Effects of Medicaid expansions on infant health among Native Americans

医疗补助扩大对美洲原住民婴儿健康的影响

基本信息

批准号：
10191658
负责人：
PINKA CHATTERJI
金额：
$ 7.73万
依托单位：
STATE UNIVERSITY OF NEW YORK AT ALBANY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10191658
关键词：
37 weeks gestation Adopted Adult Affordable Care Act American Apgar Score Area Birth Birth Certificates Birth Weight Caring Censuses Chronic Disease Communities Community Surveys County Depressed mood Distal Economic Conditions Economics Eligibility Determination Ethnic Origin Ethnic group Face Female of child bearing age Fetal Development Fetal Growth Future Generations Geographic Locations Gestational Age Goals Health Health Insurance Health Policy Health Service Area Health Services Accessibility Healthcare Heterogeneity Income Indian reservation Infant Infant Health Insurance Insurance Coverage Life Life Cycle Stages Link Location Low Birth Weight Infant Low income Maternal Health Measures Medicaid Medicaid eligibility Mothers Native Americans Not Hispanic or Latino Outcome Personal Satisfaction Plant Roots Policies Population Poverty Preconception Care Pregnancy Pregnant Women Premature Birth Prenatal care Race Resources Risk Behaviors Risk Factors Shapes Smoking Source Structural Racism Structure System Testing Time Translating Trauma Unemployment United States Indian Health Service Urban Health Services Weight Gain Woman Work economic outcome health economics improved nonmetropolitan area pregnancy health prenatal racial and ethnic rural healthcare sociodemographics trend

项目摘要

The effects of Medicaid expansions on Native American (NA) birth outcomes are understudied. Since the early 1980's, there have been two periods of notable expansions in Medicaid eligibility criteria that have been adopted by different states at varying times. In the late 1980s and 1990s, states increased Medicaid income thresholds for pregnant women to varying degrees. In 2014 and later, under the Affordable Care Act, many states expanded Medicaid thresholds for low- income adults. While the first period primarily may have increased pregnant women's access to prenatal care, the later period of expansion potentially has further increased women's access to pre-conception care. NA mothers have elevated rates of low birth weight (<2,500 gm), preterm birth (gestation < 37 weeks), and macrosomia (birth weight > 4,500 gm). These disparities, reflecting elevated rates of poverty and chronic disease in NA communities, are rooted in systems of structural racism and historical trauma. Medicaid is an important source of health insurance for NAs, covering 67% of NA births as of 2018. As such, Medicaid expansions have the potential to substantially improve NA maternal and infant health. However, NA women also may face barriers to accessing care and to having that care translate into improved infant health. In particular, heterogeneity in communities' economic and health care resources, as well as proximity to Indian Health Services, may influence how Medicaid impacts NA birth outcomes. The proposed work draws on national-level microdata from U.S. birth certificates and employs multiple measures of birth outcomes (i.e., birthweight, gestational age, fetal growth rates, and APGAR scores), capturing distinct aspects of fetal development and infant health. The American Community Survey is also used to assess trends in insurance coverage. Identifying plausibly exogenous Medicaid expansions in two periods (1989-1997 and 2010-2018), this project aims to: (1) Estimate the effects of Medicaid expansions on birth outcomes among NA mothers, testing whether effects differ for NA mothers relative to mothers from other racial- ethnic groups; (2) Evaluate whether Medicaid has differing impacts on infant health depending on the attributes of the counties in which mothers reside; and; (3) Estimate the effects of Medicaid on plausible mechanisms linked to birth outcomes, specifically, insurance coverage, prenatal care, smoking and weight gain during pregnancy, and maternal health risk factors during pregnancy. As health at birth shapes wellbeing and economic outcomes across the life course, a deeper understanding of how Medicaid influences NA maternal and infant health is likely critical to longer-term goals of improving health and economic conditions for future generations of NAs.

医疗补助扩张对美洲原住民（NA）出生结果的影响进行了研究。自1980年代初以来，医疗补助资格有两个显着扩张的时期不同国家在不同时期采用的标准。在1980年代后期和1990年代，各州在不同程度上增加了孕妇的医疗补助收入阈值。 2014年后来，根据《平价医疗法案》，许多州扩大了医疗补助阈值收入成年人。虽然第一阶段可能主要增加了孕妇的机会产前护理，后来的扩张时期可能进一步增加了妇女的机会概念前护理。 NA母亲的低出生体重（<2500 gm），早产率升高出生（妊娠<37周）和巨糖症（出生体重> 4,500克）。这些差异，反映NA社区中贫困和慢性病的率升高，植根于结构性种族主义和历史创伤系统。医疗补助是健康的重要来源 NAS的保险，覆盖2018年的NA出生67％。因此，医疗补助的扩张已有可以实质上改善NA孕产妇和婴儿健康的潜力。但是，NA女性也可能会面临障碍的障碍，并接受该护理转化为改善的婴儿健康。特别是，社区经济和医疗保健资源的异质性由于靠近印度卫生服务，可能会影响医疗补助如何影响NA的出生结果。拟议的工作借鉴了美国出生证明的国家级微型数据，并雇用多种出生结果的度量（即出生体重，胎龄，胎儿生长率和 Apgar分数），捕获胎儿发育和婴儿健康的不同方面。这美国社区调查还用于评估保险范围的趋势。识别在两个时期（1989-1997和2010-2018）中有合理的外源医疗补助扩张，这项目的目的是：（1）估计医疗补助扩张对NA的出生结果的影响母亲，测试NA母亲相对于其他种族的母亲的影响是否有所不同种族群体；（2）评估医疗补助是否对婴儿健康有不同的影响关于母亲居住的县的属性；和; （3）估计有关与出生结果有关的合理机制的医疗补助，特别是保险范围，怀孕期间的产前护理，吸烟和体重增加以及孕产妇的健康风险因素怀孕期间。随着出生的健康状况和一生的经济成果当然，对医疗补助如何影响NA孕产妇和婴儿的健康有更深入的了解对于改善未来健康和经济状况的长期目标可能至关重要几代Nas。