Bulletin Today
Iron deficiency may be more common than we think
How prevalent is iron deficiency among the American public? Authors of a recent study published in JAMA sought answers and discovered that absolute and functional iron deficiency affect a large proportion of American adults even in the absence of anemia, heart failure, chronic kidney disease, or a current pregnancy.
Out of the study sample of 8,021 U.S. adults, an estimated 14% of participants had absolute iron deficiency, and an estimated 15% had functional iron deficiency. Absolute iron deficiency results from a severe reduction or absence of iron stores. Functional iron deficiency occurs in the presence of adequate iron stores but insufficient iron availability. Data were taken from the National Health and Nutritional Examination Survey 2017 to 2020 prepandemic cycle.
Researchers hypothesized that dietary iron intake, food security, and alcohol use would be associated with iron deficiency but did not find clear patterns to support these nutritional factors as potential causes. Approximately 27% of participants reported marginal, low, or very low food security.
“This cross-sectional study indicates that both absolute and functional iron deficiency affect a large proportion of adults in the U.S., especially among those without conditions often screened for iron deficiency,” noted study authors. “Moreover, iron supplement use was infrequent among adults with iron deficiency. Absolute and functional iron deficiency may be a widespread, underrecognized public health problem.”
CDC recommends iron screening for high-risk groups, but there is no clear recommendation for iron deficiency surveillance in the general population.
According to the study authors, current screening recommendations may miss 70% of iron deficiency cases among children and during pregnancy—populations who are at high risk of developing iron deficiency or anemia and who are more commonly tested.
Although most research has focused on adverse outcomes among people with iron deficiency and anemia, iron deficiency affects nonerythropoietic tissue, such as skeletal and cardiac muscle, in the absence of anemia, according to the research. ■
CDC gives snapshot on prescription use, nonadherence among older adults
CDC’s latest National Health interview survey findings revealed that 88.6% of U.S. patients aged 65 years and older took prescription medicine—with treatments for diabetes, high cholesterol, hypertension, and pain accounting for nearly one-half of all prescriptions at the country level.
Researchers analyzed survey responses in order to estimate prescription drug use, coverage rates, and cost-related nonadherence during the time period for older, community-dwelling adults.
Results also showed that 82.7% of older U.S. adults had a prescription drug plan. However, many still struggle to afford their medications. Due to high out-of-pocket expenses, 3.6% of the sample did not get a needed prescription and 3.4% skipped or rationed doses or otherwise did not take a medication as prescribed.
The findings were particularly true for older adults with no prescription drug coverage; for those in poor or fair health versus good, very good, or excellent health; and for individuals with food insecurity.
Given the differences in outcomes based on sociodemographic and health traits, the study authors suggested their findings “may inform efforts to reduce disparities in health care access and health outcomes for older adults.” ■
For maternal RSV vaccine, provider recommendation mattered
The maternal RSV vaccine was first recommended by CDC last year during the 2023 to 2024 season. In a new MMWR report from CDC, the agency found that provider recommendation for that immunization in particular was associated with higher coverage.
According to the CDC survey findings, 33% of eligible pregnant women reported receiving an RSV vaccination to protect their infants from RSV—one of the most common reasons for infant hospitalization. CDC recommends a single dose of RSV vaccine at 32 to 36 weeks’ gestation during September to January. Among women with a live birth, 45% reported that their infant received nirsevimab. CDC also recommends nirsevimab, an RSV antibody, for infants who are less than 8 months old and born during or entering their first RSV season from October to March for most parts of the United States. Overall, 56% of infants were protected against severe RSV disease by either vaccination product or both.
Approximately one-half of pregnant women who responded to the survey did not report receiving a provider recommendation for maternal RSV vaccination or nirsevimab for their infants, indicating missed opportunities to protect infants from severe RSV disease. These findings further underscore the importance of a strong provider recommendation for immunization, noted researchers.
Not receiving a recommendation for vaccination from a physician, nurse, or other medical professional was the most frequently reported reason for nonreceipt of the maternal RSV vaccine followed by not knowing that RSV vaccination was needed during pregnancy, and patients having concerns about possible safety risks to the infant.
Among unvaccinated pregnant and recently pregnant women with a live birth whose infant did not receive nirsevimab, the main reasons for not getting nirsevimab for their infants included 1) concerns about the long-term safety of nirsevimab for the infant; 2) not planning to give the infant any vaccines; and 3) not wanting the infant to receive too many vaccines.
Authors of the report said that multiple challenges in rolling out the new RSV immunization products might have resulted in lower than anticipated coverage. These challenges included timing of recommendations and product availability, differing recommendations in terms of timing of vaccine and nirsevimab administration, complex clinical considerations and nuanced communications, limited time to improve awareness of the new recommendations for both health care providers and pregnant women, cost and reimbursement issues, access issues, and concerns about safety and efficacy of the products. ■
NIH releases mpox research agenda
NIH’s National Institute of Allergy and Infectious Diseases has rolled out an updated agenda for mpox research as part of the federal response to an ongoing global outbreak.
The agency will employ its research infrastructure both at home and overseas to accomplish four primary objectives. Those priorities include learning more about the biology of mpox strains, known as clades; evaluating different dosing regimens of existing vaccines in order to optimize the current supply while developing new vaccine concepts; advancing antivirals, monoclonal antibodies, and other existing or new therapies; and supporting strategies for virus detection with a goal of strengthening clinical care delivery and disease surveillance. ■
Study looks at market competition and vertical integration in PBM industry
Research published on September 10, 2024, in JAMA found a deep concentration of PBM services were evident across all three payer markets, especially Medicare Part D. The research team, led by Dima Qato, PharmD, from the University of Southern California, Los Angeles, found that Medicare Part D, along with Medicaid, was dominated by Optum Rx and CVS Caremark, while Express Scripts gravitated toward the commercial market.
The market dominance of a handful of large PBMs across payers has important antitrust implications, the study authors concluded, particularly in the context of escalating costs and pharmacy shutdowns.
“These findings could inform federal policies, including proposed legislation that would prohibit unfair and deceptive PBM business activities and the Federal Trade Commission’s ongoing investigation of PBM anticompetitive practices,” they wrote.
The research findings come against a backdrop of concern about PBMs’ foothold in the prescription drug market.
The dataset included 14 billion prescriptions filled last year at U.S. community pharmacies and processed through 91 market middlemen, three of whom—CVS Caremark, Express Scripts, and Optum Rx—accounted for more than three-quarters of the overall volume.
“The call for increased regulatory oversight of PBM business practices is overwhelmingly welcomed by physicians as a check against possible anticompetitive harm resulting from low competition and high vertical integration in the PBM industry,” said Bruce A. Scott, MD, president of the American Medical Association (AMA), in a news release. “The findings from the new AMA analysis warrant attention as Congress and the administration continue their work to protect patients and ensure prescription drugs remain affordable and accessible.” ■