Epidemiological miscellany: #PrEP, #gunviolence research, and the Great Recession

Wednesday, March 14, 2018

A couple of interesting tidbits have come across my radar over the last couple of days. The first is a handy new interactive state-level map on PrEP use by AIDSVu:
AIDSVu has released the first-ever interactive state-level maps visualizing a 73 percent increase year over year in persons using PrEP across the U.S. from 2012 to 2016, with 77,120 PrEP users in 2016. PrEP, or pre-exposure prophylaxis, is when people at high risk for HIV take HIV medicine daily to lower their chances of getting infected with HIV. AIDSVu’s maps visualize the growth in PrEP use at the state-level by year, and break down the data by age and sex. These data and maps offer important information and tools to public health officials, policymakers, and researchers to inform efforts to improve PrEP awareness and increase uptake where it is needed most.
The data comes primarily from Gilead:
De-identified, aggregate data were obtained from Source Healthcare Analytics, LLC (SHA) with the support of Gilead Sciences, Inc., and compiled by researchers at the Rollins School of Public Health at Emory University. SHA collects data from over 54,000 pharmacies, 1,500 hospitals, 800 outpatient facilities, and 80,000 physician practices across the U.S. SHA’s dataset contains prescription, medical, and hospital claims data for all payment types, including commercial plans, Medicare Part D, cash, assistance programs, and Medicaid. From this overall sample, AIDSVu presents a subset of data comprising prescriptions for TDF/FTC for PrEP.

There is also this piece in the Atlantic, which highlights a study done on health outcomes impacted by the Great Recession:
For the study, Teresa Seeman, an epidemiologist at UCLA, and her colleagues examined longitudinal data on 4,600 people between the ages of 45 and 84 collected between 2000 and 2012 to look for changes in their blood pressure and fasting blood-sugar levels.

They found that blood pressure increased significantly among all groups during the time period, and blood glucose did too, among certain groups. The authors speculate the reason for the spike was stress—potentially different stressors for different generations. The younger people in the cohort were either unemployed, or those still working were likely wondering how on Earth they would be able to retire. The older people may have owned their own homes and watched the housing market collapse. All of this, they found, likely drove up their stress levels, and blood pressure.

The authors also found that during the recession, many people stopped taking their medications—especially older homeowners, whose major sources of wealth were evaporating. “The evidence suggests that the stresses of the Great Recession took their greatest toll on those who are on medication,” they write—because they may not have been able to afford the drugs anymore.

These findings further confirm what other researchers have seen on a more cellular level: Economic hardship causes stress, and that stress can sneak under the skin, disrupting bodily systems.
The author takes a dig at economist Tyler Cowen, too, which was kind of fun.

Finally, guns are still in the news, despite The Donald having thrown in the towel. It would seem (for the moment, at least) that calls for more research into gun deaths and gun violence have managed to put down roots and put the spotlight on the Dickey Amendment:
The N.R.A. pushed Congress in 1995 to stop the C.D.C. from spending taxpayer money on research that advocated gun control. Congress then passed the Dickey Amendment in 1996, and cut funding that effectively ended the C.D.C.’s study of gun violence as a public health issue.

The result is that 22 years and more than 600,000 gunshot victims later, much of the federal government has largely abandoned efforts to learn why people shoot one another, or themselves, and what can be done to prevent gun violence.

After the Parkland school massacre in Florida last month, lawmakers and gun control experts have demanded that the agency take up the issue of studying gun violence again, arguing that the federal law doesn’t ban such research altogether but prohibits advocacy of gun control.
There is much ink to be spilled on the question of why the NRA and other conservatives feel that research on gun violence "advocates" for gun control - probably along the lines of the confirmation bias phenomenon and how people react when presented with evidence that challenges their cherished beliefs. Methodologically sound research does not "advocate" for anything. But I will leave that to more eloquent commentators. In the meantime, AJPH is working to bridge the research gap by making all of its published work on gun violence open access (it's typically behind a paywall).

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