Premature Babies: Risks and Costs
Teen mothers are among the most at risk for negative outcomes. The rate of live births in the United States declined 3% from 2008 to 2009 (Martin et al., 2011). The nation saw a peak in teen births in 1991. The decline in teen births to 39.1 per 1,000 total live births in 2009 is 37% below the 1991 peak of 61.8, and the lowest in seven decades. The teen birthrate declined fairly steadily from 48 live births per 1,000 teen females ages 15 to 19 in 2000, to 34 live births per 1,000 teen females of the same age group in 2010 (Centers for Disease Control and Prevention [CDC], 2012a).
The decline in teen births may be a contributing factor to the decline in preterm deliveries and low birth weight infants. Both 2008 and 2009 saw declines in preterm deliveries both before 34 weeks gestation and at 34–36 weeks gestation. The 2009 total preterm birthrate was 12.18% of all births in America. The preterm birthrate dropped only slightly to 11.99% in 2010 (Hamilton, Martin, & Ventura, 2011). The low birth weight rate in the United States has been steadily increasing since the 1980s. The low birth weight rate in 1989 was 7.05%. By 1999, the rate had increased to 7.62%. Final data for 2009 showed the low birth weight rate to be 8.16%. It is notable that African Americans have a disproportionately high incidence of low birth weight babies, though the incidence rate for this group has remained fairly steady, ranging from 13.61% in 1989, to 13.23% in 1999, to 13.61% in 2009. Hispanics also remained fairly consistent at 6.18% in 1989, to 6.38% in 1999, to 6.94% in 2009. Caucasians, however, have experienced a considerable increase in low birth weight infants. In 1989, Caucasians had a low birth weight rate of 5.62%. That number rose to 6.64% in 1999 and rose again to 7.19% in 2009 (Martin et al., 2011).
There is a difference of 9.21 per 1,000 infant mortality deaths between non-Hispanic blacks and Cubans. There is a roughly equal chance of low income and lack of medical access in both of these populations. What contributing factors might explain the difference?
A photo of a little boy sitting in a corner with a stuffed dog as he covers his face with his hands.
Courtesy of Hemera/Thinkstock
Two methods are used to count child abuse incidents, taking into consideration the fact that the same child may be the victim of multiple incidents in a given year.
Children, the elderly, and female partners and spouses are the individuals most vulnerable to abuse. Abuse comes in many forms, most prominently neglect, physical abuse, emotional abuse, and sexual abuse. Data on abuse is often unspecific regarding the type of abuse being discussed, mostly because different forms of abuse often occur simultaneously.
Many public agencies exist to deal with the problem of domestic abuse and to protect the vulnerable. The U.S. Administration for Children and Families tracks data on abuse within families. The number of reported abuse cases has increased over the last few decades. But the data is skewed by social norms. It is believed that a contributing factor to the increase in reported abuse cases is due to a social ethic that used to hide and ignore abuse, and now recognizes that it is not the victim’s fault and that abuse must be investigated. Even so, the data indicates that child abuse and neglect are on the rise.
Child abuse cases are counted in two ways. The number of incidents counted is known as the duplicate victim rate; the number of victimized children counted is known as the unique victim rate. Two separate rates are tabulated to account for the fact that the same child may be reported multiple times in a year. The duplicate victim rate in 2010 was 10 in 1,000 total children in the U.S. population. The unique victim rate was 9.2 per 1,000 children in the United States. This shows that the data collection methods are working, as the difference between the unique count and the duplicate count is small. Of the unique victims from 2006 to 2010, 75% had not been previously reported. In 2010, 81.3% of reported abused children were victims of their parents. A significantly lower 13% were victimized by people who were not their parents (U.S. HHS, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2011).
Child abuse statistics show a definite age factor, with abuse reports shrinking in number the older the victim. In 2010, 34% of child victims were infants to 3 years old, 23.4% were 4–7 years old, 18.7% were 8–11 years old, 17.3% were 12–15 years old, and 6.2% were 16–17 years old (see Figure 1.5).
Figure 1.5: Child abuse by age
A line graph shows the percent of children abused divided into six age groups (ages 0-3, 4-7, 8-11, 12-15, 16-17, and unknown). The percent of children abused in each age group decreases as the children get older.
Child abuse report rates decline as the age of the child increases.
U.S. Department of Health and Human Services (HHS). (2010). Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm10/cm10.pdf
Just as the young are vulnerable because they cannot defend themselves, so are the elderly. It is estimated that only 1 in 14 elder abuse incidents is reported, and only 1 in 25 incidents of elder financial exploitation is reported each year. Self-neglect, when a person does not attend to physical needs such as nutrition and bathing, is also a factor in elder abuse. Data from 1996 shows 450,000 seniors were abused by others, and an estimated 100,000 seniors neglected their own care (U.S. Administration on Aging, National Center on Elder Abuse, 2005).
A Closer Look: Elder Abuse Estimates
A photo of an elderly woman wearing a robe and looking distressed as she sits in an armchair in the corner of a room.
Courtesy of Simon Bourne/iStockphoto
An estimated 2.1 million older Americans experience some kind of abuse during their elder years.
The American Psychological Association (APA) (2012) estimates a staggering number of elderly abuse cases, suggesting that 2.1 million older Americans experience some kind of abuse during their elder years. Consider this scenario:
Shortly after her 87th birthday, Beth, suffering from the effects of degenerative arthritis and chronic heart disease, moved in with her adult daughter, Laura. This living arrangement caused stress between them. With her financial worries, her 25-year-old son also living at home, and her husband’s job always at risk, Laura has lost her temper numerous times. She has called Beth names and has even gone as far as blaming her mother for ruining her tranquility and home life with her family. This has made Beth feel like a prisoner in Laura’s home, isolated from the life she knew, as well as frightened and worthless.
Or take the case of Diane, 78, who lives at home with assistance from a home health nurse and a certified nurses’ aide. They visit her daily to care for and assist her with activities of daily living. She also depends on home health care assistance with home-based routines and to give her someone from the outside world to talk with. In the beginning, her nursing assistant was extremely helpful and sweet, but recently the assistant has begun ignoring requests, snapping at Diane, and has even come close to knocking her over while cleaning or vacuuming. Diane believes the assistant is bumping her deliberately, but she is afraid to say anything for fear of losing her link with the outside world, so she doesn’t confront her nursing assistant.
Neglect is the most common form of elder abuse; 36.7% of the perpetrators are adult children of their victims (U.S. Administration on Aging, National Center on Elder Abuse, 1997). Statistics show that females were significantly more likely to be the victims of elder abuse, at an incidence rate of 67.3%. Neglect can manifest as the intentional failure to meet the health-related needs of an individual, but it can also involve failing to meet the household necessities of an individual. A survey of states’ Adult Protective Services departments shows a marked increase in the number of reports of elder abuse, investigated cases of elder abuse, and substantiated reports of elder abuse from 2000 to 2004 (U.S. Administration on Aging, National Center on Elder Abuse, 2006). Whether the increases are due to expanded public awareness of the problem of elder abuse, or due to an increased number of elderly in the community, or due to an actual increase in elder abuse incidents is uncertain.
Financial exploitation is another form of mistreatment suffered by the elderly, and it can come in many forms, from the deliberate misuse of a legal relationship (power of attorney, guardianship, conservatorship, or trustee) to the embezzlement of funds under false pretenses (for example, the taking of government-issued checks or assistance).
Next we turn to a discussion of partner or spousal abuse. Child and elder abuse are more likely to be reported than spousal abuse, but family violence affects all members of a household. An estimated 30% to 60% of people who abuse their domestic partners also abuse children in the household. Approximately 16,800 homicides occur in the United States every year as a result of domestic violence. If these numbers seem low, there is reason for it because domestic partner abuse is one of the most underreported crimes in the nation (National Coalition Against Domestic Violence [NCADV], 2007).
Even with a lack of consistent reporting, trends show that domestic violence is declining. Reporting might be on the rise, at an estimated 60% of incidents reported between 1998 and 2002. The National Crime Victimization Survey (1998–2002) attempted to remedy the reporting gap by surveying members of different populations in the United States. The survey had a limited scope but some interesting findings. In 1993, the estimated victim rate was 5.4 domestic abuse victims per 1,000 U.S. residents. That number fell to 2.1 in 2002. Domestic abuse accounted for 11% of all violent crimes from 1998 to 2002. The majority of domestic abuse offenders are male, and the majority of victims are female. Domestic violence by intimate partners including current and past spouses, boyfriends, and girlfriends constituted over a quarter (26%) of all nonfatal violent crimes against women in 2009. In that same year, domestic violence constituted only 5% of all nonfatal violent crimes against men (National Center for Victims of Crime, 2011). Of the perpetrators in domestic violence cases in federal court, 67% are younger than age 40, and 72% are Caucasian (Durose et al., 2005). Although domestic abuse may be declining, many factors are unchanged.
This chapter is concerned with a discussion of the health-care needs of special populations. We have already talked about high-risk mothers, infant mortality, and households affected by substance abuse; these populations are particularly vulnerable to negative health outcomes. Why do you think abused individualsabusive families would also be categorized as a “special population”?
Chronically Ill and Disabled People
Chronic illness refers to those illnesses that are usually not fully recovered from once a person has them. Diabetes, HIV/AIDS, and emphysema are all examples of life-altering chronic illness. Chronic illnesses can create disabilities, though disabilities also include physical impairments to bodily function that interfere with activities of daily living. Disabilities and chronic ailments have a negative effect on lifestyle, and cost the country millions of dollars per year in health care and other resources. The Centers for Disease Control and Prevention show that chronic disease is the cause of 70% of U.S. deaths every year. Although chronic disease affects our community on the macrolevel, many causes of chronic illness are directly related to individual lifestyle choices. Cigarette use is linked to cancer of the lungs, throat, and other organs; habitual binge drinking causes cirrhosis of the liver; and lack of aerobic exercise leads to diabetes, obesity, and heart disease.
Heart disease was responsible for 26.6% of all registered deaths in 2005. Chronic lower respiratory diseases accounted for 53%, and diabetes was the cause of 3.1% of deaths in 2005. There has been little change in causes of death for age-adjusted death rates in the last few decades. As Figure 1.6 shows, heart disease rates have declined only slightly each year, and hypertension rates are on the rise after a small decline in the 1980s (Kung, Hoyert, Xu, & Murphy, 2008).
Figure 1.6: Leading causes of death by age-adjusted rates
A pie chart depicts the four leading causes of death by age-adjusted rates: heart diseases (44%), malignant neoplasms (37%), cerebrovascular diseases (10%), and chronic lower respiratory diseases (9%).
The pie chart shows age-adjusted death rates for select leading causes of death over the last five decades.
Center for Disease Control and Prevention. (2010). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf
The prevalence of chronic disease is tracked by the CDC’s Behavioral Risk Factor Surveillance System. This ongoing telephone survey collects anonymous information directly from patients about their chronic illnesses and quality of life. Data collected in 2009 shows a correlation between respondents who answered that their general health is fair or poor and many chronic illness risk factors such as cigarette use. According to the U.S. Department of Health and Human Service’s Healthy People 2020 initiative, almost one-half of all American adults reported at least one chronic illness.
Noninstitutionalized people over age 65 report the most limitations of activity due to chronic illnesses at a rate of 32.6%. Youth under age 18 had the next highest rate in 2006, at 7.3%, and adults ages 18 to 44 reported limited activity at a rate of 5.5% (U.S. Department of Health and Human Services, Healthy People 2020, 2012). The CDC reports that asthma is one of the most common chronic illnesses in school-age children, with 5.6 million children with asthma reported in 2007. Asthma prevalence puts a strain on schools, the health care system, and community resources.
Although many chronic diseases are related to personal lifestyle choices such as cigarette smoking, which can cause lung cancer and other serious respiratory diseases, asthma in school-age children does not seem to be related to lifestyle choice. What factors might be causing/influencing such a large population to be afflicted with a chronic disease at such a young age?
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