The economic impact of untreated maternal mental health conditions in Texas.

BACKGROUND: Maternal mental health conditions (MMHCs), which include depression and anxiety disorders during pregnancy and through five years postpartum, are among the most common obstetric complications in the United States overall and in Texas in particular. In the context of potential expansion of postpartum Medicaid coverage from 60 days to one year, we sought to capture the societal, financial burden of untreated MMHCs. METHODS: We estimated the economic impact of untreated maternal mental health conditions (MMHCs) among births in Texas in 2019 using a cost-of-illness model. RESULTS: We found that MMHCs affected 13.2% of mothers and, when left untreated, cost $2.2 billion among mothers and children born in Texas in 2019 when following the birth cohort from conception through five years postpartum. We found that MMHCs affected 17.2% of mothers enrolled in Texas' Medicaid for Pregnant Women and cost $962 million. In addition, the prevalence of MMHCs and resulting costs varied considerably among women of different races and ethnicities. Employers and health care payers, including Medicaid, bore most of these costs. CONCLUSIONS: The Texas Health and Human Services Commission's (HHSC) efforts to increase awareness about MMHCs and increase access to care represent an important step toward improving maternal and child health and maximizing benefits to Texas HHSC, employers, and insurers.

Data Equity to Advance Health and Health Equity in Low- and Middle-Income Countries: A Scoping Review.

OBJECTIVE: To assess a common hypothesis that data serve as a mechanism to improve health and health equity in low-and middle-income countries (LMICs), we conducted a synthesis of the evidence about the linkage between data capabilities in LMICs and health outcomes. METHODS: We searched and reviewed peer-reviewed and grey literature published in the past decade that focused on at least one aspect of health data or health equity or provided insights on the relationship between data use and improved health outcomes, decision-making, or both. We supplemented this with expert interviews and convenience-sampled literature. RESULTS: Of the 50 included articles, 33 discussed data collection, with 23 stating that poor accuracy, reliability, and completeness hindered data-informed decision-making. Of 27 articles discussing data access, 18 described how lack of interoperability between data systems hampered governments' and other organizations' ability to leverage the full value of data available. Of 19 articles discussing data use, 13 discussed how data were not getting to those doing work on the ground. Although key informants postulated a virtuous cycle between data and improved health outcomes, evidence did not support this connection. CONCLUSIONS: Findings indicate better data might improve health service delivery. However, more work is needed to examine whether improvements in data yield improvements in health outcomes in LMICs. Our conceptual framework of data equity for health and health equity developed through this scoping review helps identify the key components along which to assess improvements in LMICs' data capabilities.

Estimating the incidence of unintended births and pregnancies at the sub-state level to inform program design.

OBJECTIVES: Unintended (mistimed or unwanted) pregnancies occur frequently in the United States and have negative effects. When designing prevention programs and intervention strategies for the provision of comprehensive birth control methods, it is necessary to identify (1) populations at high risk of unintended pregnancy, and (2) geographic areas with a concentration of need. METHODS: To estimate the proportion and incidence of unintended births and pregnancies for regions in Missouri, two machine-learning prediction models were developed using data from the National Survey of Family Growth and the Missouri Pregnancy Risk Assessment Monitoring System. Each model was applied to Missouri birth certificate data from 2014 to 2016 to estimate the number of unintended births and pregnancies across regions in Missouri. Population sizes from the American Community Survey were incorporated to estimate the incidence of unintended births and pregnancies. RESULTS: About 24,500 (34.0%) of the live births in Missouri each year were estimated to have resulted from unintended pregnancies: about 25 per 1,000 women (ages 15 to 45) annually. Further, 40,000 pregnancies (39.7%) were unintended each year: about 41 per 1,000 women annually. Unintended pregnancy was concentrated in Missouri's largest urban areas, and annual incidence varied substantially across regions. CONCLUSIONS: Our proposed methodology was feasible to implement. Random forest modeling identified factors in the data that best predicted unintended birth and pregnancy and outperformed other approaches. Maternal age, marital status, health insurance status, parity, and month that prenatal care began predict unintended pregnancy among women with a recent live birth. Using this approach to estimate the rates of unintended births and pregnancies across regions within Missouri revealed substantial within-state variation in the proportion and incidence of unintended pregnancy. States and other agencies could use this study's results or methods to better target interventions to reduce unintended pregnancy or address other public health needs.

Characteristics, access, utilization, satisfaction, and outcomes of healthy start participants in eight sites.

To describe the characteristics, access, utilization, satisfaction, and outcomes of Healthy Start participants in eight selected sites, a survey of Healthy Start participants with infants ages 6-12-months-old at time of interview was conducted between October 2006 and January 2007. The response rate was 66% (n = 646), ranging from 37% in one site to >70% in seven sites. Healthy Start participants' outcomes were compared to two national benchmarks. Healthy Start participants reported that they were satisfied with the program (>90% on five measures). Level of unmet need was 6% or less for most services, except for dental appointments (11%), housing (13%), and child care (11%). Infants had significantly better access to medical care than did their mothers, with higher rates of insurance coverage, medical homes, and checkups, and fewer unmet needs for health care. Healthy Start participants' rates of ever breastfeeding (72%) and putting infants to sleep on their backs (70%) were at or near the Healthy People 2010 objectives, and considerably higher than rates among low-income mothers in the ECLS. The high rate of health education (>90%) may have contributed to these outcomes. Elimination of smoking among Healthy Start participants (46%) fell short of the Healthy People 2010 objective (99%). The low-birth weight (LBW) rate among Black Healthy Start participants (14%) was three times higher than the rate for Whites and Hispanics (5% each). Overall, the LBW rate in the eight sites (7.5%) was similar to the rate for low-income mothers in the ECLS, but both rates were above the Healthy People 2010 objective (5%). Challenges remain in reducing disparities in maternal and child health outcomes. Further attention to risk factors associated with LBW (especially smoking) may help close the gaps. The life course theory suggests that improved outcomes may require longer-term investments. Healthy Start's emerging focus on interconception care has the potential to address longer-term needs of participants.

Tools for developing, implementing, and evaluating state policy.

Policy can improve health by initiating changes in physical, economic, and social environments. In contrast to interventions focused on individual people, policies have the potential to affect health across populations. For this reason, the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention (CDC) advises states funded under the Heart Disease and Stroke Prevention Program to engage in activities supporting the development and maintenance of policies that can help reduce the burden of cardiovascular disease. Currently, the Division for Heart Disease and Stroke Prevention funds programs in 33 states and the District of Columbia to promote cardiovascular health. One goal of these programs is to build states' capacity to develop, implement, track, and sustain population-based interventions that address heart disease and stroke. Because of the critical role of policy in these activities, CDC provides guidance in developing, implementing, and evaluating policy. In 2004, the division contracted with Mathematica Policy Research, Inc, to conduct the Heart Disease and Stroke Prevention Policy Project, which included development of an online database of state heart disease and stroke prevention policies and a mapping application to show which states have these policies. We discuss the method for developing the database, mapping application, and other tools to assist states in developing, implementing, and evaluating heart disease and stroke prevention policies. We also highlight lessons learned in developing these tools and ways that states can use the tools in their policy and program planning.