Medicaid Expansion in Social Context: Examining Relationships Between Medicaid Enrollment and County-Level Food Insecurity

2019 ◽  
Vol 30 (2) ◽  
pp. 532-546
Author(s):  
Shilpa Londhe ◽  
Grant Ritter ◽  
Mark Schlesinger
Keyword(s):  
Social Context ◽  
Food Insecurity ◽  
County Level ◽  
Medicaid Expansion ◽  
Medicaid Enrollment

scholarly journals Family and Social Context Contributes to the Interplay of Economic Insecurity, Food Insecurity, and Health

2017 ◽  
Vol 41 (2) ◽  
pp. 67-77 ◽  
Author(s):  
ROBIN T. HIGASHI ◽  
SIMON CRADDOCK LEE ◽  
CARLA PEZZIA ◽  
LISA QUIRK ◽  
TAMMY LEONARD ◽  
...  
Keyword(s):  
Social Context ◽  
Food Insecurity ◽  
Economic Insecurity

scholarly journals Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment

2020 ◽  
Vol 17 (18) ◽  
pp. 6684
Author(s):  
Macarius M. Donneyong ◽  
Teng-Jen Chang ◽  
John W. Jackson ◽  
Michael A. Langston ◽  
Paul D. Juarez ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Antihypertensive Medication ◽  
Social Supports ◽  
Determinants Of Health ◽  
P Value ◽  
County Level ◽  
Medication Treatment ◽  
Factors Associated

Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R2 = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.

Impact of Medicaid expansion on diagnosis and management of patients with testicular cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 551-551
Author(s):  
Xinglei Shen ◽  
Mindi TenNapel
Keyword(s):  
Testicular Cancer ◽  
Stage I ◽  
Stage Iii ◽  
Medicaid Expansion ◽  
Chi Square ◽  
Medicaid Enrollment ◽  
Chi Square Test ◽  
Reduced Rate ◽  
New Diagnosis ◽  
Insured Patients

551 Background: One crucial aspect of the Affordable Care Act is the optional Medicaid expansion, which started in 2014. Patients with testicular cancer may derive particular benefit from Medicaid expansion due to demographics overlap. We hypothesize that Medicaid expansion would improve outcome in these patients. Methods: We reviewed the Surveillance Epidemiology and End Results (SEER) database for testicular cancer diagnosed from 2010 to 2014. Among the SEER regions, we separated in to states that did (CA, CT, HI, IA, KY, MI, NJ, NM, WA) or did not (AK, GA, LA, UT) undertake expansion. Medicaid data from CMMS were used to measure the degree of Medicaid expansion (EXP). Data from 2010-2013 was used as baseline, and 2014 as the effect of EXP. Chi-square test was used to compare between groups. Results: We identified 12731 cases of testicular cancer from 2010 to 2014. Within SEER regions, overall Medicaid enrollment increased by 30.4% from 2013 to 2014 in the EXP states, and by 8.4% in non-EXP states. Expansion did not affect incidence of testicular cancer. In the EXP states, Medicaid coverage for testicular cancer increased from 14.8% to 19.4% in 2014 (p < 0.001) and uninsured decreased from 8.7% to 4.3% (p < 0.001). In non-EXP states, coverage with Medicaid (9.7% to 8.8%, p = 0.60) and uninsured (13.6% to 12.9%, p = 0.68) did not change. Within individual states, we noted a linear correlation between % increase in Medicaid enrollment and % decrease in uninsured cases (R = 0.58). Among Medicaid patients in EXP states, stage I cases increased (52% to 60%), stage III cases decreased (27% to 20%). There was no change among insured patients (70.6% to 73.3% for stage I, and 10.9% to 9.1% for stage III). In contrast, in non-EXP states, Medicaid patients had decrease in stage I and increase in stage III cases. Medicaid patients had higher rates of no treatment and lower rates of lymph node assessment for stage II NSGCT compared to insured patients, but this did not vary with EXP. Conclusions: Medicaid expansion reduced rate of uninsured for patients with new diagnosis of testicular cancer. There was a shift to earlier stage of diagnosis in Medicaid patients, but no apparent effect yet on management. Future studies will focus on change over time and effect on survival.

Abstract 13360: The Association Between Food Insecurity and Cardiovascular Mortality in the United States From 2011 to 2017 - A Longitudinal Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Stephen Y Wang ◽  
Atheendar S Venkataramani ◽  
Christina A Roberto ◽  
Lauren A Eberly ◽  
Peter W Groeneveld ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Fixed Effects ◽  
The United States ◽  
Mortality Rates ◽  
County Level ◽  
Elderly Adults ◽  
Mortality Trends ◽  
Annual Percent Change ◽  
Cross Sectional ◽  
Longitudinal Changes

Introduction: Prior analyses suggest a link between food insecurity and cardiovascular (CV) health but are limited by cross-sectional designs. We investigated whether longitudinal changes in food insecurity are independently associated with CV mortality. Methods: Using National Center for Health Statistics data, we determined annual U.S. county-level age-adjusted CV mortality rates for non-elderly (20-64 years old) and elderly (65 years and older) adults. County-level food insecurity rates were obtained from the Map the Meal Gap project. We examined CV mortality trends by quartiles of average annual percent change (APC) in food insecurity. Using a Poisson fixed effects estimator, we assessed the association between longitudinal changes in food insecurity and CV mortality rates after accounting for time-varying demographic (proportion of residents who were male, black, Hispanic), economic (median household income, unemployment, poverty, education attainment, and housing vacancy rates), and healthcare access (insurance coverage, density of healthcare providers and hospital beds) variables. Results: Between 2011 and 2017, mean food insecurity rates decreased from 14.7% to 13.3%. In counties in the highest quartile of APC for absolute value change in food insecurity, non-elderly CV mortality increased from 82.2(SD=33.9) to 87.4(SD=37.3) per 100,000 individuals (p<0.001), while in counties in the lowest quartile of APC, mortality was stable [60.8(SD=22.2) to 60.0(SD=23.0) per 100,000 individuals, p=0.64]. Elderly CV mortality significantly declined in all quartiles [1643.3(SD=315.7) to 1542.7(SD=299.4) per 100,000 (p<0.001) in the highest quartile and 1408.3(SD=225.9) to 1338.6(SD=213.8) per 100,000 (p<0.001) in the lowest quartile). A 1 percentage point increase in food insecurity was independently associated with a 0.83% (95% CI 0.42 - 1.25, P<0.001) increase in CV mortality for non-elderly adults. This was not significant for elderly adults (-0.06%, 95% CI -0.39 - 0.28, P=0.74). Conclusion: From 2011 to 2017, an increase in food insecurity was independently associated with an increase in CV mortality rates for non-elderly adults in the U.S. Interventions targeting food insecurity may play a role in improving community CV health.

scholarly journals Medicaid enrollment after liver transplantation: Effects of medicaid expansion

2016 ◽  
Vol 22 (8) ◽  
pp. 1075-1084 ◽  
Author(s):  
Dmitry Tumin ◽  
Don Hayes ◽  
W. Kenneth Washburn ◽  
Joseph D. Tobias ◽  
Sylvester M. Black
Keyword(s):  
Liver Transplantation ◽  
Medicaid Expansion ◽  
Medicaid Enrollment

scholarly journals Protocol—Evaluating the Effect of ACA Medicaid Expansion on Mortality During the COVID-19 Pandemic Using County-level Matching

2021 ◽  
Vol 7 (2) ◽  
pp. S1-S31
Author(s):  
Charlotte Z. Mann ◽  
Ben B. Hansen ◽  
Lauren Gaydosh ◽  
Timothy Lycurgus
Keyword(s):  
County Level ◽  
Medicaid Expansion

scholarly journals 1030. Medicaid Expansion: How Does it Impact HIV Outcomes in One Non-urban Southeastern Ryan White HIV/AIDS Program Clinic?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S544-S546
Author(s):  
Kathleen A McManus ◽  
Karishma R Srikanth ◽  
Samuel D Powers ◽  
Rebecca Dillingham ◽  
Elizabeth T Rogawski McQuade
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Baseline Viral Load ◽  
Medicaid Expansion ◽  
Engagement In Care ◽  
Medicaid Enrollment ◽  
Ryan White ◽  
Aids Program ◽  
Research Grant ◽  
Hiv Aids

Abstract Background People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME. Methods Participants were PLWH ages 18-63 who attended &gt; 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019. Results Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes &lt; 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes &gt; 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others. Figure 1 Table 1 Table 2 Conclusion The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)

Food Insecurity Is Prevalent in Iowa’s Medicaid Expansion Population

2021 ◽  
Author(s):  
Patrick J. Brady ◽  
Natoshia M. Askelson ◽  
Brad Wright ◽  
Eliza Daly ◽  
Elizabeth Momany ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Medicaid Expansion
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