The impact of Medicaid expansion on the rural mortality penalty in the United States

医疗补助扩大对美国农村死亡率的影响

基本信息

批准号：
10726695
负责人：
Alexis R Santos-Lozada
金额：
$ 44.3万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-30 至 2025-09-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10726695
关键词：
Address Adopted Adoption Adult Age Aging Alcohol consumption Area COVID-19 COVID-19 mortality COVID-19 pandemic COVID-19 pandemic effects Cardiovascular system Categories Censuses Cessation of life Code County Data Death Records Demography Development Differential Mortality Disparity District of Columbia Elderly Eligibility Determination Ethnic Origin Exhibits Exploratory/Developmental Grant Geography Goals Health Insurance Health Policy Health Status Healthcare Income Insurance Coverage Link Longevity Low income Mathematics Measures Medicaid Mental Health Metabolic Methodology Methods Mortality Decline National Institute on Aging Outcome Pattern Persons Policies Population Principal Investigator Privacy Process Race Records Reduce health disparities Research Research Design Role Rural Scientist Shapes Standardization Statistical Models Techniques Testing Training United States United States National Center for Health Statistics Urbanization Variant Vital Statistics Work access restrictions aged deprivation design disability expectation experience federal policy health care availability innovation insight interest mortality mortality disparity mortality statistics novel population health residence rural area rural counties sex sex disparity socioeconomics trend urban area urban disparity

项目摘要

Project Summary Rural areas in the United States (U.S.) have exhibited higher mortality rates than urban areas since the late 1990s, a pattern known as the rural mortality penalty. Recent research has found that the rural mortality penalty continues growing due to mortality associated with preventable causes (metabolic and cardiovascular causes, alcohol use, and mental health). The expansion of Medicaid adopted by many states in the U.S. had the potential to reduce death due to these and other causes by facilitating access to healthcare to people who were not eligible under previous eligibility thresholds. While some state in the nation adopted this expansion, a process that started in 2014, others rejected it. While the adoption/rejection of this expansion is well-documented, little is known about the role the adoption of this policy at the state level impacted well-established demographic phenomenon such as the rural mortality penalty. This project requests access to restricted data to produce mortality rates for the population aged 19-64, by sex and by race/ethnicity to conduct a novel analysis of the differences observed in the rural mortality penalty employing a difference-in-difference design. The project evaluate whether the Medicaid expansion impacted the rural mortality penalty emphasizing the overall population, and disparities by sex and race/ethnicity. The project will also be the first to explore whether the COVID-19 pandemic impacted rural/urban mortality dynamics based on state-level adoption of the expansion of Medicaid by 2020. The analytic approach will combine formal and mathematical demographic methods with novel statistical models to evaluate the impact of the expansion of Medicaid in rural/urban mortality dynamics. Findings from this project will illustrate the role that state-level policies have in shaping diverging or congruent trajectories in mortality and in the face of the ongoing COVID-19 pandemic.

项目摘要自1990年代后期以来，美国的农村地区（美国）的死亡率比城市地区高，模式称为农村死亡率处罚。最近的研究发现，农村死亡率持续增长由于死亡率与可预防的原因有关（代谢和心血管原因，饮酒和心理健康）。美国许多州采用的医疗补助的扩大有可能减少由于这些和其他国家而导致的死亡通过促进在以前的资格阈值下不符合资格的人获得医疗保健的原因。尽管美国一些州采用了这一扩展，该过程始于2014年，另一些则拒绝了这一扩展。而对这一扩展的采用/拒绝是有据可查的，对在该政策中采用该政策的作用知之甚少州一级影响了公认的人口现象，例如农村死亡率惩罚。该项目请求访问受限制的数据，以通过性别和种族/种族进行19-64岁的人口产生死亡率对使用差异差异设计的农村死亡率惩罚中观察到的差异的新分析。这项目评估医疗补助的扩张是否影响着强调整体人口的农村死亡率罚款，性别和种族/种族的差异。该项目还将是第一个探索Covid-19的大流行的项目基于国家一级采用医疗补助到2020年的扩张，影响了农村/城市死亡率的动态。分析方法将将形式和数学人口统计学方法与新颖的统计模型相结合以评估医疗补助在农村/城市死亡率动态中扩张的影响。该项目的发现将说明国家一级政策在塑造死亡率的分歧或一致轨迹中所具有的作用 2019冠状病毒病大流行。