The impact of Medicaid expansion on the rural mortality penalty in the United States

项目摘要 美国乡村地区（美国）自1990年代末以来，死亡率一直高于城市地区， 被称为农村死亡惩罚的模式。最近的研究发现，农村死亡率继续上升， 由于与可预防的原因（代谢和心血管原因，酒精使用和心理健康）相关的死亡率。 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。 通过便利那些在以前的资格门槛下没有资格获得医疗保健的人获得医疗保健。而 美国的一些州通过了这一扩张，这一进程始于2014年，其他州则拒绝了这一进程。 采用/拒绝这一扩张是有据可查的，很少有人知道的作用，这一政策的采用， 在州一级，影响到农村死亡率惩罚等根深蒂固的人口现象。该项目要求 获取有限的数据，以按性别和种族/族裔分列19-64岁人口的死亡率， 采用差异中的差异设计，对农村死亡率惩罚中观察到的差异进行了新的分析。的 项目评估医疗补助计划的扩大是否影响了农村的死亡率惩罚，重点是总人口， 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 根据到2020年扩大医疗补助的州一级采用，影响农村/城市死亡率动态。的 分析方法将联合收割机正式和数学人口统计方法与新的统计模型相结合，以评估 扩大医疗补助对农村/城市死亡率动态的影响。该项目的结果将说明 国家一级的政策在塑造死亡率的不同或一致的轨迹方面以及在面对正在进行的 2019冠状病毒病大流行。

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.