Food insecurity among low-income adults dropped nearly 5% during pandemic-era SNAP expansion

Embargoed for release until 5:00 p.m. ET on Monday 1 January 2024 
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.  
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1. Food insecurity among low-income adults dropped nearly 5% during pandemic-era SNAP expansion

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2282

Editorial: https://www.acpjournals.org/doi/10.7326/M23-3363

URL goes live when the embargo lifts   

Benefits expansions during the COVID-19 pandemic may have helped to mitigate food insecurity among low-income adults. A survey of low-income adults showed that food insecurity dropped nearly 5% in 2021 compared to 2019. The findings are published in Annals of Internal Medicine.

Food insecurity is a major driver of health disparities in the United States. In response to the COVID-19 pandemic, the federal government expanded the social safety net, including increases in spending on the Supplemental Nutrition Assistance Program (SNAP).  Little is known about how food insecurity changed among low-income adults over the course of the pandemic.

Researchers from Beth Israel Deaconess Medical Center and Harvard Medical School used data from the National Health Interview Survey (NHIS), a nationally representative survey from the National Center for Health Statistics, to examine food insecurity among low-income adults during versus before the pandemic. They included 2019 as a pre-pandemic reference for both 2021 and 2022 cycles but excluded  2020 because the onset of the pandemic created challenges in conducting the survey. The data showed that food insecurity decreased from 20.6% in 2019 to 15.5% in 2021, despite worsening unemployment and economic loss. By 2022, food insecurity rates had returned to pre-pandemic levels, but remained lower for low-income adults receiving SNAP benefits. According to the authors, these findings highlight the importance of financial relief and nutritional benefits for vulnerable populations. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Rishi K. Wadhera, MD, MPP, MPhil, please contact rwadhera@bidmc.harvard.edu.

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2. Case raises concern that sotatercept may be associated with serious and recurrent gastrointestinal bleeding

Abstract: https://www.acpjournals.org/doi/10.7326/L23-0387 

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Physicians should be aware of a potential serious adverse effect associated with sotatercept use. A case report detailing serious and recurrent gastrointestinal bleeding is published in Annals of Internal Medicine.

Sotatercept is an investigational medicine that has shown positive results for treating adults with pulmonary arterial hypertension. In the phase 2 PULSAR and phase 3 STELLAR trials, epistaxis, skin telangiectasias, and thrombocytopenia were more frequent among those taking sotatercept compared with placebo. To date, sotatercept has not been associated with recurrent gastrointestinal bleeding.

Researchers from Beth Israel Deaconess Medical Center and Tufts Medical Center describe the case of a 68-year-old woman with pulmonary arterial hypertension who received sotatercept for approximately 12 months during the phase 3 clinical trial STELLAR and its long-term open-label extension (SOTERIA). The patient was hospitalized for gastrointestinal bleeding on 6 instances while receiving sotatercept, which resolved when therapy was discontinued. It is not clear if sotatercept increases the risk for gastrointestinal bleeding. It is not clear if taking sotatercept increases risk for bleeding in the digestive tract or if it could cause unusual changes in the blood vessels in your stomach and intestines. More research is needed to determine these issues or whether using sotatercept could lead to problems with blood clotting, like having too few platelets, which might increase the risk of bleeding. This is an important point, especially for older patients who may have other blood vessel issues in the digestive system due to aging, such as angioectasias, or who may be on other blood-thinning agents.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with an author, please contact Noah C. Schoenberg, MD at nschoenb@bidmc.harvard.edu or Harrison W. Farber, MD at hfarber@tuftsmedicalcenter.org.

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3. Understanding the downstream procedures and complications associated with lung cancer screening

Risks and benefits should be carefully discussed and weighed for individual patients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0653  

URL goes live when the embargo lifts  

A study of more than 9,000 persons screened for lung cancer found that rates of downstream procedures and complications associated with screening are substantially higher in routine clinical practice than previously observed in the National Lung Screening Trial (NLST). The study is published in Annals of Internal Medicine.

Lung cancer screening using low dose computed tomography (LDCT) reduces lung cancer mortality and can help catch lung cancer earlier in high-risk patients. As with any cancer screening exam, lung cancer screening  can also lead to downstream procedures, complications, and other potential harms. The rates of these harms and how often they may occur in clinical practice are unclear and may deviate from the NLST.

With support from the National Cancer Institute, researchers from the Perelman School of Medicine at the University of Pennsylvania in collaboration with researchers across the Population-based Research to Optimize the Screening Process (PROSPR) network studied healthcare data for 9,266 persons screened for lung cancer across 5 U.S. health care systems between 2014 and 2018 to identify rates of downstream procedures and complications associated with screening. The authors found that among all screened patients, 15.9 percent had a baseline LDCT showing abnormalities. Of those patients presenting abnormalities, 9.5 percent were diagnosed with lung cancer within 12 months. Of all patients, 31.9 percent underwent downstream imaging and 2.8 percent underwent downstream procedures. In patients undergoing invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST. According to the authors, their findings highlight the need for practice-based strategies to assess and improve variations in the quality of care and to prioritize LCS among those patients most likely to receive a net benefit from screening in relation to potential complications and other harms.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Katharine A. Rendle, PhD, MSW, MPH, please contact Meagan Raeke at meagan.raeke@pennmedicine.upenn.edu.

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4. Review provides potential framework for addressing disrespect in maternal care

Disparities in maternal health outcomes disproportionately affect Black women, with emerging research suggesting disrespectful care during childbirth as a key contributor

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2676      

Editorial: https://www.acpjournals.org/doi/10.7326/M23-3186

URL goes live when the embargo lifts  

A systemic review evaluating 37 studies relating to respectful maternal care (RMC) found that current research addressing this topic lacks a “gold standard” method for measuring respectful maternity carel. The authors also found that only one study addressed clinical outcomes for birthing patients and no studies addressed the relationship between RMC and infant health. The review is published in Annals of Internal Medicine.

Maternal mortality is worse in the United States than other comparable nations, especially for non-Hispanic Black women, for whom maternal mortality rates are 69.9 per 100,000 live births compared with 26.6 per 100,000 live births for non-Hispanic White women. Emerging research suggests that lack RMC contributes to maternal morbidity and mortality.  

Researchers from Oregon Health & Science University conducted a systemic review of 37 studies to define RMC, evaluate the validity of tools to measure RMC, the relationship of RMC with maternal and infant health outcomes, and strategies for implementation of RMC. The authors identified 12 frameworks for defining RMC that were categorized according to disrespect and abuse or rights-based frameworks.  12 tools to measure RMC were validated in 24 studies based on content validity, construct validity, and internal consistency. They noted there were no gold standard tools for evaluating criterion validity.  Additionally, there was only one trial that examined the effectiveness of RMC for improving maternal outcomes and it provided insufficient evidence. There were no studies of RMC effectiveness for improving infant health outcomes and no studies evaluating the effectiveness of RMC implementation strategies.

An accompanying editorial by authors from the Weill Cornell School of Medicine suggests that the results of this review should guide development of a standard definition of RMC and a framework to address disrespect in maternity care. The authors also note that at the policy level, this review highlights the importance and necessity of prioritizing the evaluation of efforts to implement RMC, underscoring its integral role in health care quality for birthing persons. The authors also advise that health researchers working with patients and communities should be funded to develop and test measurement tools, along with implementing a series of interventions to provide RMC for birthing persons.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Amy G. Cantor, MD, MPH, please contact Nicole Rideout at rideoutn@ohsu.edu.

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5. New protein risk score shows strong clinical utility for predicting death from heart failure

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2328    
URL goes live when the embargo lifts   
A new protein risk score developed to predict the risk of death for persons with heart failure (HF) has demonstrated good calibration and may help clinicians better stratify mortality risk in these patients. The score is published in Annals of Internal Medicine.

Heart failure is a complex clinical syndrome with high mortality rates. Current risk stratification approaches that capture the biological complexity of the HF syndrome and show clinical utility are limited. High-throughput proteomics could improve risk prediction, but its use in clinical practice to guide the management of patients with HF depends on validation and evidence of clinical benefit.

Researchers from the National Institutes of Health developed and validated a protein risk score to stratify mortality risk in persons with heart failure using a community-based cohort of 7,289 plasma proteins in 1,351 patients with HF. In the development cohort, 38 unique proteins were selected for the protein risk score. The protein risk score demonstrated good calibration, reclassified mortality risk particularly at the extremes of the risk distribution, and showed greater clinical utility compared with the clinical model. According to the researchers, these findings foreshadow the clinical utility of large-scale proteomic assays for precision risk prediction in HF. This tool may help clinicians select candidates for rapid drug titration or patients with advanced HF, at particularly high risk for adverse outcomes, that should be considered for mechanical circulatory support or transplantation.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Veronique L. Roger, MD, MPH, please contact veronique.roger@nih.gov.

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