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.”

项目总结/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/民族和残疾的医疗保健结果和医疗保健差异的福利。种族/族裔 少数民族和残疾人在疾病预防方面经历保健不平等， 管理，不利的临床事件和急性医疗保健支出。粮食不安全可能会影响这些 差异：粮食不安全的人更经常地放弃所需的护理和药物，使用紧急和 住院治疗更频繁，需要比粮食安全个人更高的支出。同时， 少数种族/族裔和残疾人粮食无保障的可能性分别是非少数种族/族裔和残疾人的2.2倍和2.8倍。 少数民族和非残疾人分别面临着食物和资源之间更严峻的权衡， 由于经济和健康方面的脆弱性更大，因此对粮食不安全的敏感性更高。 SNAP已被证明可以减少粮食不安全，并且被种族/族裔群体不成比例地使用。 少数民族和残疾人。因此，SNAP政策的变化可能会影响医疗保健结果， 种族/族裔少数群体和残疾人以不同于其他人的方式。例如，初步研究 我们的团队和其他人认为SNAP可能会减少不良的医疗保健结果和医疗补助支出， 特别是对残疾人来说。然而，这些研究仅限于人群水平或交叉水平。 截面数据，以及所有研究SNAP的非随机变化。此外，还没有研究检查 SNAP对医疗保健差异的实证研究。在这个项目中，我们利用一个自然的实验，其中任意 马萨诸塞州资格评估系统中的错误导致75，200名SNAP接受者接受任意 尽管实际上仍然有资格终止。此外，由于国家最近的立法，我们将 可以获得全面的纵向SNAP，医疗索赔和其他公共卫生数据， 国家人口。使用这些关联数据和增长曲线模型，我们将研究失去 SNAP对医疗保健结果的益处以及与疾病预防和管理相关的差异（Aim 不良临床事件（目标2）和医疗支出（目标3）。我们假设SNAP损失 与更差的医疗保健结果和更高的种族/民族和残疾差异有关。 削减SNAP福利是经常争论的问题，但关于福利损失的信息有限。 目前的接受者会影响医疗结果。我们的研究将有助于填补这一空白。更广泛地说， 像SNAP一样，目标是健康和医疗保健差异的决定因素，但它们对这些差异的潜在影响 结果得到的研究很少。通过增加这些文献，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“对健康差距的根本因素进行研究”。