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Noncommunicable Diseases: Health Affairs' September Issue



Bethesda, MD--The September Health Affairs, a theme issue, focuses on the growing burden of noncommunicable diseases. Increased wealth worldwide has reduced the frequency of some infectious diseases, while chronic diseases--heart disease, respiratory ailments, cancer, diabetes, mental illness and others--are more widespread.  The September issue was supported by Eli Lilly and Company.

Tracking Global Mortality Over Thirty Years: A Mix of Increases and Decreases.
Mohammed Ali at Emory University's Rollins School of Public Health and coauthors examined data on deaths as a result of ischemic heart disease, stroke, diabetes, respiratory disease, and common cancers across forty-nine countries using the World Health Organization's Mortality Database--finding that mortality for heart disease, stroke, and stomach and cervical cancers declined globally. From 1980 to 2012 diabetes and liver cancer deaths increased, as did chronic respiratory disease and lung cancer deaths among women. Compared to declines in high-income countries, low- and middle-income countries experienced increases in breast and colon cancer deaths and less impressive declines for other cancers, stroke, and heart disease. These country-level disparities may reflect differences in socioeconomic development and risk exposure, health care delivery, and societal-level policies. Since these diseases cumulatively account for half of global deaths, continued efforts are needed to monitor and address these conditions.
Trends In Age-Standardized Mortality Rate Per 100,000 Population For Ischemic Heart Disease Among Males And Females In Ten Selected Representative Countries, 1980-2012
Other topics in the issue include: 
DataWatch: Health Savings Accounts Increase Ten-Fold.
The number of US households owning a health savings account (HSA) increased ten-fold from 2005 to 2012--reaching 6.52 million. HSAs allow individuals enrolled in a qualifying high-deductible health insurance plan to save and pay for medical care tax free. Lorens Helmchen of George Washington University and coauthors studied US tax records to estimate growth in HSAs and identify patterns in HSA ownership. In 2005, 0.33 percent of employers recorded HSA use among their employees. By 2012 this share had grown to 3.77 percent among all employers and to nearly one-fourth among the country's largest employers. Take-up of HSAs among employees at the largest employers nearly tripled. High-income and older households were at least four times more likely to establish HSAs and fully fund them than low-income and younger households. These take-up patterns suggest that HSAs may be attractive for individuals who may have access to traditional health plans already.
Increased Use of Prescription Drugs Drives Down Other Medical Costs in Medicaid.
To understand the effect of prescription drug use on medical costs among Medicaid recipients,
M. Christopher Roebuck at RXEconomics, LLC and coauthors examined data from 2008 to 2010. They concluded that a 1.000 percent increase in overall prescription drug use was associated with decreases in total nondrug Medicaid costs by 0.108 percent for blind or disabled adults, 0.167 percent for other adults, and 0.041 percent for children. These medical cost offsets were primarily driven by reductions in inpatient, followed by outpatient, spending that are comparable to a metric used by the Congressional Budget Office for Medicare. The authors state that this research helps policy makers more accurately assess budgetary impacts of prescription drug use among Medicaid enrollees.
Can the Affordable Care Act Improve Health?
To clarify the relationship between having health insurance and the diagnosis and management of diabetes, high blood pressure, and high cholesterol, Daniel Hogan of the World Health Organization, Joshua Salomon at the Harvard T. H. Chan School of Public Health, and coauthors analyzed 1999-2012 data from the National Center for Health Statistics' National Health and Nutrition Examination Survey. They found that insured people have a significantly higher probability of being diagnosed than similar people without insurance--by 14 percentage points for diabetes and high cholesterol, and 9 points for high blood pressure. Among those already diagnosed, having insurance was associated with significantly healthier levels of blood sugar, total cholesterol, and systolic blood pressure. These results imply that the expected gains in insurance coverage from the Affordable Care Act could translate into 1.5 million more people with a diagnosis of at least one of these chronic conditions and 659 thousand fewer people with uncontrolled cases.   
Also of interest in the September issue: