Health Equity & Access Weekly Roundup: November 30, 2024

US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment

The ongoing shortage of stimulant medications has exposed critical gaps in ADHD treatment, particularly for adults, as rising diagnoses and limited clinical guidance complicate care. Stimulants like Adderall and Vyvanse are widely considered the most effective treatments, yet medication shortages, driven by DEA-imposed production caps, hinder access. Despite recent increases in production quotas, supply remains insufficient to meet growing demand, which has surged alongside heightened awareness of adult ADHD and expanded telehealth access during the pandemic. Critics argue that the DEA’s quota system, designed to prevent misuse, is inflexible and exacerbates shortages, disproportionately affecting patients who depend on these medications for daily functioning. Calls for reform stress the need to balance concerns about diversion with the reality of ADHD as a lifelong condition, as patients face ongoing disruptions in care and rising inequities in treatment access.

Racial, Ethnic Disparities Persist in Mortality for Patients With Early-Onset CRC

A study published in JAMA Network Open demonstrates significant racial and ethnic disparities in mortality from early-onset colorectal cancer (EOCRC). Non-Hispanic Black individuals and Native Hawaiian and Other Pacific Islander individuals face the highest mortality risks. Analyzing data from 22,834 EOCRC patients diagnosed in California from 2000 to 2019, researchers found that even after adjusting for socioeconomic factors, disparities remained. Native Hawaiian individuals had a 69% higher risk of mortality compared with non-Hispanic White individuals, with non-Hispanic Black and Southeast Asian individuals also at elevated risk. The findings highlight the impact of social determinants of health and the need to address systemic barriers to care to reduce mortality in vulnerable populations.

US Earns Another Low Grade on Maternal Health

The March of Dimes 2023 report reveals a worsening maternal and infant health crisis in the US, giving the nation a D+ grade for its preterm birth rate for the third year in a row. Over 370,000 babies, or 10.4%, were born prematurely, with Black birthing individuals experiencing a preterm birth rate of 14.7%, significantly higher than other groups. Infant mortality rose for the first time in 20 years, totaling over 20,000 deaths, while maternal mortality exceeded 800 deaths, returning to pre-pandemic levels. Contributing factors include inadequate prenatal care, high rates of low-risk cesarean births, and systemic inequities. Experts recommend addressing chronic health conditions, improving education, and enacting policy reforms to enhance outcomes.

Unfavorable Health-Related Social Needs Associated With Lower Cardiovascular Health Scores

A study published in the Journal of the American Heart Association found a significant connection between unfavorable health-related social needs (HRSNs)—like food insecurity, unemployment, and lack of education—and low cardiovascular health (CVH). Analyzing data from the National Health and Nutrition Examination Survey (2011–2020), researchers revealed that participants with more HRSNs had higher rates of low CVH and lower rates of high CVH, indicating systemic disparities. The study highlights the need for community-based interventions and health policies to address social determinants of health and improve CVH outcomes across populations.

How Did Vermont Get the Best Maternal Health Score in the US?

Vermont earned the only A grade in the March of Dimes 2024 report card for maternal and infant health, with a preterm birth rate of 7.7%, below the national average of 10.4%. This success is due to low rates of inadequate prenatal care (6.2%) and low-risk cesarean births (23.7%), alongside expanded Medicaid access and more maternity care providers. However, disparities persist, particularly among Hispanic populations, who have the highest preterm birth rates in the state. Vermont's rising maternal mortality rate highlights the need for policies that address systemic inequities and health risks. Improvements could include enhancing midwifery support, reimbursing doulas and mental health care, and implementing paid parental leave.