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  • 9
    Jan
    2013
    2:21pm, EST

    Fewer Americans saw docs in 'Great Recession'

    By Andrew M. Seaman, Reuters

    NEW YORK - Americans made fewer trips to their doctors' offices during the Great Recession than they did earlier in the decade, according to new research.

    "These are not dramatic drops, but in our healthcare system we're used to our numbers going up... So just seeing a reverse in the trend is interesting," said Karoline Mortensen, the study's lead author from the University of Maryland in College Park.

    Using a national database of medical expenses from about 54,000 people between the ages of 18 and 64 years old, Mortensen and her colleague compared how many times people of different races used health services during two-year periods before the recession (2005 and 2006) and during it (2008 and 2009).

    On average, white patients went to the doctor's office 7.3 times in the two-year span before the recession, compared to 7 times each during the economic downturn.

    Black patients went to the doctor about 5.8 times each before the recession, and 5.3 times during it. Hispanic patients made about 4.5 visits each to the doctors before the recession and 4.1 during it.

    That downward trend was similar for the number of people admitted to hospitals, and the number of prescriptions they filled.

    Previous studies and surveys have also suggested that people use fewer health services during tough economic times.

    In 2009, the American Academy of Family Physicians (AAFP) found in a survey of its members that 58 percent were seeing an increased number of canceled appointments.

    The AAFP also found that 60 percent of the doctors reported they had "seen more health problems caused by their patients forgoing needed preventive care." "The first thing that drops off is preventive medicine," said Dr. Jeffrey Cain, AAFP president and a family physician in Denver.

    Cain, who was not involved with the new research, said that not getting preventive care can lead to real problems for people.

    For example, he said a woman may forgo her mammogram and end up being diagnosed with breast cancer later, when it is advanced.

    "When you have a recession, people think of it in terms of dollars in their pocket, but it also affects their health," said Cain.

    Mortensen, who published her findings in JAMA Internal Medicine, said she can't say whether or not the decreased usage in her study actually led to worse care or outcomes.

    She also said that more research is needed to find out if other factors could have contributed to the decrease.

    "There is something else out there that could be behind all of this," she said.

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  • 3
    Oct
    2012
    9:06am, EDT

    Recession contraception? Birth rate down in US for 4th year

    By Mike Stobbe, The Associated Press

    U.S. births fell for the fourth year in a row, the government reported Wednesday, with experts calling it more proof that the weak economy has continued to dampen enthusiasm for having children.

    But there may be a silver lining: The decline in 2011 was just 1 percent — not as sharp a fall-off as the 2 to 3 percent drop seen in other recent years.

    "It may be that the effect of the recession is slowly coming to an end," said Carl Haub, a senior demographer with the Population Reference Bureau, a Washington, D.C.-based research organization.

    Most striking in the new report were steep declines in Hispanic birth rates and a new low in teen births. Hispanics have been disproportionately affected by the flagging economy, experts say, and teen birth rates have been falling for 20 years.

    Falling births is a relatively new phenomenon in this country. Births had been on the rise since the late 1990s and hit an all-time high of more than 4.3 million in 2007.

    But fewer than 4 million births were counted last year — the lowest number since 1998.

    Among the people who study this sort of thing, the flagging economy has been seen as the primary explanation. The theory is that many women or couples who are out of work, underemployed or have other money problems feel they can't afford to start a family or add to it.

    The economy officially was in a recession from December 2007 until June 2009. But well into 2011, polls show most Americans remained gloomy, citing anemic hiring, a depressed housing market and other factors.

    The report by the Centers for Disease Control and Prevention is a first glimpse at 2011 birth certificate data from state health departments. More analysis comes later but officials don't expect the numbers to change much.

    Early data for 2012 is not yet available, and it's too soon to guess whether the birth decline will change, said the CDC's Stephanie Ventura, one of the study's authors.

    Highlights of the report include:

    • The birth rate for single women fell for the third straight year, dropping by 3 percent from 2010 to 2011. The birth rate for married women, however, rose 1 percent. In most cases, married women are older and more financially secure.
    • The birth rate for Hispanic women dropped a whopping 6 percent. But it declined only 2 percent for black women, stayed the same for whites and actually rose a bit for Asian-American and Pacific Islanders.
    • Birth rates fell again for women in their early 20s, down 5 percent from 2010 — the lowest mark for women in that age group since 1940, when comprehensive national birth records were first compiled. For women in their late 20s, birth rates fell 1 percent.
    • But birth rates held steady for women in their early 30s, and rose for moms ages 35 and older. Experts say that's not surprising: Older women generally have better jobs or financial security, and are more sensitive to the ticking away of their biological clocks.
    • Birth rates for teen moms have been falling since 1991 and hit another historic low. The number of teen births last year — about 330,000 — was the fewest in one year since 1946. The teen birth rate fell 8 percent, and at 31 per 1,000 girls ages 15 through 19 was the lowest recorded in more than seven decades.

    "The continued decline in the teen birth rates is astounding," said John Santelli, a Columbia University professor of population and family health.

    Did the economy have anything to do with a drop in teen births?

    Yes, indirectly, Santelli said. Teenagers watch the struggles and decisions that older sisters and older girlfriends are making, and what they see influences their thinking about sex and birth control, he said.

    "Teens tend to emulate young adults," Santelli said. "They are less influenced directly by the economy than by people."

    Studies show that since 2007, larger percentages of sexually active teenage girls are using the pill and other effective birth control. Studies also show a small decline in the proportion of girls ages 15 through 17 who say they've had sex, Santelli noted.

    The new birth report also noted a fourth straight decline in a calculation of how many children women have over their lifetimes, based on the birth rates of a given year.

    A rate of a little more than 2 children per woman means each couple is helping keep the population stable. The U.S. rate last year was slightly below 1.9.

    Countries with rates close to 1 — such as Japan and Italy — face future labor shortages and eroding tax bases as they fail to reproduce enough to take care of their aging elders.

    Officials here aren't as worried.

    The U.S. replacement rate is still close to 2. And it has dropped in the past and then bounced back up again, said Ventura, an official at the CDC's National Center for Health Statistics.

    "And we haven't seen any studies that show couples want to have fewer children or no children," she added.

    One more report highlight: The U.S. C-section rate may have finally peaked at just under 33 percent, the same level as last year.

    Cesarean deliveries are sometimes medically necessary. But health officials have worried that many C-sections are done out of convenience or unwarranted caution, and in the 1980s set a goal of keeping the national rate at 15 percent.

    The C-section rate had been rising steadily since 1996, until it dropped slightly in 2010.

    "It does suggest the upward trend may be halted," said Joyce Martin, a CDC epidemiologist who co-authored the new report. But CDC officials want a few more years of data before declaring victory, she added.

    More top health news:

    Too fat for TV? Anchor fires back at critics

    Docs claim first mom-to-daughter uterus transplant

    If you have a cold, skip the vitamin D, study says

    © 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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