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

项目摘要/摘要 本项目将研究失去补充营养援助计划(SNAP)的影响 医疗结果的福利和基于种族/族裔和残疾的医疗差距。种族/民族 少数群体和残疾人在疾病预防和保健领域存在医疗差距 管理、不利的临床事件和急性医疗费用。粮食不安全可能会影响到这些 差距：粮食不安全的人更频繁地放弃必要的护理和药物，使用紧急和 住院治疗更频繁，并且需要比有食物保障的人更高的支出。同时， 少数族裔和残疾人粮食不安全的可能性是非 少数族裔和非残疾人分别面临着食物和资源之间更为严峻的权衡。 由于经济和卫生方面的脆弱性更大，对粮食不安全的敏感性也更高。 Snap已被证明可以减少粮食不安全，并被种族/民族不成比例地使用 少数群体和残疾人。因此，Snap政策的变化可能会影响以下方面的医疗结果 以不同于其他人的方式对待种族/族裔少数群体和残疾人。例如，初步研究 我们团队和其他人提出的SNAP可能会减少糟糕的医疗结果和医疗补助支出， 尤其是对残疾人来说。然而，这些研究仅限于人群水平或交叉- 截面数据，并且都研究了SNAP的非随机变化。此外，还没有研究检查这种药物的影响。 从经验上看，医疗保健差距很大。在这个项目中，我们利用了一个自然实验，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收件人收到任意 尽管实际上仍然符合资格，但仍被终止。此外，由于该州最近的立法，我们将 能够访问全面的纵向SNAP、医疗索赔和其他公共卫生数据 州人口。使用这些关联数据和增长曲线建模，我们将检查损失的影响 与疾病预防和管理相关的医疗保健结果和差距的快速收益(目标 1)、不良临床事件(目标2)和医疗保健支出(目标3)。我们假设SNAP损失 与更糟糕的医疗结果和更大的种族/族裔和基于残疾的差异有关。 削减SNAP福利是经常辩论的问题，但关于如何减少福利损失的信息有限 目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，计划 像SNAP这样的目标是健康和医疗差距的决定因素，但它们对这些因素的潜在影响 结果只得到了最少的研究。通过对这些文献的补充，我们的分析将进一步促进NIH健康 差异战略计划的目标是支持“对健康差异背后的因素的研究”。

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.”