Access to Healthcare as a Driver of Place-Based Inequality in Mid-Life Mortality: Evidence from Movers in Medicaid

获得医疗保健是中年死亡率地区不平等的一个驱动因素：来自医疗补助推动者的证据

基本信息

批准号：
10583235
负责人：
Jacob Witt Samuel Wallace
金额：
$ 49.94万
依托单位：
YALE UNIVERSITY
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：
2023-09-15 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10583235
关键词：
Address Adoption Adult American Area California Caring Characteristics Climate Clinical Communities Complex Consensus Country County Data Set Destinations Disparity Economics Effectiveness Ethnic Origin Evidence based treatment Family Gender Geography Goals Grant Health Health Insurance Health Services Health Services Accessibility Healthcare Improve Access Individual Inequality Inequity Institution Insurance Coverage Interdisciplinary Health Team Intervention Life Expectancy Literature Living Costs Longevity Low Income Population Low income Medicaid Medicare Mental Health Services Mental disorders Methodology National Institute of Mental Health Neighborhoods Outcome Persons Pharmaceutical Preparations Policies Population Positioning Attribute Public Health Public Policy Quasi-experiment Race Research Research Design Research Personnel Role Shapes Social Gradients Sorting Source Substance Use Disorder Suicide System Time United States United States National Institutes of Health Vermont Woman alcohol-related death behavioral health design evidence base geographic difference health care availability health care delivery health care disparity health care service health care service utilization health difference health disparity health disparity populations health equity health inequalities improved innovation men middle age migration mortality novel policy implication population health programs sociodemographic group sociodemographics

项目摘要

PROJECT SUMMARY It is well-documented that where you reside in America shapes when you die, and this has been shown to be particularly true among low-income Americans. These place-based inequalities in health have grown over time in the United States, driven by increased mid-life mortality due to drug- and alcohol-related deaths and suicides. While the drivers of this rise in mid-life mortality are complex and multifactorial, there is broad consensus that the adoption of evidence-based treatments for substance use disorder and mental illness has the potential to improve health and save lives. Despite their effectiveness, behavioral health services are generally thought to be underused, with very limited access to these services in some regions of the country. We study the drivers of place-based inequities in the Medicaid program, the primary source of insurance coverage and payer of behavioral health services for low-income populations. This application seeks to understand whether and to what extent place-based inequalities in mid-life mortality — and their gradients by gender and race/ethnicity — are driven by the causal effects of place on access to evidence-based behavioral healthcare treatment by studying the low-income population on Medicaid. Because families sort into areas based on a wide range of factors — e.g., economic opportunity, amenities, cost-of-living, etc. — if people predisposed to poor (or good) health outcomes tend to cluster in particular localities then observed health differences between areas may reflect this non-random sorting (or “selection”) rather than the causal effects of place. To address this challenge, we use a quasi-experimental movers research design that follows otherwise similar Medicaid enrollees residing in the same place that move to different destinations. Subsequent differences in their healthcare utilization and health can be attributed to place effects if movers are observed for a period of time before the move to adjust for baseline outcomes. Second, to better under social gradients we stratify by sociodemographic characteristics and recover the effects of places for distinct groups —comparing differences in the impacts of a place on different groups reveals whether it tends to narrow or widen inequalities. Finally, we examine whether place-based effects correlated with immutable characteristics of areas (e.g., climate) or features that are more readily amenable to policy intervention (e.g., the healthcare delivery system). We make an original contribution, by advancing the understanding of the relationship between “place” and health for low-income populations, with a focus on understanding the role of differential access to high-quality, behavioral healthcare services.

项目概要有据可查的是，你在美国居住的地方会影响你去世时的情况，这已被证明是在低收入美国人中尤其如此，这些基于地点的健康不平等随着时间的推移而加剧。在美国，由于与毒品和酒精相关的死亡和自杀导致中年死亡率增加。虽然中年死亡率上升的驱动因素是复杂且多因素的，但人们普遍认为采用循证治疗药物滥用障碍和精神疾病有可能尽管行为健康服务有效，但人们普遍认为可以改善健康并拯救生命。未得到充分利用，在该国某些地区获得这些服务的机会非常有限。我们研究了这些服务的驱动因素。医疗补助计划中基于地方的不平等，医疗补助计划是保险承保的主要来源和付款人该应用程序旨在了解是否为低收入人群提供行为健康服务以及提供什么服务。中年死亡率的地域不平等程度及其按性别和种族/民族划分的梯度通过研究，由地点对获得循证行为医疗保健治疗的因果影响驱动因为家庭根据多种因素对地区进行分类—— 例如，经济机会、便利设施、生活成本等——如果人们倾向于健康状况不佳（或良好）结果往往集中在特定地区，然后观察到的地区之间的健康差异可能反映了这一点非随机排序（或“选择”）而不是位置的因果效应为了应对这一挑战，我们使用了准实验推动者研究设计遵循居住在其他类似医疗补助计划的参与者搬到不同目的地后，他们的医疗保健利用率和健康状况存在差异。如果在搬家之前观察搬家者一段时间以进行调整，则可以归因于地点效应其次，为了更好地根据社会人口特征和社会梯度进行分层。恢复地点对不同群体的影响——比较一个地点对不同群体的影响差异最后，我们研究了基于地点的影响是否会缩小或扩大。与区域的不变特征（例如气候）或更容易适应的特征相关我们通过推进政策干预（例如医疗保健服务系统）做出原创贡献。了解低收入人群的“地点”与健康之间的关系，重点是了解获得高质量行为医疗保健服务的差异化的作用。