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

项目摘要 孕产妇死亡率和严重孕产妇发病率的上升突出表明， 妇女在怀孕前长期享受持续和全面的健康保险 在分娩后很长一段时间。高龄产妇（≥35岁）和低社会经济地位 是导致孕产妇发病率高的重要风险因素，因此， 此外，由于收入低，高龄母亲享有持续的健康保险。2014年及以后，在 平价医疗法案（ACA），37个州和DC（截至2020年）扩大了医疗补助门槛， 包括低收入成年人。虽然不是针对母亲，ACA医疗补助扩张可能 改善了医疗补助覆盖范围从怀孕前到怀孕后的连续性， 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%。在这项研究中，我们研究了ACA是否 医疗补助扩张与孕产妇健康结果和行为相关， 年龄在18-49岁之间的妇女，重点是年龄较大的母亲（≥35岁）。我们使用差分中的差分 方法和数据来自2010-2018年的人口动态统计出生证明记录。测量 州的医疗补助扩展状态，我们创建了一个指标，表明母亲是否住在一个州， 在孩子出生前一年扩大医疗补助计划。为了捕捉潜在的年龄特异性 变异，我们还创建了模拟措施的医疗补助资格的母亲年龄，状态， 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。

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.