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  • Private equity’s appetite for hospitals may put patients at risk

    Private equity’s appetite for hospitals may put patients at risk


    Home / News / Private equity’s appetite for hospitals may put patients at risk
    Illustration: A female healthcare practitioner, left, and a businessman, right, face off in an illustration describing relationship between fall care and rising costs.
    Illustration: Traci Daberko

    In the wake of the Steward Health Care crisis, corporate and private equity ownership of health care has come under new scrutiny. Here, Harvard health policy experts weigh in on the growing corporatization of the U.S. health care system and what it means for patients, practitioners, and public health.

    Throughout 2024, eye-opening news headlines from around the country trained a spotlight on the collapse of Steward Health Care:

    As Steward hospitals teeter, CEO’s $40 million yacht is docked in the Galapagos Islands

    Sick patients collapsed waiting for care in overwhelmed Steward hospital’s emergency department

    Steward Health Care files for Chapter 11 bankruptcy

    Steward owned more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas. Its volatility and eventual crash jeopardized access to health care for millions of patients.

    How did Steward, at one point the largest private for-profit health system in the U.S., go belly up?

    The long and short: In 2010, private equity firm Cerberus Capital Management purchased Caritas Christi Health Care, a struggling eastern Massachusetts hospital system, from the Archdiocese of Boston, converting it from non-profit to for-profit and rebranding it as Steward Health Care. In 2016, after years of continued financial instability, Steward signed a sale-leaseback agreement with Medical Properties Trust (MPT), selling the land and buildings occupied by its hospitals to the real estate investment trust then leasing them back. Steward made $1.25 billion from the agreement—enough to steady its financial footing, pay off Cerberus, and fund a growth spree. The next year, the company purchased 26 more hospitals across the country. But with the agreement came what many viewed as inflated rents.

    By 2020, Cerberus, having made $800 million in profit on its initial investment, decided to sell Steward hospitals to a group of its physicians, essentially transferring ownership back to Steward’s management team, led by CEO Ralph de la Torre. Over the next several years, concerns about patient care and safety at Steward hospitals mounted as the company opted to cut costs and neglect bills in order to keep up with its rent payments to MPT. In January 2024, MPT announced that Steward was $50 million behind on those payments. By May, the company filed for bankruptcy. Financial documents made clear that the company had paid hundreds of millions to investors and leadership, including de la Torre, who enjoyed a lavish lifestyle while patients at Steward hospitals faced increasingly unsafe conditions. De la Torre was subpoenaed by Congress in July; he failed to appear.

    After months of tense negotiations between state governments, Steward, MPT, and potential buyers, by November, most Steward hospitals had found new owners, a mix of non- and for-profit hospital systems and private equity firms. But two hospitals didn’t survive: Carney Hospital, which served Boston’s low-income, majority Black and Hispanic southern neighborhoods, and Nashoba Valley Medical Center, which served 17 suburban and rural communities across central Massachusetts. Thousands of patients and hundreds of staff have been left to find health care and jobs with new providers farther away.

    The Steward meltdown has captured the attention of the public and policymakers not as an outlier, but as an object lesson. Its story shines a light on the growing role of private equity in the U.S. health system, helps explain rising discontent among patients and clinicians, and lays bare the dangers of prioritizing profits over people in health care.

    A ‘core contradiction’

    John McDonough, professor of the practice of public health at Harvard Chan School, calls private equity “the sharp end of capitalism.”

    “It’s otherwise often described as ‘capitalism on steroids,’” McDonough said. “It’s for-profit business in its most aggressive form. [Private equity firms] seek returns on their investment as high as possible as quickly as possible, then rush to sell off that investment and go on to their next conquest.”

    After decades establishing a presence everywhere from manufacturing, to telecommunications, to grocery stores, in the mid 2000s private equity firms began targeting health care. It was a natural next step: The industry is worth nearly $5 trillion in the U.S., offering significant, dependable cash flow. Firms saw the potential for profits and began buying up physician practices and health facilities, from hospitals to nursing homes to fertility clinics, looking to at least double their initial investment and then sell within a short time, often three to seven years.

    Private equity’s foothold in health care has continued to grow. In 2021, according to researchers at UC Berkeley, 5,779 physician practices, specializing in everything from primary care to oncology, were owned by private equity firms—up from 816 in 2012. Nonprofit watchdog the Private Equity Stakeholder Project (PESP) reported that, as of February 2024, nearly 460 U.S. hospitals were owned by private equity firms. These hospitals—which include non-specialty acute care hospitals, rehabilitation hospitals, psychiatric facilities, and long-term acute care facilities—represent 8% of all private (not owned by the government) hospitals and 22% of for-profit hospitals.

    5,779

    physician practices were owned by private equity in 2021—up from 816 in 2012

    22%

    of for-profit hospitals—460 in total—are currently owned by private equity

    80%

    of physicians are employed by a hospital system or corporation—up from 60% in 2019

    But ownership by private equity is just the latest version of capitalism’s creep into health care. Its way was paved by corporations entering the industry in the 1980s as an era of free market fundamentalism emerged and the “maximizing shareholder value” movement began to boom. Publicly traded companies began buying up hospitals and health facilities, as well as physicians and physician practices, to establish their own health systems. Today, nearly a quarter of U.S. hospitals are run by for-profit entities that promise to bring business smarts and a flow of capital to health care delivery.

    “The pitch is that corporations can raise capital and invest in improving the business—quality of care, operations, professional management—in a way non-profits can’t,” said Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy. “But the challenge is that because health care is so important, the public expects these corporations to prioritize public interest over profits. And that’s not what they’re built to do.”

    Because health care is so important, the public expects corporations to prioritize public interest over profits. And that’s not what they’re built to do.

    Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy

    “Medical care has always had a for-profit element. Physicians were mostly small businesspeople,” McDonough said. “But there’s a difference between a sole proprietor or small business and a mega-corporation that believes its only purpose in the world is return on equity to shareholders. Hold that belief up against a medical provider’s belief that patients come first, and right away there’s conflict. It’s this core contradiction that I think American society has never sufficiently grappled with.”

    Non-profits like profits, too

    It’s not just corporate health care providers producing this dilemma. Non-profits, which remain the majority of U.S. hospitals and health care facilities, sometimes prioritize profits over their social missions—and community benefit requirement cementing their tax-exempt status—in order to grow, and even just survive, in a tight economy and increasingly competitive health care market.

    “Economists have studied whether non-profits behave differently than for-profits. Do they provide more charity care [free or discounted medical services for poor patients]? Do they invest more in community well-being? The answer generally has been no,” Rosenthal said.

    One study, conducted in 2020 by Joseph Bruch, PhD ‘21 and David Bellamy, PhD ’23, indeed found no significant difference between what non-profit and for-profit hospitals spend on charity care as a percent of their total expenses.

    “It’s getting harder and harder to tell the difference between a non-profit and for-profit board of directors,” McDonough said. “It’s this for-profit ethos that has swarmed and swamped the U.S. medical space. Many people think the system can prioritize patients and profits at the same time and that it will be okay. But then we look at calamities like Steward, and we think to ourselves, maybe it can’t. And maybe it won’t be okay.”

    Consequences of cost-cutting

    For Steward patients, it wasn’t okay. Reports of poor-quality care and compromised patient safety ran the gamut: from understaffed emergency rooms and ill-equipped maternity wards, to stairwells infested with bats, to cancelled surgeries and suspended trash service due to unpaid invoices. These extreme examples represent what a growing body of research suggests: Health care quality declines when private equity and its extreme for-profit approach take over.

    A 2023 study found that Medicare patients at private equity-owned hospitals suffered a 25% increase in hospital-acquired complications compared to Medicare patients at hospitals not owned by private equity. These complications included a 38% increase in bloodstream infections from central lines—longer-term, surgically inserted ports through which patients can intravenously receive fluids, medications, and blood—despite 16% fewer central lines placed. Similarly, the rate of surgical site infections doubled at private equity-owned hospitals while those at the control hospitals decreased. And while falls at hospitals not owned by private equity have been trending downward—a product of a nationwide, decades-long hospital safety movement—falls at private equity-owned hospitals have remained steady, amounting to a 27% relative increase.

    “We believe [these findings are] largely explained by staffing cuts,” said the study’s senior author Zirui Song, PhD ’12, associate professor at Harvard Medical School and Massachusetts General Hospital. “The unique financial pressures private equity-owned hospitals face, such as new debt placed on them from the acquisition and expectations of profitability in the short run, may lead to cutting the costs of delivering care—such as through reducing staffing. But while you may be able to substitute people with machines in other industries, health care remains human-labor intensive, especially inpatient care. Cutting staff can have salient consequences for quality of care and patient outcomes.”

    Another study by Song and colleagues found that private equity-owned hospitals earned 27% more income after acquisition than hospitals not owned by private equity. That financial gain was fueled by increasing charges—the asking prices for hospital services—by between 7% and 16%, depending on the department, as well as by issuing more charges per day and seeing fewer patients enrolled in Medicare, which provides lower reimbursements than commercial insurers.

    A white and magenta yard sign reads
    A “Save Our Hospital” sign is displayed outside the former Nashoba Valley Medical Center, which was part of the bankrupt Steward Health Care company and closed on Aug. 31, 2024. (Charles Krupa / AP Photo)

    Exacerbating disparities

    What type of hospitals does private equity tend to target?

    New evidence from Song and colleagues suggests that firms typically set their sights on financially healthier—rather than struggling—hospitals, compared to similar peer hospitals that were not acquired. That’s because private equity firms tend to place new debt onto acquired hospitals, and those on stronger financial footing are better able to take on that debt.

    There are examples, however, of hospitals serving mostly uninsured or publicly insured patients being taken over by private equity firms. These takeovers may exacerbate health disparities, as many of these disadvantaged patients belong to racial or ethnic minorities and already suffer worse health outcomes, said Song. When discontinuation of hospital services—or total closure—occurs, it has an outsize impact in communities where access to health care is already limited. Carney Hospital is one such example; in an op-ed, Harvard Chan School’s Alecia McGregor, assistant professor of health policy and politics, called its closure “a matter of life and death” that threatens to deepen Boston’s already extreme racial disparities in health.

    “I don’t think there is enough evidence to definitively say that private equity targets hospitals that mostly serve people of color. But in some cases, these financially vulnerable facilities may fit their business model,” McGregor said. “And when private equity backed acquisitions lead to closures, this is when marginalized communities often hurt the most. Take Hahnemann University Hospital, for instance—a historic facility serving mostly low-income Black and Hispanic Philadelphians that was closed by its private equity owner after less than two years. Many viewed the closure as a maneuver for the hospital’s prime city real estate.”

    PESP also reports that a quarter of private equity-owned hospitals serve rural populations, whose health care alternatives are sparse if they’re unsatisfied with quality or costs and whose outcomes are jeopardized if the only hospital in town closes. Since Nashoba Valley Medical Center was closed, first responders travel around 15 miles to transport patients to emergency care, according to a local fire chief. They used to travel three.

    Policy potential

    “Theoretically, there could be benefits to private equity investments in health care. They could provide facilities and clinicians with an infusion of capital, but also with managerial know-how and business acumen that might improve health care, such as through making care more ‘efficient,’” Song said. “Unfortunately, however, the current evidence base does not support that. Rather, evidence seems to suggest that by cutting the human labor and other inputs that make care delivery possible—also seen in private equity acquisitions of physician practices and nursing homes—the care might just become less safe.”

    Song published a series of policy recommendations for officials looking to reduce corporate influence, specifically that of private equity, over health care delivery and outcomes. His recommendations for state policy included reviving or enforcing corporate practice of medicine laws, which, in their aim to protect physicians as independent practitioners, can go as far as prohibiting corporations from hiring physicians or influencing medical decisions. His recommendations for federal policy included:

    • Strengthening fraud and abuse protections
    • Improving Federal Trade Commission staffing and bandwidth, in order to improve oversight over health care acquisitions and mergers
    • Discouraging risk-taking behavior by corporate owners (sometimes referred to as moral hazard), through measures like legally affiliating private equity firms with their rolled-up set of acquired entities, limiting the percent debt a firm can use to make an acquisition, and reforming the tax benefit that allows private equity proceeds to be taxed at 20% (rather than the regular corporate business rate, which is higher)
    • Regulating health care prices and prohibiting surprise billing
    • Increasing public transparency into private equity acquisitions

    Some policymakers have already begun efforts to enact these recommendations. In June, Massachusetts senators Elizabeth Warren and Edward Markey introduced the Corporate Crimes Against Health Care Act, which would penalize private equity firms if a health facility they own closes or has poor finances resulting in injury or death to a patient. A month later, Markey proposed another bill, the Health Over Wealth Act, which would require greater transparency for private equity firms and for-profit companies that own health care entities.

    Meanwhile, in the last year, several congressional committees—including the Senate Budget Committee, the Senate Committee on Homeland Security and Governmental Affairs, and the House Committee on Ways & Means—have launched investigations into and held hearings on the role of private equity in health care. On a state level, legislation to regulate private equity in health care is pending in Massachusetts, New Jersey, New York, and Pennsylvania. California, Indiana, Minnesota, New Mexico, and Oregon already have programs that do so. (In September, California Governor Gavin Newsom vetoed a bill that would further intensify regulations.)

    A group of protestors in front of the Masscushetts state house. They hold signs that read
    Protesters gather in front of the Massachusetts State House to advocate for keeping Nashoba Valley Medical Center and Carney Hospital open. (Steve LeBlanc / AP Photo)

    Deeper changes

    These regulations—if passed—could help protect physicians as well as patients. One of the significant changes from the corporatization of health care is that, increasingly, physicians are no longer working for themselves. In the 1980s, most doctors owned their own small clinics. Today, nearly 80% are employed by a hospital system or corporation—up from just over 60% in 2019, according to Avalere Health.

    “If you’re a physician working in a hospital, chances are you don’t work for the hospital. You work for a corporation,” McDonough said. “And when you sign on with the corporation, you sign a non-compete clause. You can’t criticize anybody or raise your voice even as your workload keeps growing, even when you’re the only physician in the emergency department with multiple traumas, even when you’re seeing patients being put at risk and your colleagues being exploited.”

    As this hypothetical proves reality for more and more physicians, many are banding together to advocate for some of the policies Song recommends. A physician advocacy group called Take Medicine Back, for instance, is working to garner support for corporate practice of medicine laws.

    Burnt out, frustrated—and organizing

    In November, primary care physicians employed by Massachusetts’ largest health system, non-profit Mass General Brigham, cited the “corporatization of medicine” among their reasons for pushing to unionize. Across the country, a small number of doctors—around 70,000, representing 8% of the profession—already belong to a union. But that number has been growing steadily, and will likely continue to do so with the arrival of a new generation of physicians. Currently, 20% of medical residents—more than 32,000—belong to a union, a number that has doubled since 2019.

    But tighter regulations on private equity and corporations in health care can only achieve so much. Many experts believe deeper changes to health policy and investments in public health are equally needed. Examples include:

    • Higher reimbursements for public insurance, so that, in McGregor’s words, “small community hospitals that serve populations largely on Medicare or Medicaid can better meet their costs and remain in business without the private sector filling in”
    • Simplified health insurance systems, like those in the Netherlands and Switzerland, that use private insurance plans that are streamlined, with fewer choices, making them more transparent and easier to understand and regulate
    • Funding for non-medical social care, such as housing and food—in Rosenthal’s words, “social supports that make a big difference in people’s lives and that, when underinvested in, drive up our health care costs”

    ‘One of the biggest lies we’ve ever been told’

    These additional policy levers could help diminish for-profit health care’s influence, but by how much is a matter for debate.

    “At the end of the day, I think we’re always going to have this kind of mixed public and private system,” Rosenthal said. “Politically, it would be very challenging for us to go in a more government-focused direction. There’s just a lot of distrust. And the one big thing that’s quite different about our country is that we don’t consider health a right. It’s not in our constitution like it is for many of our peers.”

    But significant change may be on the horizon, driven by public discontent around health care and growing visibility, brought by cases like Steward, into the consequences of a system where profits can come at the expense of patient care.

    When health care follows the money, we get sicker and sicker.

    Alecia McGregor, assistant professor of health policy and politics

    “As a country, we’ve become desensitized to this notion that health care is the same as any ordinary commodity, and that the provision of health care can be run like any other business,” McGregor said. “I think this is one of the biggest lies we’ve ever been told, because we’ve seen health care costs skyrocket in a way that’s different from any of our wealthy country counterparts, yet our outcomes—life expectancy, maternal health, infant mortality—are abysmal. When health care follows the money, we get sicker and sicker.”

    “Surrendering our health care system to the for-profit marketplace was a fundamental error that we’re paying the debts of right now,” McDonough added. “But I see people working on it, reassessing the role and value of for-profits and asking what a post-neoliberal health care system might look like.”

    In the meantime, the story of Steward, now under new ownership and a new name, continues to unfold. Its physician network, made up of 5,000 doctors, was recently purchased by Rural Healthcare Group and rebranded as Revere Medical. Rural Healthcare Group is owned Kinderhook Industries, a private equity firm.

    For concerned patients, Rosenthal offered some concrete advice. “Find a provider you trust and be skeptical. Always ask about the benefits of an intervention. Because more services, more tests, more treatments are not always beneficial—but they’re always profitable.”

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  • Is Your Drinking Water Safe? This Metal In Your Supply May Pose Cancer Risk

    Is Your Drinking Water Safe? This Metal In Your Supply May Pose Cancer Risk

    With the rise in cancer diagnoses, it’s high time we pay attention to what we consume daily, including food and water. Could your drinking water be a source of exposure to carcinogenic metals? A recent study conducted in Texas found that even low levels of arsenic in water, below the regulatory threshold of 10 parts per billion, could pose health risks, including an increased risk of kidney cancer.

    In the latest study, researchers from the Texas A&M University School of Public Health investigated the link between arsenic levels in drinking water and kidney cancer rates across 240 Texas counties. Arsenic is naturally present in groundwater in Texas and other regions.

    Kidney cancer is the seventh most common cancer in the U.S. It has an age-adjusted incidence rate of 17.2 per 100,000 people from 2017 to 2021. Several factors can increase the risk, including being male, African American, or having a family history of the disease. In addition, lifestyle choices such as smoking, alcohol use, and obesity, along with health conditions like high blood pressure, diabetes, and advanced kidney disease, can elevate the risk. Studies also show that exposure to certain chemicals, such as trichloroethylene, may increase the risk of developing kidney cancer

    The latest study results suggest a dose-response relationship between arsenic in drinking water and kidney cancer, with cancer risk increasing by 4% with each doubling of arsenic levels. The researchers also noted that moderate levels (1–5 ppb) and high levels (>5 ppb) of arsenic exposure raised cancer risk by 6% and 22%, respectively.

    “Some public water systems are poorly managed and could expose customers to arsenic, but the 40 million people in the United States who rely on private wells are particularly vulnerable,” said Taehyun Roh, from the Department of Epidemiology and Biostatistics who was involved in the study.

    “This [study] suggests that even low-level arsenic exposure in drinking water may be associated with an increased risk of kidney cancer, which aligns with previous research indicating an association between this exposure and lung, bladder, and skin cancers,” Roh said.

    The researchers caution that the study establishes associations between factors but does not prove causality. They emphasize the need for future studies to assess the effects of factors such as lifestyle, family history of kidney cancer, and other potential sources of arsenic exposure. However, based on the findings, researchers call for stricter regulation and targeted public health interventions.

    “Our findings indicate that reducing arsenic exposure could reduce the incidence of kidney cancer, and this could be achieved through efforts such as enhanced regulatory oversight and targeted public health interventions,” Nishat Tasnim Hasan, a researcher involved said.

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  • Miscarrying Texas Mother Becomes Latest Woman to Die As Doctors Risk 99-Year Prison Sentence for Administering Life-Saving Drug

    Miscarrying Texas Mother Becomes Latest Woman to Die As Doctors Risk 99-Year Prison Sentence for Administering Life-Saving Drug

    A Texas mother became the third woman to die as a result of the state’s abortion ban when legislation prevented a doctor from administering life-saving care.

    In June of 2023, 35-year-old Porsha Ngumezi suffered a miscarriage at just 11 weeks pregnant, causing her to lose an immense amount of blood. Ngumezi, who already had young children, had been “passing large clots the size of grapefruit,” according to nurse’s notes obtained by ProPublica.

    “You need a D&C,” Hope Ngumezi, Porsha’s husband, was told by his mother who was a former physician. A dilation and curettage, also referred to as a D&C, is a common procedure by which a doctor removes the remaining tissue from a uterus in order to allow the uterus to close up and stop bleeding. The procedure addresses first-trimester miscarriages and abortions.

    However, the obstetrician on duty, Dr. Andrew Ryan Davis, gave Porsha misoprostol, a drug intended to help her body pass the tissue independently instead of administering life-saving care due to hospital policy.

    The drugs were not enough to stop the bleeding, and Porsha eventually passed away.

    Porsha’s death could have been easily prevented by a simple medical procedure that has become intertwined in state abortion laws because it is sometimes used to enact first-trimester abortions. Texas state law demands a prison sentence of up to 99 years for any doctor who violates legislation.

    Porsha’s death is the fifth preventable death caused by a lack of access to a D&C in the first trimester or a dilation and evacuation in the second. Three of these deaths occurred in Texas, according to ProPublica.

    Instead of administering D&Cs, doctors are giving patients misoprostol instead as the drug is often used to induce labor and treat postpartum hemorrhage, making it less directly related to abortion. However, the drug is not recommended to treat unstable patients.

    “Stigma and fear are there for D&Cs in a way that they are not for misoprostol,” said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.”

    “All Houston Methodist hospitals follow all state laws,” said a spokesperson for Houston Methodist, “including the abortion law in place in Texas.”

    Originally published by Latin Times.

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  • Cardiovascular Fitness May Lower Dementia Risk, Even For Those With Genetic Predisposition, Study Finds

    Cardiovascular Fitness May Lower Dementia Risk, Even For Those With Genetic Predisposition, Study Finds

    Regular exercise is known to prevent chronic conditions and slow cognitive decline. New research suggests that cardiovascular fitness, the body’s ability to deliver oxygen to muscles during exercise, could also play a crucial role in reducing dementia risk.

    A recent study found that improved cardiorespiratory fitness is linked to better cognitive performance and a lower risk of dementia, even among those genetically predisposed.

    As people age, cardiovascular fitness typically declines by 3% to 6% every decade in their 20s and 30s. However, this decline accelerates to over 20% per decade once individuals reach their 70s. With reduced fitness, there is an increased risk of cardiovascular events such as strokes and heart attacks and mortality from all causes, according to the researchers of the latest study.

    The study evaluated 61,214 participants between the ages of 39 and 70 enrolled in the UK Biobank study between 2009 and 2010. The participants did not have dementia and were followed for up to 12 years.

    The researchers assessed the cardiorespiratory fitness of participants at the beginning of the study by conducting a 6-minute submaximal exercise test on a stationary bike. While neuropsychological tests were used to evaluate cognitive function, the participant’s genetic predisposition for dementia was estimated using the polygenic risk score.

    During the follow-up, 553 people were diagnosed with dementia. Based on the cardiorespiratory fitness scores, the participants were divided into three equal-sized groups standardized by age and sex.

    The analysis revealed that people with higher fitness scores were 40% less likely to develop dementia than those with lower scores. Also, dementia onset was delayed by nearly 1.5 years for those with high scores.

    The researchers noted that in those with a moderate to high genetic risk of dementia, high cardiovascular fitness reduced their risk of developing dementia by 35%.

    Since the study is observational, the researchers could not establish a direct cause-and-effect relationship. They noted some limitations, including the potential underestimation of dementia cases, as UK Biobank participants are healthier than the general population. Individuals with certain health conditions were excluded from the exercise test, making the study group healthier which may have impacted the findings.

    However, based on the current findings, the researchers suggest that “enhancing CRF could be a strategy for the prevention of dementia, even among people with a high genetic predisposition for Alzheimer’s disease.”

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  • Study Finds Two Common Gynecological Disorders Linked To Increased Risk Of Early Death

    Study Finds Two Common Gynecological Disorders Linked To Increased Risk Of Early Death

    History of two common gynecological disorders, endometriosis and uterine fibroids, is linked to an increased risk of early death, a recent study revealed.

    Endometriosis is a chronic reproductive disorder that affects about 10% of women of reproductive age. It occurs when tissue similar to the uterine lining grows outside the uterus, causing symptoms such as severe period pain, chronic pelvic pain, bloating, nausea, fatigue, and infertility. There is no permanent cure for the condition, so treatment involves managing symptoms.

    Fibroids are noncancerous growths on uterine walls that can cause symptoms such as heavy menstrual bleeding, back pain, and frequent urination. Around 40% to 80% of women have uterine fibroids.

    In a large-scale study, researchers analyzed 110,091 women from the Nurses’ Health Study II, aged 25-42 in 1989. The participants had no prior hysterectomy, cardiovascular diseases, or cancer. Diagnoses of endometriosis (via laparoscopy) and fibroids (via ultrasound or hysterectomy) were self-reported every two years from 1993.

    Over 30 years, there were 4,356 premature deaths, including 1,459 from cancer and 304 from cardiovascular diseases.

    The all-cause premature death rate for women with confirmed endometriosis was 2 per 1,000 person-years, compared to 1.4 per 1,000 for those without. After accounting for factors such as age, weight, diet quality, physical activity, and smoking status, individuals with endometriosis were 31% more likely to die prematurely (before age 70) compared to those without these disorders. The majority of these deaths were attributed to gynecological cancers.

    Although uterine fibroids were not linked to all-cause premature death, the condition elevated the risk of death due to gynecological cancers.

    “Women with a history of endometriosis and uterine fibroids might have an increased long-term risk of premature mortality extending beyond their reproductive lifespan,” the researchers concluded.

    “These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women’s health,” they wrote in the study published in the journal BMJ.

    The researchers caution that since it is an observational study relying on self-reported data, it can be prone to errors. Also, as the participants were predominantly white healthcare workers, the findings may not be generalizable to other populations.

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  • Less Sugar In First 1000 Days Of Life Slashes Diabetes, Hypertension Risk: Study

    Less Sugar In First 1000 Days Of Life Slashes Diabetes, Hypertension Risk: Study

    Healthy eating with minimal sugar is essential for long-term health and lowering the risk of chronic conditions. A recent study suggests these efforts should begin as early as conception. Researchers found that limiting sugar intake during the first 1000 days of life, from pregnancy through a child’s second birthday, could dramatically reduce their risk of diabetes and hypertension.

    The study revealed that less sugar intake during the critical period of early life could cut the diabetes risk by 35% and the risk of hypertension by 20%.

    The researchers came up with these interesting findings by evaluating the long-term health impact of sugar rationing that occurred during World War II. They used recent data from the U.K. Biobank, which includes medical histories and genetic and lifestyle factors, to examine how early-life sugar restrictions impacted adult health in those conceived just before and after wartime sugar rationing ended.

    “Using an event study design with UK Biobank data comparing adults conceived just before or after rationing ended, we found that early-life rationing reduced diabetes and hypertension risk by about 35% and 20%, respectively, and delayed disease onset by 4 and 2 years,” the researchers wrote in the study published in the journal Science.

    The researchers noted that the chronic health risks were significantly reduced when expectant mothers limited their sugar intake during pregnancy. However, the benefits increased even more when children continued to be on a sugar restriction after birth, averaging no more than 8 teaspoons (40 grams) per day.

    The end of wartime rationing offered a unique window for a natural experiment when sugar intake surged sharply, while other foods remained unchanged. Individuals’ early-life sugar exposure varied depending on whether they were conceived or born before or after September 1953. While those conceived just before experienced sugar-scarce conditions, those born just after entered a more sugar-rich environment.

    “Studying the long-term effects of added sugar on health is challenging. It is hard to find situations where people are randomly exposed to different nutritional environments early in life and follow them for 50 to 60 years. The end of rationing provided us with a novel natural experiment to overcome these problems,” study corresponding author Tadeja Gracner said in a news release.

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  • Behavioral Therapy For Insomnia May Lower Risk Of Postpartum Depression: Study

    Behavioral Therapy For Insomnia May Lower Risk Of Postpartum Depression: Study

    Good sleep is essential for mental well-being of every human being. While it is difficult to ensure good sleep during pregnancy, getting behavioral therapy for insomnia could not only solve sleep issues, but could even reduce the risk of postpartum depression, a recent study has revealed.

    Postpartum depression is a mental health condition that affects around 10% of women after giving birth. The symptoms include severe mood disorder, constant fatigue, difficulty sleeping at night with daytime drowsiness, difficulty caring for oneself or the baby, withdrawal from social contact, trouble concentrating and making decisions, and distressing thoughts, such as fears of harming the baby.

    The patients are recommended to get sleep, rest, and exercise, and seek therapy or medications for relief, depending on the severity of the symptoms.

    According to the latest study published in the Journal Of Affective Disorders, getting cognitive behavioral therapy for insomnia (CBTi) may serve as a protective factor against postpartum depression.

    “Early intervention is crucial for infant and parental mental health. Our research explores how addressing sleep problems like insomnia can lead to better mental health outcomes for families, helping parents and their children thrive,” said Dr. Elizabeth Keys, the study’s co-author, in a news release.

    The therapy starts by identifying a patient’s thoughts, behaviors, and sleep patterns that contribute to insomnia. Misconceptions or habits disrupting sleep are then challenged and reframed to enhance sleep quality.

    “CBTi is the gold standard for the treatment of insomnia and has consistently been shown to improve symptoms of depression. Its treatment effects are similar to antidepressant medications among adults, but with fewer side effects, and is therefore often preferred by pregnant individuals,” said Dr. Keys.

    During the trial, researchers evaluated 62 women with insomnia, who underwent a five-week CBT-I intervention specifically adapted for pregnancy. The participants’ insomnia and depression symptoms were tested before the intervention, immediately after, and again six months postpartum.

    The results revealed that there was a significant improvement in sleep among the participants and reduced depressive symptoms six months after postpartum.

    “These are enormously encouraging results for anyone who has struggled in those early weeks and months with their newborns. Our study adds to the growing evidence that treating insomnia during pregnancy is beneficial for various outcomes. It’s time to explore how we can make this treatment more accessible to pregnant individuals across the country to improve sleep health equity,” Dr. Keys added.

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  • Diabetes Onset Before 40 Raises Risk Of Death To Four Times: Study

    Diabetes Onset Before 40 Raises Risk Of Death To Four Times: Study

    Diabetes is not just about having high blood sugar levels; it is a chronic condition that could potentially lead to several health issues, such as heart attack and stroke. But does the timing of diabetes onset affect the risk of complications and mortality? A recent study revealed that developing diabetes before age 40 is linked to a significantly higher risk of early death.

    While diagnosing diabetes before 40 quadrupled the risk of early death, later onset was linked to a one-and-a-half times higher risk of death compared with the general population without the condition, according to the study published in the Lancet Diabetes & Endocrinology. The findings underscore the importance of delaying the onset of diabetes to reduce complications and risk of premature death.

    To understand the impact of diabetes on overall health, researchers followed up 4,550 individuals newly diagnosed with diabetes for over 30 years. The participants were between the ages of 25 and 65.

    The analysis revealed that diabetic diagnosis at an earlier stage was linked to a higher rate of related complications, particularly microvascular diseases such as eye damage and kidney failure, and a higher risk of death. Diabetes onset at a younger age also was linked to poorer blood sugar control.

    “Over the past 30 years, the number of young adults diagnosed with type 2 diabetes has increased markedly worldwide. Evidence to date suggests that younger-onset type 2 diabetes, characterized by earlier and longer exposure to high levels of blood glucose, maybe more aggressive than later onset disease. This might include a faster deterioration in β-cell function—the cells in the pancreas that produce and release insulin- and a greater risk of complications such as cardiovascular and kidney disease,” said Amanda Adler, co-author of the study in a news release.

    According to the lead author of the study, Dr. Beryl Lin, more clinical trials should focus on tailored treatments for delaying diabetic complications in young people.

    “We particularly need to understand why young adults with type 2 diabetes suffer greater risks of complications, and how we can identify and help this vulnerable group of people who have to live with diabetes for the rest of their lives,” Dr. Lin said.

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  • History Of Eating Disorders, Pre-Pregnancy Obesity Raises Offspring’s Risk Of Mental Health Diagnosis

    History Of Eating Disorders, Pre-Pregnancy Obesity Raises Offspring’s Risk Of Mental Health Diagnosis

    Children whose mothers have a history of eating disorders and obesity before pregnancy are at a greater risk of mental health diagnosis, a recent study revealed.

    The results of the latest study involving a Finnish population of nearly 400,000 mothers and around 650,000 offspring revealed significant links between maternal health and the mental well-being of their children.

    The research suggests associations between a mother’s history of eating disorders and pre-pregnancy body mass index (BMI) higher than the normal weight range to most of the nine psychiatric diagnoses examined in the offspring.

    The psychiatric diagnoses involved in the study include mood and anxiety disorders, sleep disorders, intellectual disabilities, specific developmental disorders, autism spectrum disorder (ASD), ADHD, conduct disorders, social functioning and tic disorders (like selective mutism and Tourette syndrome), as well as feeding disorders in infancy and childhood.

    The results showed that around 53% had pre-pregnancy overweight or obesity, nearly 6% had underweight, and 1.6% had a history of an eating disorder.

    When comparing differences in the impact of maternal eating disorders and higher BMI on children’s mental health diagnoses, the study found generally stronger associations with maternal eating disorders than those linked to maternal BMI.

    “The largest effect sizes were observed for maternal eating disorders not otherwise specified in association with offspring sleep disorders and social functioning and tic disorders, while for maternal severe pre-pregnancy obesity, offspring intellectual disabilities had the largest effect size,” the researchers wrote in the study published in Jama Network.

    Eating disorders not otherwise specified (EDNOS) refer to a category of eating disorders that do not fit the specific criteria for more commonly recognized disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder. Some examples of EDNOS include behaviors such as pica, which involves cravings for and consumption of non-food items, or night eating syndrome, characterized by binge eating during the evening hours.

    “The study confirms previously published associations between maternal eating disorders and BMI and offspring psychiatric disorder, but also reports new associations,” Ida Nilsson, a study author told MedPage Today.

    “The findings underline the importance of considering maternal eating disorders and BMI in maternity care, aiming to reduce the number of offspring with neurodevelopmental and psychiatric disorders. The findings also strengthen the importance of the nutrition of pregnant women,” Nilsson said.

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  • Vitamin D Deficiency In Kids Raises Risk Of Auto-Immune Disorders: Study Explains How

    Vitamin D Deficiency In Kids Raises Risk Of Auto-Immune Disorders: Study Explains How

    Ensure your child is getting adequate sunshine vitamins. Beyond the role of calcium absorption and bone strengthening, researchers have discovered more about its connection to the immune system. A recent study revealed how a deficiency of vitamin D in young children can raise the risk of developing autoimmune disorders.

    According to the latest study published in the journal Science Advances, the deficiency of vitamin D in kids is linked to premature aging of the thymus gland. The thymus is a small lymph gland that makes and trains T-cells that are crucial for the immune system, defending the body against infections and diseases. While most of these vital cells are produced before birth, the remainder are generated during childhood, and by puberty, individuals would have developed the complete T cells for their lifetime.

    “An aging thymus leads to a ‘leaky’ immune system. This means the thymus becomes less effective at filtering out immune cells that could mistakenly attack healthy tissues, increasing the risk of autoimmune diseases like type 1 diabetes,” said the lead author of the study John White in a news release.

    Studies have shown that vitamin D is essential for immunity but according to White, the recent study findings “bring new clarity to this connection and could lead to new strategies for preventing autoimmune diseases.”

    During the trial, researchers examined mice that could not produce vitamin D to assess how this deficiency affected their thymus glands. They then conducted cell analyses and gene sequencing to understand the impact of vitamin D deficiency on the immune system. The researchers expect similar findings in humans as the thymus functions similarly in both species.

    Based on the study findings, researchers suggest that young children should get adequate vitamin D, either through natural sources such as fortified food and sunlight or through supplementation.

    “If you have a young child, it’s important to consult with your healthcare provider to ensure they’re getting enough,” said White.

    Earlier research conducted by the same team in 2021, which followed up more than 10,000 children showed that early vitamin D supplementation can reduce the risk of developing type 1 diabetes by up to five-fold.

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