Effects of the Supplemental Nutrition Assistance Program on racial/ethnic and disability-based healthcare disparities

补充营养援助计划对种族/族裔和基于残疾的医疗保健差异的影响

• 批准号: 10533748
• 负责人: Rajan Anthony Sonik
• 金额: $ 12.66万
• 依托单位: ALTAMED HEALTH SERVICES CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-13 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10533748
• 关键词: Accounting; Acute; Address; Affect; Area; Blood Glucose; Budgets; Caring; Chronic; Clinical; Data; Disabled Persons; Disease Management; Disparity; Economics; Eligibility Determination; Emergency Care; Emergency department visit; Ethnic Origin; Evaluation; Event; Expenditure; Face; Food; Goals; Growth; Health; Health Expenditures; Health Status; Health trends; Hospitalization; Housing; Individual; Institute of Medicine (U.S.); Link; Literature; Massachusetts; Measures; Medicaid; Medical; Methodology; Methods; Minority; Modeling; Natural experiment; Outcome; Outpatients; Persons; Pharmaceutical Preparations; Policies; Population; Population Programs; Prevention; Preventive; Preventive healthcare; Public Health; Race; Research Support; Resources; Secure; Statutes and Laws; Strategic Planning; System; United States; United States National Institutes of Health; Visit; Work; accountable care organization; care outcomes; compliance behavior; cooking; disability; disorder prevention; ethnic minority; experience; food insecurity; health care disparity; health care service utilization; health data; health definition; health determinants; health disparity; improved; inpatient service; medication compliance; model building; nutrition; operation; programs; racial minority; racial minority population; safety net; social; socioeconomics; trend

Project Summary/Abstract This project will examine the impact of losing Supplemental Nutrition Assistance Program (SNAP) benefits on healthcare outcomes and healthcare disparities based on race/ethnicity and disability. Racial/ethnic minorities and people with disabilities experience healthcare disparities in the areas of disease prevention and management, unfavorable clinical events, and acute healthcare expenditures. Food insecurity may affect these disparities: food insecure individuals forgo needed care and medications more often, use emergency and inpatient care more often, and require higher expenditures than food secure individuals. Meanwhile, racial/ethnic minorities and people with disabilities are 2.2 and 2.8 times as likely to be food insecure as non- minorities and people without disabilities, respectively, face starker tradeoffs between food and resources such as housing, and have greater sensitivity to food insecurity given greater economic and health vulnerabilities. SNAP has been shown to reduce food insecurity and is disproportionately utilized by racial/ethnic minorities and people with disabilities. SNAP policy changes could therefore affect healthcare outcomes for racial/ethnic minorities and people with disabilities in different ways than for others. For example, initial studies by our team and others suggest SNAP may reduce poor healthcare outcomes and Medicaid expenditures, particularly for people with disabilities. However, these studies were limited to population-level or cross- sectional data, and all studied non-random changes to SNAP. Further, no studies have examined the effects of SNAP on healthcare disparities empirically. In this project, we exploit a natural experiment in which arbitrary errors in the Massachusetts eligibility evaluation system caused 75,200 SNAP recipients to receive arbitrary terminations despite actually still being eligible. Moreover, because of recent legislation in the state, we will have access to comprehensive longitudinal SNAP, medical claims, and other public health data on the entire state population. Using these linked data and growth curve modeling, we will examine the impact of losing SNAP benefits on healthcare outcomes and disparities related to disease prevention and management (Aim 1), unfavorable clinical events (Aim 2), and healthcare expenditures (Aim 3). We hypothesize SNAP losses are associated with worse healthcare outcomes and elevated racial/ethnic and disability-based disparities. Cuts to SNAP benefits are routinely debated, but there is limited information on how benefit losses for current recipients would affect healthcare outcomes. Our study will help fill this gap. More broadly, programs like SNAP target determinants of health and healthcare disparities, yet their potential effects on these outcomes have received minimal study. By adding to this literature, our analyses will further the NIH Health Disparities Strategic Plan’s goal of supporting “research on the factors underlying health disparities.”

项目摘要/摘要 该项目将研究失去补充营养援助计划（SNAP）的影响 基于种族/种族和残疾的医疗保健结果和医疗保健差异的好处。种族/种族 少数民族和残疾人在预​​防疾病和 管理，不利的临床活动和急性医疗支出。粮食不安全感可能会影响这些 差异：粮食不安全的人会更频繁地忘记需要护理和药物，使用紧急情况和 与粮食安全的个人相比，住院治疗更频繁，需要更高的支出。同时， 种族/族裔少数民族和残疾人是不安全的2.2和2.8倍 少数民族和没有残疾的人分别面临着粮食和资源之间的鲜明权衡 作为住房，鉴于更大的经济和健康脆弱性，对粮食不安全感具有更大的敏感性。 SNAP已被证明可以减少粮食不安全，并因种族/种族而过度使用 少数民族和残疾人。因此，改变政策的变化可能会影响医疗保健结果 种族/族裔少数民族和残疾人的方式与其他族裔不同。例如，初步研究 由我们的团队和其他人提出，SNAP可能会减少不良的医疗保健成果和医疗补助支出， 特别是对于残疾人。但是，这些研究仅限于人口级或跨 截面数据以及所有研究的非随机变化以改变。此外，尚无研究检查 紧急抢购医疗保健分配。在这个项目中，我们利用了一个自然实验，其中 马萨诸塞州资格评估系统中的错误导致75,200个SNAP接收者接收任意 终止实际上仍然有资格。而且，由于该州最近的立法，我们将 可以访问整个全面的纵向快照，医疗索赔和其他公共卫生数据 国家人口。使用这些链接的数据和增长曲线建模，我们将研究丢失的影响 在与疾病预防和管理相关的医疗保健结果和分配中获取益处（目标 1），不利的临床事件（AIM 2）和医疗保健支出（AIM 3）。我们假设快照损失 与较差的医疗保健结果以及种族/种族和基于残疾的差异有关。 通常会辩论削减扣除利益，但是关于如何损失的损益的信息有限 当前的接受者将影响医疗保健结果。我们的研究将有助于填补这一空白。更广泛地说，程序 就像SNAP目标确定了健康和医疗保健分布一样，但它们的潜在影响 结果获得了最少的研究。通过添加这些文献，我们的分析将进一步促进NIH健康 差距战略计划的目标是支持“研究对健康差异的基本因素”的目标。