures more majestic than elephants,” concluded Puria. “Their behavioral characteristics might be better understood through their hearing capabilities. We need better data about their absolute hearing sensitivity across frequencies with air and bone-conduction stimulation. We have tried this and found that it is easier said than done.”

Journal

Frontiers in Audiology and Otology

DOI

10.3389/fauot.2026.1744613 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Bone-Conduction Hearing in Elephants and Humans: A Middle-Ear Comparative Study

Article Publication Date

15-Jul-2026

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Lancet landmark Commission reports on global female health: takes lifespan approach to menstruation and bleeding disorders



Columbia Mailman School of Public Health’s Marni Sommer is a co-author of the Commission




Columbia University's Mailman School of Public Health


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July 16, 2026 — The Lancet Haematology today published its Commission on Global Female Health and Haematology, a multidisciplinary international collaboration that examines the unique hematologic health challenges faced by women and girls around the world and outlines recommendations for improving outcomes. Marni Sommer, DrPh, RN, professor of Sociomedical Sciences at Columbia University Mailman School of Public Health, is a co-author of the report by the Commission.

The Commission focuses on hematologic health across multiple stages of life, addressing issues ranging from menstruation, reproductive health, pregnancy and aging. It also explores socioeconomic disparities, such as poverty, access to care and social determinants of health influence outcomes for women around the world.

“The Commission highlights how under-recognized, underdiagnosed, and stigmatized heavy menstrual bleeding is around the world, leaving many people with inadequate support and care, and with negative impacts for their health and quality of life,” said Dr. Sommer.

The Commission launches in conjunction with the International Society on Thrombosis and Haemostasis (ISTH) 2026 Congress in Paris, where more than 6,000 experts from around the world gathered to advance research and clinical care in thrombosis and hemostasis.

The Lancet Commission on Global Female Health and Haematology arrives at a pivotal moment for women's health, according to the authors, as growing recognition of longstanding disparities in the diagnosis, treatment and research of bleeding and thrombotic disorders drives global calls for action.

The launch also coincides with the ISTH's expanding commitment to women's health through the newly established ISTH Women's Health Hub, a comprehensive global initiative dedicated to advancing education, collaboration, research and advocacy for bleeding and clotting disorders across every stage of a woman's life. This commitment is also reflected at the ISTH 2026 Congress through the Society's first-ever regulatory session, convening international regulatory leaders to explore collaborative approaches to strengthening evidence generation and improving care for women worldwide.

"This Commission is driven by a recognition that women's hematologic health deserves greater visibility, investment and action," said Bethany Samuelson-Bannow, MD, lead author of the Commission and a member of the ISTH. President of the ISTH Pantep Angchaisuksiri, MD, noted, “The publication of this Commission represents an important milestone for women's health and hematology. Women experience unique challenges related to bleeding and clotting disorders throughout their lives, yet many aspects of their care remain underrecognized or understudied. This Commission provides an important resource for clinicians, researchers, policymakers and advocates to improve outcomes globally."

In a separate, accompanying Commentary by Dr. Sommer in the The Lancet Haematology, she says, "Until menstrual health is recognized as a fundamental aspect of population health, meaningful progress in improving access worldwide will remain out of reach. We need to recognize the menstrual cycle as a lifelong health issue—that also means ensuring people who menstruate, and those who support them, have access to accurate information and evidence-based care," noted Sommer.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

Journal

The Lancet Haematology

DOI

10.1016/S2352-3026(26)00079-7 

Article Title

Reducing mortality, improving outcomes, and establishing equity for women with classical haematological disease: a Lancet Haematology Commission

Article Publication Date

13-Jul-2026

Many women still confused about perimenopause



New large-scale study estimates that roughly one-third of women experience perimenopause uncertainty




The Menopause Society

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CLEVELAND, Ohio (July 15, 2026)—Perimenopause is an underrecognized life stage that is often accompanied by complex and fluctuating symptoms. A new study sought to quantify the prevalence of perimenopause uncertainty and identify the primary causes. It found that perimenopause uncertainty is prevalent and largely because of knowledge gaps and barriers to confirmation and care. Results of the study are published online today in Menopause, the journal of The Menopause Society.

Perimenopause is the transitional period leading up to the final menstrual period. Known as a time of considerable hormone changes, it usually begins when women are aged in their mid-40s, although onset can vary widely. It is estimated that approximately two million women begin perimenopause each year in the United States and remain in this phase for roughly 4 to 8 years.

Perimenopause symptoms can significantly affect women’s well-being, with more than half (59%-65%) experiencing hot flashes as well as psychological or urogenital symptoms that can impair daily functioning, diminish quality of life, and reduce work productivity. Despite its prevalence, recognizing perimenopause remains a challenge for both women and clinicians. A key reason is that there is no laboratory test or biomarker to definitively determine the perimenopause stage. Complicating a clear diagnosis is the fact that perimenopause symptoms vary widely and evolve over time. These symptoms also overlap with a wide range of other conditions, including premenstrual syndrome, thyroid disease, and mental health conditions.

Limited public awareness and inconsistent clinical recognition further compound this uncertainty. Many women report little prior knowledge about perimenopause, and clinicians typically receive inadequate training and education on perimenopause and menopause care. In addition, there has been a propagation of misinformation about menopause and symptom management in recent years.

Prior studies have described elements of perimenopause uncertainty, such as confusion about symptoms, misconceptions about the age at which symptoms might occur, and invalidating healthcare encounters, but most were small, focused only on women aged older than 40 years and were rarely US based. In addition, there is no known study to have quantified how common perimenopause uncertainty is, what its common drivers are, and whether those drivers differ across age groups or levels of symptom burden.

In this new study involving more than 7,600 US women aged 35 years and older, researchers sought to estimate the prevalence of perimenopause uncertainty and examine subgroup differences by age and symptom severity. Overall, 34% of participants reported being unsure of their reproductive stage. Uncertainty varied by age and symptom severity, peaking at 42% in those aged 40 to 44 years, and 37% in those with severe symptom burden.

Symptom confusion and attribution were the most common (56%), reflecting difficulties interpreting bodily changes and distinguishing perimenopause from other causes. Knowledge gaps and information-seeking accounted for 28% of responses, highlighting limited health literacy, age-based assumptions, and active searches for evidence. Barriers to confirmation and care (16%) described dismissive healthcare encounters and reluctance to acknowledge perimenopause. Younger women (aged 35-39 y) were more likely to cite knowledge gaps, whereas healthcare barriers peaked in the 40 to 44-year-old age group.

Based on these results, the researchers recommend that clinicians should be more open and flexible to consider the multidimensional symptom profiles of perimenopause and normalize cognitive, emotional, and physical changes that can occur earlier rather than over-relying on menstrual irregularity as the principal indicator. Although cycle irregularity is characteristic of perimenopause, many women have symptoms before they experience significant cycle changes.

Survey results are published in the article “Exploring prevalence and drivers of perimenopause uncertainty among US Women: a mixed-methods study.”

“This large study showed that one in three US women aged older than 35 years are not sure whether they are in perimenopause. Further, the study highlights that symptom confusion, misconceptions, and barriers to care are leaving many women without the clarity and support they need during the menopause transition. Recognizing perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to navigate this natural life transition with confidence,” says Dr. Stephanie Faubion, medical director for The Menopause Society and one of the authors of the study.

For more information about menopause and healthy aging, visit www.menopause.org.

The Menopause Society is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org.   

Journal

Menopause

DOI

10.1097/GME.0000000000000002837 

Method of Research

Survey

Subject of Research

People

Article Title

exploring prevalence and drivers of perimenopause uncertainty among US Women: a mixed-methods study

Article Publication Date

15-Jul-2026

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Childhood health crisis: One in 11 Aussie kids has high blood pressure




Edith Cowan University
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Australian children are developing high blood pressure at alarming rates, with experts saying the condition could be setting kids up for heart attacks, strokes and kidney disease later in life. 

Australia’s first-ever clinical guidelines on childhood hypertension aim to address findings that some primary school children already have signs of developing heart damage.  

The guidelines were developed by Edith Cowan University’s (ECU) Nutrition and Health Innovation Research Institute (NHIR) and Murdoch Children’s Research Institute (MCRI) in partnership with Hypertension Australia. 

Experts are calling for blood pressure checks to become a routine part of childhood healthcare starting at the age of seven.   

“We regularly see children as young as 7 and 8 years old with high blood pressure who already have organ damage, including thickening of the heart muscle,” ECU’s Dr Nicholas Larkins said.  

“It’s a silent disease. One in 11 Australian children now have high blood pressure, which is often symptom-free. It can damage young bodies for years before it’s picked up.” 

MCRI’s Associate Professor Jonathan Mynard said childhood hypertension had become a major emerging health threat. 

“There is now strong evidence that high blood pressure in childhood is linked to serious health conditions such as heart attack and stroke later in life,” he said. 

“High blood pressure in children has rarely been on the radar of health professionals or the public. We hope the new guideline will bring this important issue into focus.”  

The guideline says while childhood obesity is the main driver of increasing rates of hypertension, other factors include:  

  • Diets high in salt and processed food 

  • Not enough exercise 

  • Too much screen time 

  • Family history of high blood pressure 

  • Being born prematurely or small for age 

  • Economic disadvantage 

The researchers say the most important action for children with hypertension is lifestyle changes, which can reverse or delay the need for medical intervention.  

“The most important interventions are often the simplest,” Dr Larkins said. 

“Improving diet, increasing physical activity, reducing salt intake, and helping families make sustainable lifestyle changes can make a real difference to blood pressure and long-term health outcomes.” 

The new guidelines are the first to provide a clear pathway for identifying and managing high blood pressure among Australian children and adolescents. 

“Previous guidelines haven’t covered children because the evidence linking blood pressure in childhood and later health conditions was less certain. But now we have multiple, large long-term studies demonstrating strong links to adverse health outcomes,” Associate Professor Mynard said. 

Hypertension Australia says the new guidelines address a long-standing gap in paediatric care. 

“Many people still think of high blood pressure as something that only affects older adults, but that’s clearly not the case,” Hypertension Australia President, Professor Markus Schlaich said.  

Dr Larkins said blood pressure should be part of routine health care for children, just like height, weight and vision checks. 

“Our goal is to get the message out to parents to get their children checked so we can provide families with the support they need before high blood pressure causes lasting harm.” 

Published in the Journal of Paediatrics and Child Health, the guidelines developed by BPOzKids Network and Hypertension Australia have been endorsed by the Heart Foundation. 

 

 

 

Journal

Journal of Paediatrics and Child Health

DOI

10.1111/jpc.70491 

Method of Research

Observational study

Subject of Research

People

Article Title

Australian Guideline for the Identification and Management of Hypertensions in CHildren and Adolescents

Article Publication Date

14-Jul-2026

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