Beyond Red & Blue

The state of the prostate in Massachusetts is "fair"

Massachusetts gets a "C+" from the National Prostate Cancer Coalition in its 2008 report card, but only 10 states got better grades. (No one got an "A"; Wisconsin got an "F".) Massachusetts finished near the top in terms of the percentage of men who get screened for the disease and near the bottom in terms of the mortality rate from the disease, but we lost points for not (yet) having a state law requiring insurance companies to cover screens.

Our worst category was "support of important legislation and initiatives by the Congressional delegation in the U.S. House of Representatives and the U.S. Senate," but practically everyone got lousy grades for that (New York was the only one above a "C"). The NPCA wanted not only increased spending for prostate cancer screening and research, but also a new "Office of Men's Health" at the Department of Health and Human Services; it got very little of what it asked for from Congress.

Evidently, the condition of our prostates won't warrant an "A" until Washington does something about the federal deficit.

Night Shift (spoilers for those about to have extended hospital stays)

You have good reason to be afraid of hospitals in the middle of the night, suggests an article in the latest New England Journal of Medicine. Dr. David Shulkin, CEO of Beth Israel Medical Center in New York, writes that reduced staffing in the wee hours may mean a "stark discrepancy in quality between daytime and nighttime inpatient services." From "Like Night and Day: Shedding Light on Off-Hours Care":

The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors...

Financial constraints play a role in the lack of provider services. Shrinking reimbursements from government programs and third-party payers make it economically prohibitive for many hospitals to fully staff their facilities 24 hours a day. ... Another major obstacle is the nursing shortage. More-experienced nurses understandably choose desirable day shifts. As a result, night and weekend shifts are filled with a greater percentage of temporary or agency nursing staff, many of whom have less training and less familiarity with the hospital.

So if you're in for a long convalescence, perhaps it would be better to commute from home. Perhaps there's a nurses' carpool you can join.

Hat tip:  A Healthy Blog.

Expensive shrinks cost Massachusetts billions in lost productivity

The Milken Institute reported on Tuesday that the US economy took a hit of more than $1 trillion in 2003, all from lost workdays and lower productivity due to chronic disease. Click here to get the details, including a map showing which states suffered the most, as well as state-by-state data on cases of cancer, diabetes, heart disease, hypertension, strokes, pulmonary conditions, and "mental disorders."

That last category seems to be responsible for the odd geographic pattern of the "State Chronic Disease Index." Massachusetts ranks 40th (or 11th worst), between South Carolina and Alabama, even though other surveys have tagged it as one of the healthiest states. (See, for example, the United Health Foundation.) The explanation seems to be emotional: According to the Milken study, 17.5 percent of the population in Massachusetts suffered from "mental disorders," a figured exceeded only by Oregon (18.0 percent) and well above the national average of 10.7 percent. But there's reason to wonder whether this ranking was skewed by more accurate (or more aggressive) diagnoses of mental conditions here, and perhaps less stigma associated with those conditions than in other states (all data in the study were reported by patients themselves). Still, even these caveats don't seem to account for the fact that the mental disorder rate in Massachusetts was more than twice that in similarly stressed-out New York (8.5 percent), or why first-place Oregon is right next to last-place Washington state (5.1 percent).

By the way, Massachusetts also seems to lose points because the treatment of mental health is costlier here ($1,928 per person per year) than in any state but Alaska. For a chart of how we rank on mental health criteria, click here: Download mental_disorders_by_state_in_2003_selfreported.xls

The Milken report doesn't have much to say about the accompanying mental health data. The authors do point to the relatively high rate of cancer in Massachusetts (4.1 percent of the population, versus 3.7 percent nationally) as one reason for our low ranking on their index, but the difference isn't nearly as great as it is for mental disorders. And the state is relatively low in the rates of diabetes (4.6 percent vs. 4.9 percent), heart disease (6.3 percent vs. 6.8 percent), and hypertension (12.3 percent vs. 13.0 percent).

Given the wide regional variations in the mental health data, perhaps they should not have been treated separately, or not included in the study at all. People see mental health professionals for enough reasons already; there's no need to lay a statewide guilt trip over lost productivity.