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

• 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
• 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

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.

项目概要 自 20 世纪 90 年代末以来，美国农村地区的死亡率高于城市地区， 这种模式被称为农村死亡惩罚。最近的研究发现，农村死亡率的惩罚持续增加 由于与可预防原因（代谢和心血管原因、饮酒和心理健康）相关的死亡。 美国许多州采用的医疗补助计划的扩大有可能减少由于这些和其他原因造成的死亡 通过为那些不符合先前资格门槛的人获得医疗保健提供便利来解决这一问题。尽管 该国的一些州采纳了这一扩张计划，这一进程于 2014 年开始，但其他州则拒绝了它。虽然 采用/拒绝这一扩展的情况有据可查，但人们对采用这一政策的作用知之甚少。 州一级影响了农村死亡率等既定的人口现象。本项目要求 获取有限数据以生成 19-64 岁人口按性别和种族/族裔划分的死亡率，以便开展调查 采用双重差分设计对农村死亡率处罚中观察到的差异进行了新颖的分析。这 项目评估医疗补助扩大是否影响农村死亡率，强调总体人口， 以及性别和种族/民族的差异。该项目也将是第一个探索 COVID-19 大流行是否 到 2020 年，州级扩大医疗补助计划对农村/城市死亡率动态的影响。 分析方法将形式和数学人口统计方法与新颖的统计模型相结合来评估 医疗补助扩大对农村/城市死亡率动态的影响。该项目的调查结果将说明 国家层面的政策在塑造不同或一致的死亡率轨迹以及面对持续的疫情方面所发挥的作用 2019冠状病毒病大流行。