Black Illinois women continue to die at disparately higher rates from medical causes, while substance use disorder is the leading cause of pregnancy-related death, according to a state report released this week. [Health News Illinois]

The Department of Public Health's study, which looked at deaths between 2018 and 2020, found that Black women are twice as likely to die from any pregnancy-related condition and three times as likely to die from pregnancy-related medical conditions as white women.

The data are similar to what the agency reported in 2021.

“This third edition of the maternal morbidity and mortality report underscores that Illinois still has a long way to go towards ensuring that all Illinoisans can have a safe and healthy pregnancy,” said department Director Dr. Sameer Vohra. “We continue to see unacceptable inequities in maternal mortality for Black women and women with lower socioeconomic status.”

Nearly one-third of all pregnancy-related deaths were tied to substance use disorder. Other common causes of death were cardiac and coronary conditions, pre-existing chronic medical conditions and sepsis.

The report offers the first glimpse of the effect of the COVID-19 pandemic on maternal mortality. There were 110 deaths reported in 2020, compared to 70 in 2019 and 83 in 2018.

The Maternal Mortality Review Committees, which helped to compile the report, determined that 91 percent of pregnancy-related deaths were potentially preventable due to clinical, system, social, community or patient factors.

“We need to continue to emphasize that our healthcare systems provide respectful, patient-centered care for all patients,” said Dr. Robin Jones, chair of the committees and a Rush University Medical Center OB-GYN. “Our nation will not have a health system that promotes health equity and delivers quality outcomes until we better understand the role that racism plays in maternal mortality and take action to address it.”

In recent years, state officials have worked to improve maternal health outcomes by extending Medicaid coverage to one year postpartum, reimbursing services provided by doulas and home visiting programs, and expanding postpartum visits and services like family planning coverage.

 “I encourage all of our partners to come together to achieve the goal of making Illinois the healthiest state to give birth,” Vohra said. 

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As the severity of the child mental health crisis came into full view during the COVID-19 pandemic, Illinois state officials became serious about writing policy that could help transform how families and children find and access treatment in communities across the state. [Crains]

The effort is led by Dana Weiner, who is working for Gov. J.B. Pritzker's office on loan from the Chapin Hall Center for Children at the University of Chicago, where she's long studied behavioral health and well-being in children.  

Now, as Illinois' chief officer for children's behavioral health transformation, Weiner has spearheaded a report that outlines the state's various plans for addressing the child mental health crisis. The report, ambitiously titled "Blueprint for Transformation," calls for state agencies to better collaborate on expanding mental health service capacity, making services easier to find on a comprehensive website and providing intervention earlier, among other things. 

Download Blueprint for Transformation report here> 

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Since child mental health professionals declared the state of youth mental health a national emergency in 2021, emergency department visits have shown some signs of declining but remain a concern along with drug overdoses and suicide rates. Meanwhile, Black youth have been in crisis for 20 years  and there are no signs of improvement. [MedPage Today]

The Biden-Harris administration recently announced that over $200 million will be invested in the youth mental health. But with no mention of race, I'm concerned the research and interventions pursued may once again leave Black kids behind.

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The Illinois Department of Public Health (IDPH) has launched a redesigned and enhanced Illinois Hospital Report Card website, with patient safety and quality of care information presented in a more user-friendly format. The same website,   https://www.healthcarereportcard.illinois.gov, also includes an updated Illinois Public Health Community Map, with county-level information on health outcomes and access to care across Illinois.

“Illinois residents deserve access to accurate, reliable data about the quality of health care provided in our State,” said IDPH Director Dr. Sameer Vohra.  “This updated website will allow consumers to be more knowledgeable about their health care options, as well as provide greater information on the health needs of their communities.  Our goal is that these resources – the updated, enhanced Hospital Report Card and Community Map - will provide Illinois residents, elected officials, and health care professionals with greater insight on where resources can be utilized to achieve better health for all.”

The Illinois Hospital Report Card currently tracks over 150 measures for hospitals across Illinois; it also assesses operations of ambulatory surgical treatment centers. It allows consumers to obtain information about what services are provided, the cost of those services, patient satisfaction, patient safety, medical complications, and other quality and safety data. The enhanced website is significantly faster and offers other features to improve its functionality for consumers:

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Copays will remain suspended in a program that provides Medicaid-like coverage to undocumented individuals, an official from the Department of Healthcare and Family Services said Tuesday. [Health News Illinois]

Omar Shaker, a department attorney, told members of the Joint Committee on Administrative Rules that work continues to address an issue that prevented the existing system from allowing them to receive matching federal dollars when a non-citizen requires an emergency room visit.

“We do concede that at this time we are not prepared to move forward with the copay and cost-sharing elements,” Shaker said.

The agency sent a notice last month to providers saying they should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

Shaker said they do not have a hard timeline for when cost-sharing measures may return. The earliest could be January.

The agency this summer also placed a pause on new enrollees between the ages of 42 and 64. Seniors can still join the program until their enrollment reaches 16,500.

Shaker said Tuesday that 16,117 individuals 65 years and older are enrolled in the program.

 Additionally, Shaker said the department remains in communication with managed care organizations to establish a coordinated effort to incorporate them into the program next January. The move, he said, will help in “lowering the cost of the program while still providing all of the necessary elements.”

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Social determinants of health (SDOH), the “conditions in which people are born, grow, live, work, and age,”^1,2 can affect health outcomes,^3-5 including mental, cognitive, and physical well-being.^6,7 Children are raised in neighborhoods with diverse SDOH profiles, including high poverty levels and unemployment; rural settings; limited access to quality health care, nutritious food, clean water, or educational opportunities; and increased exposure to crime and drug sales, and these SDOH are linked to an array of developmental problems, including mental health disorders,^7-12 suicidal behaviors,^13-15 cognitive performance,^6,7,16 and physical health issues.^10,17 Unraveling the complex relationships between SDOH and child development is crucial to understanding which SDOH combinations are associated with which developmental outcomes. Without such information, it is not possible to devise effective, targeted policies and interventions. [JAMA]

This study shows that an unbiased quantitative analysis of multidimensional SDOH can permit the determination of how SDOH patterns are associated with child developmental outcomes. Children exposed to socioeconomic deprivation showed the worst outcomes relative to other SDOH categories. These findings suggest the need to determine whether improvement in socioeconomic conditions can enhance child developmental outcomes. 

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Download paper here>

See previous IOMC presentation with Dr. Matt Davis, MD, Lurie Children's Hospital and Northwestern Medicine here> 

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Sen. Tammy Duckworth is calling on health plans to do more to boost access for children to a drug that helps treat respiratory syncytial virus. [Health News Illinois]

The Democratic senator wrote in a letter to America’s Health Insurance Plans CEO Matt Eyles that increased access to nirsevimab will help ensure that millions of Americans can receive affordable care ahead of the expected rise in respiratory illnesses this fall.

“What must never be a hindrance to providing children with this potentially life-saving immunization is provider confusion over policies and coverage, or worse, a penny-wise, but deadly-foolish decision to deny coverage of the RSV immunization or subject families to onerous out-of-pocket costs,” she said.

The association should work with its members to cover nirsevimab and with the Biden administration on “clear and urgent guidance on the importance and need for all insurance carriers to update every plan beneficiary of the cost-free RSV immunization coverage," Duckworth said.

The association did not return a request for comment.

 The Food and Drug Administration approved nirsevimab this summer for children younger than 8 months of age born during or entering their first RSV season and for those between 8 and 19 months who remain vulnerable to severe disease through their second RSV season.

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Eric Topol with Medscape's Medicine and the Machine podcast. We have a new episode today with a really interesting fellow physician, Dr Adam Rodman. He's an internist at Beth Israel Deaconess Medical Center. He's an educator and instructor at Harvard Medical School, author of the book Short Cuts: Medicine, and has a podcast called Bedside Rounds. He also had articles in both the August 3 and August 10 issues of The New England Journal of Medicine.

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The annual publication of the US maternal mortality rate leads to extensive, often alarmed, commentary from politicians, public health officials, and women’s health advocates. The official 2021 rate from the National Vital Statistics System (NVSS) was 32.9 maternal deaths per 100 000 births,¹ which is the highest rate since 1964. The US rate, even accounting for COVID-19–related cases,² remains higher than any other high-income country. [JAMA]

Download viewpoint here>

There are currently 3 different government data sources on US maternal mortality: the NVSS, which provides official reports used for international comparisons (includes deaths related to pregnancy that occur during pregnancy and up to 42 days postpartum); the Centers for Disease Control and Prevention’s Pregnancy Related Mortality Surveillance System (PMSS), which reports the pregnancy-related mortality rate (pregnancy-related deaths that occur during pregnancy and up to 1 year postpartum); and state Maternal Mortality Review Committees (MMRCs), which report either or both of these rates for individual states, as well as a third category of pregnancy-associated deaths (deaths of pregnant/birthing people whether related to pregnancy or not). All 3 measures rely on state vital statistics systems to provide the initial data, which are then refined into mortality estimates using different approaches. These different sources typically yield inconsistent estimates of the magnitude of, and trends in, maternal mortality, with the NVSS system reporting a core national public health measure more than 50% higher than the PMSS. The NVSS system does have the considerable advantage of timeliness, having already produced a 2021 national estimate. In contrast, the most recent PMSS rate is for 2019, and most state MMRCs have not published rates past 2017.

It is challenging to identify deaths in those who were pregnant or recently pregnant and then make a judgment as to whether the pregnancy caused or contributed to the death.³ The World Health Organization has offered guidance on improving identification of pregnancy-related deaths, including adding a pregnancy checkbox to death certificates asking certifiers to identify whether the individual had been pregnant at the time of death or the death occurred within 42 days or 1 year of a birth.⁴ The US added the checkbox in a 2003 revision of the standard death certificate and all states adopted the pregnancy checkbox by 2018, although California opted to exclude the 42-day cutoff.⁵ Although the checkbox has improved identification of deaths during pregnancy, NVSS research identified numerous false-positive responses associated with the pregnancy checkbox, and steps have been taken to minimize this problem.⁵

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