Thursday, May 19, 2016

The poor have more heart attacks

That the poverty is a strong correlate of worse health tends to be ignored in the medical literature so a strong study pointing it out is worth noting. It is more support for the idea that there is a general syndrome of biological fitness

Geographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013

Erica S. Spatz et al.


Importance:  During the past decade, the incidence and mortality associated with acute myocardial infarction (AMI) in the United States have decreased substantially. However, it is unknown whether these improvements were consistent across communities of different economic status and geographic regions since efforts to improve cardiovascular disease prevention and management may have had variable impact.

Objective:  To determine whether trends in US county-level, risk-standardized AMI hospitalization and mortality rates varied by county-based median income level.

Design, Setting, and Participants:  In this observational study, county-level risk-standardized (age, sex, and race) hospitalization and 1-year mortality rates for AMI from January 1, 1999, to December 31, 2013, were measured for Medicare beneficiaries 65 years or older. Data analysis was performed from June 2 through December 1, 2015. Counties were stratified by median income percentile using 1999 US Census Bureau data adjusted for inflation: low- (<25th average-="" high-="" or="" th-75th="">75th) income groups.

Main Outcomes and Measures:  The effect of income on the slope of AMI hospitalizations and mortality, measured as differences in the rate of change in AMI hospitalizations and mortality by county income and by the 4 US geographic regions, and a possible lag effect among low-income counties.

Results:  In the 15-year study period, AMI risk-standardized hospitalization and mortality rates decreased significantly for all 3 county income groups. Mean hospitalization rates were significantly higher among low-income counties compared with high-income counties in 1999 (1353 vs 1123 per 100 000 person-years, respectively) and in 2013 (853 vs 648 per 100 000 person-years, respectively). One-year mortality rates after hospitalization for AMI were similar across county income groups, decreasing from 1999 (31.5%, 31.4%, and 31.1%, for high-, average-, and low-income counties, respectively) to 2013 (26.2%, 26.1%, and 25.4%, respectively). Income was associated with county-level, risk-standardized AMI hospitalization rates but not mortality rates. Increasing 1 interquartile range of median county consumer price index–adjusted income ($12 000) was associated with a decline in 46 and 37 hospitalizations per 100 000 person-years for 1999 and 2013, respectively; interaction between income and time was 0.56. The rate of decline in AMI hospitalizations was similar for all county income groups; however, low-income counties lagged behind high-income counties by 4.3 (95% CI, 3.1-5.9) years. There were no significant differences in trends across geographic regions.

Conclusions and Relevance:  Hospitalization and mortality rates of AMI declined among counties of all income levels, although hospitalization rates among low-income counties lag behind those of the higher income groups. These findings lend support for a more targeted, community-based approach to AMI prevention.

JAMA Cardiol. Published online May 11, 2016. doi:10.1001/jamacardio.2016.0382


Vermont college to close due to ‘crushing’ debt incurred by Bernie Sanders’s wife

If you want a sneak peak into what the U.S. economy would look like under a Bernie Sanders presidency, look no further than Vermont’s Burlington College. Sanders’s wife, Jane O’Meara Sanders, was president of the private liberal arts school from 2004 to 2011. She must’ve not been very good at her job, though, because the college announced Monday that it will close May 27 due to “the crushing weight of the debt” incurred under Ms. Sanders’s presidency:

At the end of 2010, Ms. Sanders took out $10 million in loans on behalf of Burlington College to purchase a 32-acre swathe of land from the Roman Catholic diocese, which put the land up for sale to help cover the costs of a $17 million sexual-abuse settlement.

As Heat Street reported last month, the college almost immediately fell short on its financial obligations as fundraising pledges and commitments Ms. Sanders cited in the loan agreements never materialized.

Less than a year after leading Burlington College into massive debt, Ms. Sanders resigned, taking with her a $200,000 severance package. By 2014, because of its shaky finances and running deficits, Burlington College found itself placed on probation for two years by the regional accreditation agency.

A Burlington College news release issued this morning called these financial hurdles “insurmountable at this time.”

And if displacing hundreds of college students (the very demographic for which Bernie has claimed to be a champion) and shuttering an institution of higher education isn’t enough, Catholics in Vermont want to investigate Ms. Sanders for fraud:

Catholic parishioners in Vermont have called for an investigation into whether Ms. Sanders committed federal bank fraud by deliberately misrepresenting the amount that the college had secured in fundraising pledges as she sought financing for the land purchase.

As Ms. Sanders pursued financing for the land acquisition, she repeatedly said that Burlington College had received more than $2 million in fundraising commitments and pledges, according to numerous records.

But in fiscal year 2011, Burlington College raised only $279,000—though the college had earlier claimed to have secured $1.2 million in confirmed pledges.

Apparently Bernie isn’t the only Sanders who thinks other people’s money grows on trees.



Clueless Republicans Don't Realize It's the Democrats Who Have the Problem


I'm a bit perplexed with the continued resistance of so many of my right-wing brothers and sisters to Donald Trump. If it's just his brash style and vulgar taste, his preference for glittery gold over brushed nickel or flat black for his bathroom fixtures, I could understand it. I'm a flat black guy myself. But it's so much more than that.

The latest "betrayal" is that Trump admitted his tax plan was negotiable  Imagine that—a tax plan being negotiated between the administration and Congress! Never heard of that before.... oh, wait.

Never mind that the Trump plan, even negotiated, would be considerably lower than just about any on offer and well within the parameters of conventional GOP proposals.  (Now be honest—who would you rather have negotiating for you, Donald Trump or Paul Ryan? Who do you think would get a better result?) Nevertheless The Donald, in the opinion of the cognoscenti, once more has shown himself to be a feckless character not worthy of support—and the Republican gulf widens.

Or so we're supposed to believe, even though he has the nomination completely nailed down, signed, sealed and delivered, everything but set in bronze.

Meanwhile,  to almost everyone's surprise, the Democrats are still fighting, their internal enmity growing as Comrade Bernie wins primary after primary, sometimes by large majorities, and Lady Hillary clings to her super delegates like a three-year-old to a blanket. What happens if she loses California? According to West Virginia exit polls, a full third of Democratic primary voters are ready to defect to Trump. In the latest poll of swing states, Donald is already ahead of Clinton in Ohio and neck-and-neck in Florida and Pennsylvania. And the big show is just getting started.

It is the Democrats, not the Republicans, that have the problem, but you wouldn't know it if you watched, say, The Kelly File or had your Internet perpetually wired to National Review or The Weekly Standard, where the writing is as elegant as the thinking, these days, is often fuzzy. The Democrats are fighting a real war of ideas, disreputable though those ideas may be, while the Republicans fight a status war among themselves, a battle over control, not, except in the margins, over ideology.

Am I wrong? Remind me again where Trump, at least currently, is not a conservative? Taxes, check. Deficit, check. Immigration, check. Sanctuary cities, check. Strong defense, check.  Supreme Court, check. Veterans, check. Common core, check. Iran deal, check. Israel, check. Healthcare, check. Pro-life, check.... Oh, yes, Planned Parenthood.  He thinks the part of that operation that treats cervical cancer is okay. What a sin.

But...but...but... he has those whacky ideas on NATO and nuclear weapons and trade.

Are they so whacky? Other nations maybe should pay the part of NATO they contracted to. And the Japanese and South Koreans themselves have been talking about building nukes.  Wouldn't you after eight years of Obama? And then trade, who would doubt it could have been negotiated better, considering how our foreign policy deals have been negotiated?

And of course there's the matter of Muslim immigration. He wants that restricted for now. So do most Americans, according to polls. Again, this is the opening point of a negotiation. Who knows where it will end? But no one, other than the extreme left, would like to see the Syrian refugees pouring in. Trump will have the public on his side in preventing it.

As I said, the real problem is with the Democrats.  They are the ones in true disarray and are likely to remain so through their convention. This is a huge gift to the Republicans if they can only suck it up, shelve their egos, get together and take advantage of it. It doesn't matter whether you are a neocon, a social con, a libertarian, a financial con or just a plain con. Ideology is so last year. (Well not completely, but it doesn't have to be on the front burner all the time, does it?) Just do it.



More Leftist authoritarianism

Smokers in California from 18 to 20 years old have only three and a half weeks until the state’s new tobacco restrictions kick in. Come June 9—two days after the California primary election—tobacco consumption for the under 21 crowd will be verboten.

Young adults will still be able to make many life-or-death decisions, but they won’t be able to light up legally unless they are in the military. But that doesn’t necessarily mean all will abstain from indulging in tobacco: Many will have access to smokes and chew via the underground market that is sure to emerge. For evidence, observe how black markets arose in New York in response to the Empire State’s tax on cigarettes.

“New York’s experience is instructive,” write Independent Institute Senior Fellow William F. Shughart II and Strata Policy Analyst Josh T. Smith. “Largely because of the titanic tax that it places on cigarettes, almost 60 percent of the cigarettes sold in New York are smuggled into the state, according to the Tax Foundation.”

While experience with other prohibitions (and exorbitant tax hikes) offers strong reasons to oppose California’s new tobacco law, the moral case against it is even stronger. “It is absurd to claim that 18-year-olds are too young to buy a pack of cigarettes, but are mature enough to consent to sex, marry, or vote,” Shughart and Smith write. “It is a double standard that threatens the protection of all personal choices, even the ones still considered sacrosanct.... Lawmakers should let adults be adults and allow them to make their own decisions because they are worthy of our respect as equal, autonomous human beings.”



America's slide downhill?

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