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Educational Attainment, Geography, and U.S. Adult Mortality Risk

教育程度、地理和美国成人死亡率风险

基本信息

批准号：
10200308
负责人：
Jennifer Karas Montez
金额：
$ 23.41万
依托单位：
SYRACUSE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10200308
关键词：
Address Adult Affect Affordable Care Act Age Area Behavior Birth Birth Certificates Centers for Disease Control and Prevention (U.S.)Childbirth Clinical Comprehensive Health Insurances Conceptions Country Data Developed Countries Eligibility Determination First Births Geography Goals Guidelines Health Health Insurance Healthcare Hospitals Income Infant Mortality Insurance Insurance Coverage Knowledge Laws Low income Maternal Age Maternal Health Maternal Mortality Measures Medicaid Medicaid eligibility Methods Morbidity - disease rate Mothers Outcome Policies Population Postpartum Period Poverty Pregnancy Pregnancy Complications Pregnancy Outcome Pregnant Women Records Reporting Research Risk Risk Factors Role Source Structure Testing Time Uninsured Variant Vision Vital Statistics Woman Women&apos s Health Work advanced maternal age adverse maternal outcomes adverse outcome aged base design experience federal poverty level health care delivery improved insurance plan interest low socioeconomic status maternal morbidity maternal risk middle age mortality risk population health pregnancy related death programs severe maternal morbidity teenage mother trend

项目摘要

PROJECT SUMMARY Rising rates of maternal mortality and severe maternal morbidity highlight an unmet need for continuous and comprehensive health insurance coverage for women long before pregnancy and well after childbirth. Advanced maternal age (≥35 years old) and low socioeconomic status are important risk factors for severe maternal morbidity, making it particularly important that low- income, older mothers have continuous health insurance coverage. In 2014 and later, under the Affordable Care Act (ACA), 37 states and DC (as of 2020) expanded Medicaid thresholds to include low-income adults. Although not targeted at mothers, ACA Medicaid expansions may have improved the continuity of Medicaid coverage from the pre-conception through the post- partum period by expanding eligibility to all adults (including childless adults) with incomes below 138% of the Federal Poverty Level. In this proposed study, we examine whether ACA Medicaid expansions are associated with maternal health outcomes and behaviors among women ages 18-49, with a focus on older mothers (≥35 yr.). We use difference-in-difference methods and data from Vital Statistics birth certificate records from 2010-2018. To measure states’ Medicaid expansion status, we create an indicator of whether the mother lived in a state that expanded Medicaid in the year prior to the child’s birth. To capture potential age-specific variation, we also create simulated measures of Medicaid eligibility by maternal age, state, and year. The findings from this work are intended to provide policy-relevant, timely information on the potential role of the ACA Medicaid expansions in improving health among older mothers.

项目概要孕产妇死亡率和严重孕产妇发病率的上升凸显了对医疗保健的需求未得到满足早在怀孕前就为女性提供持续和全面的健康保险以及分娩后的良好情况。高龄产妇（≥35岁）和低社会经济地位是严重孕产妇发病的重要危险因素，因此低孕产妇发病率尤为重要收入，高龄母亲有持续的医疗保险。 2014年及以后，在《平价医疗法案》(ACA)、37 个州和华盛顿特区（截至 2020 年）将医疗补助门槛扩大到包括低收入成年人。虽然 ACA 医疗补助计划的扩展不是针对母亲，但可能会改善了从怀孕前到怀孕后医疗补助覆盖的连续性将资格扩大到所有有收入的成年人（包括无子女的成年人）低于联邦贫困线的 138%。在这项拟议的研究中，我们检查 ACA 是否医疗补助的扩大与孕产妇健康结果和行为有关 18-49 岁的女性，重点是高龄母亲（≥35 岁）。我们使用双重差分法 2010-2018 年人口动态统计出生证明记录的方法和数据。测量州的医疗补助扩展状态，我们创建了一个指标来衡量母亲是否居住在某个州在孩子出生前一年扩大了医疗补助范围。捕捉潜在的特定年龄变化，我们还根据母亲的年龄、州和州创建了医疗补助资格的模拟衡量标准年。这项工作的结果旨在提供与政策相关的及时信息 ACA 医疗补助扩展在改善老年母亲健康方面的潜在作用。