Health related social needs and whole person health: Relationship between unmet social needs, health outcomes, and healthcare spending among commercially insured adults

Commercially-insured adults comprise a majority of health plan members but are least likely to be surveyed about their social needs. Little is known, consequently, about health-related social needs (HRSNs) in this population. The primary aim of this study was to assess the prevalence of HRSNs and health among commercially-insured adults and estimate their relationship with health outcomes and spending. This cross-sectional study used survey data from a representative sample of Elevance Health commercially insured members residing in Georgia and Indiana (U.S.) Adult members reported on HSRNs across nine different domains. Survey data were linked to medical claims data, and regression models were used to estimate the relationship between HRSNs and self-reported health, emergency department visits, three major health outcomes, and healthcare spending (medical and pharmaceutical). Of 1,160 commercially insured adults, 76 % indicated ≥ 1 HRSN, and 29 % reported > 3 HRSNs, (i.e., "high" HRSN). Each HRSN was associated with 2.2 (95 % CI, 1.84-2.55) additional unhealthy days per month, 3.0 percent (95 % CI 1.36 - 4.57) higher prevalence of anxiety/depression, 2.2 percent (95 % CI 0.88 - 3.50) higher prevalence of hypertension, 3.9 more ED visits per 1,000 member-months (95 % CI, 0.29-7.42), and $1,418 higher total healthcare spending (95 % CI, $614.67-$2,220.39) over a 12-month period. The widespread prevalence of HRSNs among commercially insured adults demonstrates the importance of screening all health plan members for HRSNs-not just Medicare and Medicaid members. Commercially insured members who experience high HRSN are at significantly higher risk for worse health, even after controlling for income and demographic characteristics.

Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching

BACKGROUND

This evaluation of doula care emerges at a time when maternal mortality in the U.S. outranks every country in the developed world. Study objectives were to: 1) examine when over the maternity care continuum and with whom (i.e., clinical providers) doula care provides the greatest benefits to clinical health outcomes and health care utilization; and 2) evaluate whether women gain differential benefits from doulas depending upon race/ethnicity and health status.

METHODS

We conducted a retrospective cohort study using Medicaid medical claims from California, Florida, and a northeastern state (USA) to compare maternal health outcomes between women who did and did not receive doula care between January 1, 2014 and December 31, 2020. We used propensity score matching and logistic regression models to calculate associations between selected health outcomes and doula care. Our analysis included 298 pairs of women matched on age, race/ethnicity, state, socioeconomic status, and hospital type (teaching or non-teaching).

FINDINGS

Women who received doula care had 52.9% lower odds of cesarean delivery (OR: 0.471 95% CI: 0.29-0.79) and 57.5% lower odds of postpartum depression/postpartum anxiety (PPD/PPA) (OR: 0.425 95% CI: 0.22-0.82). Doulas who provided care with a clinical team that included a midwife most consistently showed a reduction in odds of cesarean delivery, regardless of the trimester when doula care was received. Women who received doula care during labor and birth, but not necessarily during pregnancy, showed a 64.7% reduction in odds of PPA/PPD (OR: 0.353 95% CI: 0.16-0.78) of PPA/PPD.

INTERPRETATION

The use of doulas appears an effective strategy for improving maternal health, especially among socioeconomically vulnerable and marginalized minority populations. Future studies could address research gaps through focusing on the relationship between doula care received in the postpartum period and postpartum health.

FUNDING

No sources of funding were used to assist in the preparation of this manuscript. Research was completed as part of the usual employment obligations to Anthem, Inc.

Shifts in Women's Paid Employment Participation During the World War II Era and Later Life Health

PURPOSE

The greatest proportional increase in female labor force participation of the 20th century occurred post-World War II (WWII) when shifts in policy and growth in service and clerical work spurred an influx of women into the labor force. Research has yet to demonstrate how variation in women's employment participation during this era related to their later life health. We examined how shifts in women's employment patterns during the WWII era influenced their disease and mortality risk.

METHODS

Using data from the Women's Health Initiative Observational Study, we evaluated the employment history of a cohort of 6,158 women across the U.S. during the WWII era. We fit logistic regression models estimating the association between involvement in the workforce over 5-year intervals and health (i.e., cancer, cardiovascular disease, and mortality). We also ran models with a younger cohort (n = 12,435) of women to assess how associations between work and health varied between cohorts.

RESULTS

The older cohort of women who entered the workforce before the onset of WWII showed mixed to no differences in health relative to homemakers. The younger cohort of women who entered the workforce during WWII tended to show negative relationships between work during their late/post-childbearing years and health, experiencing higher risks for mortality.

CONCLUSIONS

The policies, social forces, and broader environment in which women live appear to significantly influence how involvement in the workforce over the life course influences health. Women whose entry into the workforce was initially encouraged socially but were later confronted with opposition experienced increased health risks.

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Despite the implications of gender and sex differences for health risks associated with blue-collar work, adverse health outcomes among blue-collar workers has been most frequently studied among men. The present study provides a "state-of-the-field" systematic review of the empiric evidence published on blue-collar women's health. We systematically reviewed literature related to the health of blue-collar women published between January 1, 1990 and December 31, 2015. We limited our review to peer-reviewed studies published in the English language on the health or health behaviors of women who were presently working or had previously worked in a blue-collar job. Studies were eligible for inclusion regardless of the number, age, or geographic region of blue-collar women in the study sample. We retained 177 studies that considered a wide range of health outcomes in study populations from 40 different countries. Overall, these studies suggested inferior health among female blue-collar workers as compared with either blue-collar males or other women. However, we noted several methodological limitations in addition to heterogeneity in study context and design, which inhibited comparison of results across publications. Methodological limitations of the extant literature, alongside the rapidly changing nature of women in the workplace, motivate further study on the health of blue-collar women. Efforts to identify specific mechanisms by which blue-collar work predisposes women to adverse health may be particularly valuable in informing future workplace-based and policy-level interventions.

Puberty and perimenopause: reproductive transitions and their implications for women's health

This scoping review synthesizes existing research on two major transitions in females' lives: puberty and perimenopause. These two periods of vast physiological change demarcate the beginning and the end of the reproductive life cycle and are associated with major neuroendocrine reorganization across two key systems, the hypothalamic-pituitary-gonadal (HPG) axis the hypothalamus-pituitary-adrenal (HPA) axis. Despite growing evidence suggesting that the timing and experience of puberty and perimenopause are related to various physical and mental health outcomes (e.g., mood disorders, metabolism, cardiovascular health, autoimmune conditions, and cancer), these two processes are rarely examined together. In this paper, we bridge these disparate literatures to highlight similarities, isolate inconsistencies, and identify important areas for future research in women's health.