Today’s older population is mostly better off than prior generations when it comes to health and poverty, and they’re also living longer. But incidence of chronic conditions is up, and older adults today spend proportionally more of their income on health care.
In her column for Generations Beat Online, AHCJ member Eileen Beal offers a reading list for health journalists and focuses on two books in particular that she believes will help prepare reporters for the first wave of baby boomers, which will hit Medicare next year (scroll down to item 4, “Beal’s Beat”).
The subjects these books cover, doctors’ decisions and statistics, are broad enough to be useful to even those journalists not focused on aging coverage.
Her suggestions include “How Doctors Think,” by Harvard professor and oncologist Jerome Groopman, and “Know Your Chances: Understanding Health Statistics.
In an e-mail separate from her column, Beal pointed out that Covering Health readers also might be interested in an edited, ranked and extensive list of health resource books compiled by the Agency for Healthcare Research and Quality that includes general and specific offerings.
One in five people in Utah have been prescribed pain medication in the past year, according to new figures from the Morbidty and Mortality Weekly report from the Centers for Disease Control and Prevention.
While the survey only takes into account the use of pain medications in Utah, the CDC notes that “This percentage is comparable to the 18.4% of insured persons aged ≥18 years who reported receiving a prescription for opioids in a national study in 2002.”
The report says that deaths in Utah as a result of “poisoning by prescription pain medications” increased nearly 600 percent from 1999 to 2007. It also looks at the problem of leftover medication and people using medications not prescribed to them:
An estimated 72% of respondents who were prescribed an opioid had leftover medication, and 71% of those with leftover medication kept it; during the same period, 97% of those who used opioids that were not prescribed to them said they received them from friends or relatives.
The state has set out some recommendations for health care providers aimed at reducing the availability of unused medications.
The data comes from the Behavioral Risk Factor Surveillance System, an on-going telephone survey system that collects information about health risk behaviors, preventive health practices and health care access. Utah is apparently the first state to include pain medication questions in the BRFSS, “although Kansas added a module of questions regarding chronic pain in 2005 and 2007 with one follow-up question asking how the pain was treated.”
For a 574-page, 10.22 MB government document, it’s surprisingly easy to navigate. There’s a table of contents, links and a nifty little feature which allows you to pull up a spreadsheet of the data from any chart or graph. In addition to the lead story on medical technology and scanning, the report includes 150 data tables. That’s a bit too much to summarize here, so we’ll settle for the CDC’s version of the highlights:
- … the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.
- The rate of adults aged 45 and over discharged from the hospital after receiving at least one knee replacement procedure increased 70 percent from 1996 to 2006 (26.5 per 10,000 population in 1996 to 45.2 per 10,000 in 2006).
- From 1988-1994 to 2003-2006, use of antidiabetic drugs among adults aged 45 years and over increased about 50 percent, and the use of statin drugs to lower cholesterol among this age group increased almost tenfold.
- The number of new organ transplantations per 1 million people increased 31 percent for kidney transplants (43.7 per 1 million in 1997 vs. 57.2 in 2006) and 42 percent for liver transplants between 1997 and 2006 (15.6 per 1 million in 1997 vs. 22.2 in 2006).
- Life expectancy at birth increased more for the black than for the white population between 1990 and 2007, thereby narrowing the gap in life expectancy between these two racial groups. Overall U.S. life expectancy in 2007 was 77.9 years.
- In 2007, 20 percent of U.S. adults were current cigarette smokers, a slight decrease from 21 percent in the previous three years. Men were more likely to be current cigarette smokers than women (22 percent vs. 17 percent).
- In 2005-2006, 30 percent of adults often or almost always had trouble sleeping in the past month.
- In 2007, 20 percent of adults 18 years and over had at least one emergency department visit in the past year, and 7 percent had two or more visits.
- The percentage of the population taking at least one prescription drug during the previous month increased from 38 percent in 1988-1994 to 47 percent in 2003-2006, and the percentage taking three or more prescription drugs increased from 11 percent to 21 percent.
Writing in mathematics-focused Plus Magazine, Mike Pearson (bio) and David Spiegelhalter (bio|wikipedia) examine not only the variety of methods used to report health statistics, but also just how each of those methods is employed to mislead physicians, patients and journalists alike. The piece was adapted from their Understanding Uncertainty Web site. The site, which is aimed in part at helping journalists understand statistics and probability, is profiled in this story.
The duo point out and illustrate common pitfalls and summarize relevant research. Not only do they point out fundamentals such as advantages that “number needed to treat,” and to a lesser extent absolute risk (1 in 100,000), numbers have over the popular relative risk (30 percent more likely), they also go much deeper. For example:
Photo by Letting Go of Control via Flickr.
One of the most misleading, but rather common, tricks is to use relative risks when talking about the benefits of a treatment, for example to say that “Women taking tamoxifen had about 49% fewer diagnoses of breast cancer”, while potential harms are given in absolute risks: “The annual rate of uterine cancer in the tamoxifen arm was 30 per 10,000 compared to 8 per 10,000 in the placebo arm”. This tends to exaggerate the benefits, minimise the harms, and in any case make it hard to compare them. This way of presenting risk is known as mismatched framing, and was found in a third of studies published in the British Medical Journal.
And mixing and matching numbers isn’t the only way statistics can be misleading; the writers list many. Even the humble denominator can be manipulated.
For example, people have been offered a prize for drawing a red ball from a bag, and then given the choice of two bags: one containing 1 red ball and 9 white balls, the other containing 8 red balls and 92 white balls. The majority chose the bag with 8 red balls, presumably reflecting a view that it gave more opportunities to win, even though the chance of picking a red ball was lower for this bag. Similarly, people confronted with the statement “Cancer kills 2,414 people out of 10,000,” rated cancer as more risky than those told “Cancer kills 24.14 people out of 100”. The potential influence of the size of the numerator and denominator is known as the ratio bias. Frequencies are generally used in risk communication, but it is important to keep a common denominator in all comparisons.
For a thorough primer on statistics and health, the authors highly recommend Helping Doctors and Patients Make Sense of Health Statistics (pdf), an engaging 2008 paper that makes heavy use of examples and anecdotes to illustrate key issues in the interpretation of statistics.
That paper’s authors recommend the following best practices for writing about health statistics:
We recommend using frequency statements instead of single-event probabilities, absolute risks instead of relative risks, mortality rates instead of survival rates, and natural frequencies instead of conditional probabilities.
Also of interest is this related editorial (pdf) in which media are described as “enablers” of statistical illiteracy. The author also points out that, even if journalists communicate risk in the most objective possibly fashion, folks from different cultural backgrounds will still perceive it differently. It includes an interesting side note about the far-reaching impact of how physicians are allowed to define their own legal standard of care.
AHCJ tip sheets
- Statistical errors even you can find
- What you need to know about risks, rates and ratios
- Medicine 101: Words, numbers and journals