New Data on HIV Diagnoses; Disproportionate in Rural Areas. The Centers for Disease Control and Prevention (CDC) recently released a new Morbidity and Mortality Weekly Report (MMWR) on HIV testing.  The CDC data show that less than 40% of people in the U.S. have ever been tested for HIV; in the seven states with rural areas that are particularly affected by HIV, just 26% of people recommended for annual HIV testing were tested in the past year.  The proposed HHS-wide initiative, “Ending the HIV Epidemic – A Plan for America,” is  multiyear initiative designed to end the HIV epidemic over 10 years by significantly increasing public health resources, technology, and expertise on the ground in the hardest-impacted areas. The plan, if funded, will focus first on the geographic areas with the greatest HIV burden, including the 50 local jurisdictions and seven states highlighted in the MMWR report, before expanding to reach all areas of the nation affected by HIV.

A new report finds that during a 12-month period, about 1,800 babies entered this world dependent on addictive drugs, or about 14 of every 1,000 babies born in the state. The report from the Pennsylvania Health Care Cost Containment Council (PHC4) focuses on a one-year period ending in late 2018. If there is any good news in the report, it is that the data show a leveling off after rising each of the last 15 years. The report shows wide variation by county with, for example, rural Elk County with the highest rate of 63 per 1,000 births, Philadelphia County at about 14 per 1000 births, and Bradford County with only six addicted babies per 1000. Neonatal abstinence syndrome (NAS) results in higher rates of respiratory distress and premature birth compared to other babies, with NAS babies averaging 16 days in the hospital, compared to 3.4 for other births. The report also found that the highest rate of NAS babies involved whites (18 out of 1,000 babies), and rates of 9.5 per 1,000 among blacks and 6.2 per 1,000 among Hispanics. About 90% of the hospital costs of NAS babies are borne by Medicaid. Read more.

The Pennsylvania State Data Center has released a Child Diversity Dashboard and report in collaboration with their affiliate, Pennsylvania Partnerships for Children.  The report highlights state level trends relating to the increase in children of color while the dashboard allows users to get data at the school district level.

Some key findings include that one-in-three Pennsylvania children are children of color and that over 80 percent of school districts had a higher share of children of color in 2017 than 2009.

To view the dashboard and report, visit:  https://pasdc.hbg.psu.edu/Data/Visualizations/ChildDiversity

A HRSA study of 8,509 mother-newborn pairs from the Boston Birth Cohort found that 5.3 percent of the babies had in-utero opioid exposure, leading to higher risks of fetal growth restriction and preterm birth.

Among preschool-aged children, opioid exposure was associated with increased risks of lack of expected physiological development and conduct disorder/emotional disturbance. In school-aged children, opioid exposure was associated with a higher risk of attention-deficit/hyperactivity disorder.

Read the abstract.

Learn how HRSA is addressing the opioid crisis

In 2011, The Pew Center on the States, a division of The Pew Charitable Trusts, released a report that graded states’ ability to serve insured and soon-to-be insured children and compared results to 2010 grades. In 2018, Pennsylvania completed their own report card to monitor for any changes and improvements. Pennsylvania has made updates and met additional benchmarks.  Click here to view the report card.

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis authored by Abigail R. Barker, PhD; Timothy D. McBride, PhD; Keith J. Mueller, PhD

The Patient Protection and Affordable Care Act of 2010 established Health Insurance Marketplaces (HIMs) as a mechanism to improve the functioning of existing individual insurance markets. However, to be successful, this model requires the presence of at least a handful of insurers from which beneficiaries in each local market can choose. Over the first five years of HIMs, rural counties have often struggled to attract sufficient numbers of HIM insurers. In this project, county-level data were combined from HIM plan availability files, Medicare Advantage (MA) availability and enrollment files, and Federal Employees Health Benefits Program (FEHBP) availability and enrollment files. We calculated the Herfindahl Index, which is a measure of competition in a given market, for MA and FEHBP markets for each county in 2013-16.

We found that, within a given population density category, the number of HIM insurers was positively correlated with the prior level of FEHBP market competition in a county. Note, also, that market competition was generally higher as population density increased. In 2017, the pattern continued to hold, with those counties that still attracted several insurers (rather than just one or two) averaging the lowest prior-year FEHBP Herfindahl index. We found that many of the population measures were in fact significant in their own right, including population density, total population, primary care providers per capita, and rural status of the county. Furthermore, even when controlling for these measures, prior FEHBP market concentration (low competition) was a significant predictor of low insurer participation in HIMs. In addition, from 2014 to 2017, the magnitude of the effect increased.

Click to download a copy: Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others?

Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries.  Cost is often a significant barrier to accessing care for the rural Medicare population, so having a better understanding of the variations in cost-sharing per claim (deductibles and coinsurance amounts) at various types of safety-net facilities is important. The purpose of this study from the North Carolina Rural Health Research and Policy Analysis Center is to investigate cost as a barrier to accessing care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for the rural Medicare population.

Measuring Access to Care in National Surveys: Implications for Rural Health.  In order to assess the efficacy of healthcare in meeting the needs of the population and to ensure access to timely, appropriate care, it is important to have nationally representative measures of access and barriers to healthcare. Given the unique healthcare context in rural settings, it is also important to understand whether, and how, access is measured in ways that are salient for rural populations. This brief from the University of Minnesota Rural Health Research Center reviews access measures included in major national surveys and presents implications for rural research on access to care.

Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence. Using 2010-2016 data from the National Survey on Drug Use and Health, researchers from the Rural and Underserved Health Research Center found that the overall mean prevalence of suicidal thoughts among adults was significantly higher for non-metropolitan and small metropolitan counties.  This page on the Rural Health Research Gateway contains links to additional research on illicit drug and opioid use disorders in rural areas.

Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults.  In its latest Morbidity and Mortality and Weekly Report, the Centers for Disease Control and Prevention finds that the prevalence for physical activity remains low, especially for some rural subgroups with high incidences of chronic diseases.  The report recommends incorporating culturally appropriate strategies into local, evidence-based programs might help communities build on recent progress.