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Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation. Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures. Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures. Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded. (Am J Public Health. 2024;114(9):882–891. https://doi.org/10.2105/AJPH.2024.307731) [ABSTRACT FROM AUTHOR]

PurposeTechnology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.MethodsTwelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey.ResultsIn 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%).ConclusionsMany patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.

Objectives: Approximately half of US pregnancies are unintended and 43% of these end in induced abortions. Male partners and their involvement in reproductive decisions is not well understood. We examined the association between couple pregnancy intentions and induced abortion in US women. Materials and Methods: Data came from the National Survey of Family Growth (2006-2010). Primiparous women who lived with one husband or partner before conception of their first pregnancy were included in the analysis (N=4263). Multiple logistic regression was used to assess the relationship between couple pregnancy intentions and induced abortion of first pregnancy. Results: Approximately 17.1% of women reported discordant intentions and 32.3% reported that pregnancy was unintended by both parents. Among these couples, the women were more likely to be unmarried, minorities, of lower income and education, and 19 years of age or younger at conception than were couples in which both parents intended pregnancy. Compared to couples with a mutually intended pregnancy, those with discordant pregnancy intentions were significantly more likely to have induced abortion, even in women who desired pregnancy. Conclusion: Partners had a vital role in decisions to have an induced abortion. Health providers should consider the interpersonal decision-making process in couples to best prevent induced abortions due to unintended pregnancy. Providers should also be aware of the role of violence on reproductive decisions in couples with discordant pregnancy intentions. Women in healthy relationships can benefit from having frequent conversations about pregnancy with their partners.

Awareness of the impact of education on health remains relatively low among the public, professionals, and policy makers. Virginia Commonwealth University's Center on Society and Health sought to raise awareness among key decision makers about the impact of education on health outcomes through its Education and Health Initiative (EHI). EHI utilized four key strategies to raise awareness: user-oriented research, strategic communication, local and national stakeholder engagement, and policy outreach to decision makers. We review the research highlighted in four stages of EHI product releases, as well as the development, process, products, and key outcomes associated with this initiative.

Key Points: Question: What causes of death are associated with the widening disparities in mortality among US youth of different races and ethnicities in recent years? Findings: In this cross-sectional study of mortality in youth aged 1 to 19 years in the US, injuries, especially firearm injuries, were associated with worsening disparities between Black and American Indian or Alaska Native and White youth. Between 2016 and 2020, the homicide rate in Black youth was 12.81 per 100 000 youth (rate ratio with White youth, 10.20), and the suicide rate for American Indian or Alaska Native youth was 11.37 per 100 000 youth (rate ratio with White youth, 2.60). Meaning: In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease and were associated with recent increases in US mortality rates. Importance: Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective: To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants: This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures: Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results: Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance: In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms. This cross-sectional study compares all-cause and cause-specific mortality trends and rates among youth from different races and ethnicities between 1999 and 2021. [ABSTRACT FROM AUTHOR]

The health of Americans is in decline, a crisis that has been building for some years. Since the 1980s, US life expectancy has risen at a slower pace than in [...]

We estimated changes in life expectancy between 2019 and 2021 in the United States (in the total population and separately for 5 racial/ethnic groups) and 20 high-income peer countries. For each country's total population, we decomposed the 2019–2020 and 2020–2021 changes in life expectancy by age. For US populations, we also decomposed the life expectancy changes by age and number of coronavirus disease 2019 (COVID-19) deaths. Decreases in US life expectancy in 2020 (1.86 years) and 2021 (0.55 years) exceeded mean changes in peer countries (a 0.39-year decrease and a 0.23-year increase , respectively) and disproportionately involved COVID-19 deaths in midlife. In 2020, Native American, Hispanic, Black, and Asian-American populations experienced larger decreases in life expectancy and greater losses in midlife than did the White population. In 2021, the White population experienced the largest decrease in US life expectancy, although life expectancy in the Native American and Black populations remained much lower. US losses during the pandemic were more severe than in peer countries and disproportionately involved young and middle-aged adults, especially adults of this age in racialized populations. The mortality consequences of the COVID-19 pandemic deepened a US disadvantage in longevity that has been growing for decades and exacerbated long-standing racial inequities in US mortality. [ABSTRACT FROM AUTHOR]

This article discusses the importance of disaggregating racial and ethnic data to accurately understand disparities in youth mortality rates in the United States. The authors acknowledge that grouping diverse populations into broad categories can obscure important differences. They explain the historical changes in race categories used in data collection and highlight the challenges of using bridged-race data. The authors emphasize the need for more precise racial and ethnic groups in public health research and note that the CDC has transitioned to providing single-race death counts. They conclude by emphasizing the importance of interpreting racial and ethnic trends over time as institutions adopt more precise categories. [Extracted from the article]

This Viewpoint explores increasing mortality rates in the US due to a variety of causes unrelated to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]