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Scholarship & Creative Work
Most seniors have drug coverage, study shows

More than 90 percent of Americans age 65 and older have prescription drug coverage today, compared to 76 percent who were covered in 2004, an analysis shows. And poor seniors are just as likely to have coverage as the rich.

The analysis compared drug coverage among a nationally representative sample of 9,321 older Americans who were interviewed both in 2004 and after the Medicare Part D prescription drug benefit started in 2006.

The Health and Retirement Study, conducted since 1992 by the Institute for Social Research is funded primarily by the National Institute on Aging.

"Despite widespread concerns that the plan is complex and confusing, our findings show that 60 percent of seniors who had no drug coverage signed up for Part D," says economist Helen Levy, who co-authored the paper with economist David Weir, who directs the Health and Retirement Study.

"Further, 70 percent of those who had three or more conditions requiring medication signed up for Part D," Levy says, "compared with 37 percent who had no such medical conditions. This suggests that the decision to sign up reflects a rational economic choice, based on the need for prescription medication."

While the results suggest that Plan D has been an effective program, Levy and Weir noted that additional analysis needs to be done, as beneficiaries don't always make optimal decisions about which Plan D plan to choose.

The report was published in January as a National Bureau of Economic Research working paper.


Poor people suffer disproportionately from chronic infections

Kids from low-income families are much more likely to suffer from serious infections such as herpes or hepatitis A than their counterparts in wealthier households.

Two recent studies show a startlingly strong correlation between income and chronic infection in both adults and children, with lower income populations suffering much higher rates of chronic infections and clusters of infections than higher income families.

"There is a large body of research showing that people of lower socioeconomic status are at greater risk for numerous chronic diseases," says Allison Aiello, senior author on the studies and an assistant professor of epidemiology at the School of Public Health. "In this study, we found that lower income populations are also more likely to be exposed to a cluster of persistent infections."

"The primary infections and their long-term effects are both a concern," says Jennifer Dowd, principal investigator on the child paper and co-author on the adult paper.

Dowd completed the research as a Robert Wood Johnson Foundation Health & Society Scholar in SPH epidemiology. Dowd is an assistant professor of epidemiology and biostatistics at Hunter College, City University of New York, and the CUNY Institute for Demographic Research. The lead author on the adult paper is Anna Zajacova, research fellow at the Population Studies Center, Institute for Social Research. She also collaborated on the child study.

The studies are unique because they used data from the Third National Health and Nutrition Examination Survey, a national study that is representative of the general U.S. population. The next step is more research on exactly what factors, such as exposure to chronic stressors and poor nutrition, lead to these disparities, Aiello says.


Living with a spouse can improve health of Chinese elderly

Much older people in China — one of the world's largest populations — are healthier if they live with a spouse, a new study shows.

The study found that living arrangements can predict mortality, personal care ability and self-rated health among Chinese age 80 and older. In addition, living arrangements affect men and women differently, in terms of mortality.

"Our findings suggest that with whom older Chinese live (or do not live) matters to their health," says Lydia Li, an associate professor in the School of Social Work and the study's lead author. "In the past decade, significant changes in living arrangements among older persons in China have been observed. Policy makers should keep close attention to these changes as they have implications for population health."

The study's sample began with more than 9,000 Chinese respondents whose ages ranged from 77 to 122 years old. More than half were re-interviewed two years after the baseline. In addition to reporting background information, such as age, ethnicity and gender, the respondents answered questions about their household composition, health and ability to perform personal care activities.

Relative to older Chinese who lived alone, those living with a spouse or with a spouse and children were less likely to die at follow-up. Men living in an institution also had lower mortality risk than men living alone, but this wasn't the case for women. Men probably benefited from the care and support provided by institutions more than women, Li says.

Li wrote the study with Jiaan Zhang, a social work graduate student, and Jersey Liang, a professor in the School of Public Health. Their findings appear in the latest issue of Social Science & Medicine.


Researchers discover metabolite linked to aggressive prostate cancer

Researchers from the Comprehensive Cancer Center have identified a panel of small molecules, or metabolites, that appear to indicate aggressive prostate cancer.

The finding could lead to a simple test that would help doctors determine which prostate cancers are slow-growing and which require immediate, aggressive treatment.

Results of the study appeared in the Feb. 12 issue of Nature.

"One of the biggest challenges we face in prostate cancer is determining if the cancer is aggressive. We end up overtreating our patients because physicians don't know which tumors will be slow-growing. With this research, we have identified a potential marker for the aggressive tumors," says senior study author Dr. Arul Chinnaiyan, director of the Michigan Center for Translational Pathology and S.P. Hicks Endowed Professor of Pathology at the Medical School.

The researchers looked at 1,126 metabolites across 262 samples of tissue, blood or urine associated with benign prostate tissue, early stage prostate cancer and advanced, or metastatic, prostate cancer "It allows us to look very deeply at some of the functions of the cells and the biochemistry that occurs during cancer development," says Chinnaiyan, a Howard Hughes Medical Institute investigator.

Additional U-M authors include Christopher Beecher, Arun Sreekumar, Laila Poisson, Thekkelnaycke Rajendiran, Amjad Khan, Qi Cao, Jindan Yu, Bharathi Laxman, Rohit Mehra, Robert Lonigro, Yong Li, Mukesh Nyati, Aarif Ahsan, Shanker Kalyana-Sundaram, Bo Han, Xuhong Cao, Jaemun Byun, Gilbert Omenn, Subramaniam Pennathur, John Wei and Sooryanarayana Varambally.


Scientists unmask genetic markers associated with psoriasis

Scientists at the Department of Dermatology, the School of Public Health (SPH) and their collaborators have found DNA "hotspots" that may reveal how genetic differences among individuals result in psoriasis, an autoimmune disease of the skin.

Published in Nature Genetics, the findings could lead to new drug targets and tailored treatments for the disease, notes Dr. James Elder, a professor in the Department of Dermatology who was a co-leader of the research.

"This discovery highlights the role of several genes in mediating the immune responses that result in psoriasis," says Goncalo Abecasis, co-principal investigator on the project, and associate professor of biostatistics in SPH. "Some of the highlighted genes, like those in the IL-23 pathway are already targeted by effective psoriasis therapies. Others, like TNFAIP3 and TNIP1, may become targets for the psoriasis treatments of the future."

Psoriasis affects some 7.5 million people in the United States, causing sore, itchy patches of red, scaly skin. In many cases psoriasis not only is disfiguring; between 10 and 30 percent of patients develop psoriatic arthritis, a painful inflammation of the joints. Current treatments, including different types of immunosuppressive agents, aren't always effective, and they can cause serious side effects.

Psoriasis has a strong genetic component; a child with two affected parents has a 50 percent chance of developing it; siblings have a three- to six-fold risk. But the genes responsible for psoriasis haven't yet been completely understood.

The study was led by Elder and Abecasis. Among the first authors were Rajan Nair, assistant research professor of dermatology, and Jun Ding of the Department of Biostatistics in SPH.


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