Joe Falvo

States with citizens who exhibit the most need for increased health care spending often spend the least

New research from the Center for Medicare and Medicaid Services (CMS) shows that states with high per capita personal income, Medicare-Medicaid enrollment and health care capacity spent the most on health care, while states with many uninsured citizens spent less.

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Lead author David Lassman, a statistician from the CMS, and a team of researchers found that macroeconomic factors caused the rate of health care spending to increase, but did not affect state spending rankings over the past 2 1/2 decades.

“These estimates, which provide information about consumption of health care by residents of a state, serve as a baseline for state and national-level policy discussions,” the team said in 

New England spent 26 percent more than the 2014 national average on health care, while the Rocky Mountain region spent 15 percent less, according to the study. Alaska spent the most on health care in 2014 at $11,064, Utah spent the least at $5,982 and the national average was $8,045.

“Regression analysis of per capita personal health care spending at the state level also suggests a strong positive relationship between that spending and per capita income,” the team said.

States with higher per capita income had higher health care expenses than states with lower per capita income. Regional income data accounted for approximately 60 percent of the variation in health care spending between states from 1991 and 2014.

Unemployment following the 2008 economic recession led to decreased per capita income and loss of private health insurance for many citizens. Areas hit hardest by the economic recession saw a large decrease in personal health care spending rates and an increase in uninsured citizens and Medicaid enrollment.

From 2010 through 2013, however, economic recovery generated employment and personal income, causing the opposite effect. States with rapid per capita income growth had the greatest personal health care spending acceleration, while states with slow per capita income growth had the lowest.

“State-specific impacts of the ACA coverage expansions are most evident in the underlying trends for Medicaid and private health insurance spending by state,” the study said.

Per capita Medicaid expenses increased by 12.3 percent in expansion and by 6.2 percent in nonexpansion states. Per enrollee Medicaid expenses, on the other hand, decreased by 5.1 percent in expansion states while increasing the same percentage in expansion states.

The research showed the opposite trend for private health insurance. Nonexpansion states saw faster private health insurance enrollment growth than expansion states.

“This more rapid growth was caused, in part, by enrollment in Marketplace plans, as nonexpansion states accounted for 53.4 percent of Marketplace enrollment but 45.5 percent of overall private health insurance enrollment in 2014,” Lassman said

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The United States spends more on health care per person than other nations with similar life expectancy. However, this truth does not necessarily mean equality across states and class lines. Overall, the wealthiest states with the most insured citizens spend the most on health care. Continue below to learn more about health care spending.

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Koo and his fellow researchers conducted a two-part study to get to the bottom of childhood tooth decay.

Early Childhood Caries (ECC), a form of severe primary tooth decay in children between birth and 71 months, effects 23 percent of toddlers in the U.S. alone. But current preventative measures, such as fluoride rinse, operate on the outdated belief that the bacteria S. mutans acts alone in creating a biofilm over the teeth.

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Dr. Hyun (Michel) Koo and his team at University of Pennsylvania School of Dental Medicine have discovered that ECC are caused by more than just bacteria. In fact, ECC come from a co-infection of bacteria and the fungus C. albicans, according to the new research.

Koo and his team have taken the first steps in developing an effective therapy to target both fungal and bacterial components of ECC. The new study, published in

, reveals specific molecular interactions which form the biofilm.

The two-part study determines if biofilm is created by binding between mannoproteins on the fungal surface and glue-like bacterial exoenzyme secretions. Mannoproteins, which are glycoproteins, protrude from many fungal surfaces and have mannose sugar components.

Performing the first stage using an in-vitro model, the team created multiple groups of biofilms using different types of mutated fungal strains. They then tested the mechanical strength of the biofilm using a custom atomic force microscopy system.

Results from the examination revealed a stark decrease in the mechanical strength of biofilms, which were created using fungal strains with inhibited mannoprotein production in comparison to biofilms created with the unaltered fungus. The mutation was so successful that it caused a three-fold reduction mechanical strength of the biofilm.

Inspired by these promising findings, the team took to phase two of the study to examine the mutation’s effect in-vivo. Studying rats that were infected with ECC-causing bacteria and the same groups of mutated fungi used in phase one, they fed the rats a high sugar diet to create the best environment for biofilms growth. Teeth from each of the rat groups were examined over the course of 30 days using a scanning electron microscope.

The in-vivo model proved to be even more effective in preventing biofilm formation than the in-vitro test. Rats infected with the mutated fungus had drastically less biofilm formation than those infected with the unaltered fungus. Biofilm production was so inhibited by the mutation that the team saw a complete absence of fungus when they performed microbiological analysis.

Koo said there was approximately five times less bacteria in the mutated biofilms than in the normal biofilms. This new research is essential to understanding of cross-kingdom biofilm formation between bacteria and fungi.

“[We hope our research will] provide new perspectives for devising effective therapies to disrupt this cross-kingdom relationship associated with an important childhood oral disease,” the team said in the study.

Going forward, the researchers will build on their recent findings by beginning the search for a topical formulation that targets ECC-causing bacteria and fungi. This research has the potential to considerably preserve the health and integrity of primary teeth in toddlers.

Tooth decay is the single most common chronic childhood disease, surpassing asthma, obesity and diabetes. However, little research on Early Childhood Caries exists, and current practices may not be effective enough. A new study from researchers at UPenn hopes to change that and reduce the prevalence of this preventable oral health epidemic. Continue below to learn about the latest research.
 