Unwinding pandemic-era social programs: Effects on healthcare outcomes and disparities

放松大流行时代的社会计划：对医疗保健结果和差异的影响

• 批准号: 10835335
• 负责人: Rajan Anthony Sonik
• 金额: $ 233.2万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835335
• 关键词: Affect; COVID-19; Caring; Clinical; Complement; Coronavirus; Data; Disabled Persons; Disease Management; Disparity; Economic Conditions; Economics; Eligibility Determination; Ethnic Origin; Event; Expenditure; Family; Food; Goals; Growth; Health Insurance; Health Services Accessibility; Health system; Health trends; Healthcare; Healthcare Systems; Housing; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Learning; Link; Machine Learning; Massachusetts; Measures; Medicaid; Medical; Methods; Modeling; Natural experiment; Outcome; Pattern; Policies; Politics; Population; Preventive; Primary Care; Public Health; Race; Records; Reduce health disparities; Registries; Research; Social Policies; Social Welfare; Speed; Strategic Planning; Techniques; United States National Institutes of Health; Variant; Vulnerable Populations; Work; care outcomes; cooking; disability; disorder prevention; ethnic minority; experience; expiration; flexibility; food insecurity; health care disparity; health determinants; health disparity; health disparity populations; insight; minority health; minority health disparity; nutrition; pandemic disease; programs; racial minority; response; secondary analysis; social

Project Summary/Abstract This project will study the effects of the expiration of Families First Coronavirus Response Act (FFCRA) increases to Supplemental Nutrition Assistance Program (SNAP) benefit levels on healthcare outcomes and disparities by disability, race, and ethnicity. These groups experience disparities in disease prevention and management, unfavorable clinical events, and care expenditures, each of which are associated with food insecurity. Existing studies have found SNAP to reduce food insecurity and suggest SNAP may reduce unfavorable healthcare outcomes, especially for vulnerable groups, but these studies suffered key causal inference limitations and have focused on SNAP changes substantially different from the FFCRA unwinding. Meanwhile, state-level variation in approaches to unwinding the FFCRA SNAP increases (e.g., timing ranging from April 2021 to March 2023), individual-level variation in the size of benefit losses (ranging from $95 per month to over $1,000 per month), and a Massachusetts (MA) policy that broke the state’s SNAP rollbacks into two uneven steps all create natural experiments we can use to identify the causal impacts of SNAP. Further, we will use robust policy tracking to identify and adjust for non-SNAP policy unwinding patterns, and we will leverage both national T-MSIS Medicaid data and uniquely detailed linked data from MA. Ultimately, the MA and US analyses will complement each other and provide high internal and external validity. Specifically, we will create a registry of policies related to the unwinding of food, housing, and Medicaid access and then develop parsimonious sets of policy unwinding patterns to identify adjusters for later analyses (we will similarly attend to other healthcare, public health, and economic conditions) (Aim 1). We will then estimate the effects of SNAP unwinding on Medicaid event rates (preventive use, unfavorable event rates, and expenditures; Aim 2), and we will finally estimate the effects of SNAP unwinding on disparities in these event rates by disability, race, and ethnicity (Aim 3). For Aims 2 and 3 (2020-2026), we will measure differences in the levels and trends of healthcare outcomes and disparities before and after unwinding-related changes using a multilevel approach to growth curve modeling that is flexible and robust to many validity threats (while also utilizing eligible non-participants with past SNAP applications as a comparator with no unwinding exposure). Current policy proposals would reduce SNAP access, but there is little data to shed light on how such reductions may affect healthcare outcomes and disparities. Our study will reduce this critical knowledge gap. Studying the ongoing SNAP unwinding will extend past work that has focused on SNAP increases and/or changes uniform in their size and timing, and learnings from this project will also advance the NIH Minority Health and Health Disparities Strategic Plan’s Goal 3 to assess “interventions to reduce health disparities.”

项目摘要/摘要 该项目将研究家庭第一冠状病毒反应法案（FFCRA）的影响 增加了补充营养援助计划（SNAP）在医疗保健结果和 残疾，种族和种族的差异。这些群体在预防疾病和 管理，不利的临床事件和护理支出，每种都与食物有关 不安全感。现有的研究发现了减少粮食不安全的快照，并建议快照可以减少 不利的医疗保健结果，尤其是对于弱势群体，但是这些研究遭受了关键因果关系 推理局限性，并集中在与FFCRA放松的大不相同的快照变化上。 同时，放松FFCRA快照的方法的状态级别差异增加了（例如，时间安排 从2021年4月到2023年3月），福利损失规模的个人级别差异（从$ 95不等） 每月至每月超过1,000美元）和马萨诸塞州（马萨诸塞州）的政策，打破了该州的快照回滚 分为两个不平衡的步骤，所有的自然实验都可以用来识别SNAP的因果影响。 此外，我们将使用强大的策略跟踪来识别和调整非SNAP策略放松模式，以及 我们将利用国家T-MSIS医疗补助数据和MA的独特详细链接数据。最终， MA和美国的分析将相互补充，并提供高内部和外部有效性。 具体而言，我们将创建与食品，住房和医疗补助的政策注册表 访问然后开发简约的策略放松模式集，以识别调节器以供以后分析 （我们将同样地参加其他医疗保健，公共卫生和经济状况）（AIM 1）。然后我们会 估计SNAP放松对医疗补助事件率的影响（预防性使用，不利的事件率和 支出；目标2），我们最终将估计捕捉对这些事件差异的影响 残疾，种族和种族的比率（AIM 3）。对于目标2和3（2020-2026），我们将衡量 医疗保健结果和差异的水平和趋势，并在与之相关的变化之前和之后使用 一种多层次的增长曲线建模方法，对许多有效性威胁具有灵活性和鲁棒性（同时也是 使用符合条件的非参与者将过去的快照应用作为比较器，没有放松的暴露）。 当前的政策提案将减少SNAP访问权限，但几乎没有数据可以阐明如何这样 减少可能会影响医疗保健结果和差异。我们的研究将减少这种关键的知识差距。 研究正在进行的快照将扩展过去的工作，该工作集中在捕捉增加和/或 改变其规模和时机的变化统一，并从该项目中学习也将推动NIH少数民族 健康与健康差异战略计划的目标3评估“干预措施以减少健康差异”。