The Affordable Care Act Reduced Income Inequality In The US

Health inequality and health insurance coverage: The United States and China compared

We study inequality in the distribution of self-assessed health (SAH) in the United States and China, two large countries that have expanded their insurance provisions in recent decades, but that lack universal coverage and differ in other social determinants of health. Using comparable health survey data from China and the United States, we compare health inequality trends throughout the period covering the public health insurance coverage expansions in the two countries. We find that whether SAH inequality is greater in the US or in China depends on the concept of status and the inequality-sensitivity parameter used; however, the regional pattern of SAH inequality is clearly associated with health-insurance coverage expansions in the US but not significant in China.

Neighborhood socioeconomic status is associated with low diversity gut microbiomes and multi-drug resistant microorganism colonization

Social disparities continue to limit universal access to health care, directly impacting both lifespan and quality of life. Concomitantly, the gut microbiome has been associated with downstream health outcomes including the global rise in antibiotic resistance. However, limited evidence exists examining socioeconomic status (SES) associations with gut microbiome composition. To address this, we collected information on the community-level SES, gut microbiota, and other individual cofactors including colonization by multidrug-resistant organisms (MDROs) in an adult cohort from Wisconsin, USA. We found an association between SES and microbial composition that is mediated by food insecurity. Additionally, we observed a higher prevalence of MDROs isolated from individuals with low diversity microbiomes and low neighborhood SES. Our integrated population-based study considers how the interplay of several social and economic factors combine to influence gut microbial composition while providing a framework for developing future interventions to help mitigate the SES health gap.

Moral reframing increases support for economically progressive candidates

Economically progressive candidates-candidates who champion redistributive policies designed to reduce inequality-rarely win elections in the United States. Here, we propose that progressive candidates achieve greater support by framing their policy platforms in terms of values that resonate beyond their progressive base. In two experiments (total N = 4,138), including one preregistered experiment conducted on a nationally representative probability sample, we found that a presidential candidate who framed his progressive economic platform using values consistent with the "binding" moral foundations-e.g. patriotism, family, and respect for tradition-as opposed to values consistent with the "individualizing" foundations, e.g. equality and social justice, received significantly stronger support. This effect was driven by increased support among conservatives and, unexpectedly, moderates as well. By comparison, a manipulation of how progressive the candidate's platform was had small and inconsistent effects. Despite the potential gains associated with binding framing, analyses using presidential candidates' debate speeches reveal that appeals to binding values are least common among progressive candidates. These findings show, however, that the alignment between values and candidate support is malleable, suggesting economically progressive candidates can build broader coalitions by reframing the values they associate with their platforms.

Population-Based Impact of Rurality and Neighborhood-Level Socioeconomic Disadvantage on Pediatric Cancer Mortality in Washington State

BACKGROUND

Childhood cancer-related mortality differs by socioeconomic factors, but the impact of residential location, including rurality and neighborhood-level socioeconomic disadvantage, is not well-characterized.

METHODS

This retrospective cohort study linked Washington State cancer registry data (1992-2013) to state birth (1974-2013) and death records (1992-2013) to identify residents <20 years diagnosed with cancer (n = 4,306). Census-based rural-urban commuting area codes and Area Deprivation Index (ADI) defined rural residence and neighborhood socioeconomic disadvantage at time of cancer diagnosis, respectively. Neighborhoods in the highest state ADI quintile were classified as the most disadvantaged. Kaplan-Meier estimates and Cox hazards models, adjusted for key characteristics, were used to compare mortality by rural and ADI classification.

RESULTS

Five-year overall survival for children from non-rural low ADI neighborhoods (referent) was 80.9%±0.8%, versus 66.4%±2.9% from non-rural high ADI neighborhoods, 69.4%±3.8% from rural low ADI neighborhoods, and 66.9%±3.8% from rural high ADI neighborhoods (P < 0.01 for each comparison versus referent). Compared with the referent group, children from comparator neighborhoods had a greater mortality risk: Rural low ADI [hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.12-2.02], rural high ADI (HR, 1.53; 95% CI, 1.16-2.01), and non-rural high ADI (HR, 1.64; 95% CI, 1.32-2.04). Associations of ADI and rurality with mortality varied in sub-analyses by cancer type.

CONCLUSIONS

Children with cancer living in rural and/or socioeconomically disadvantaged neighborhoods at diagnosis experienced greater mortality relative to those without either factor.

IMPACT

Future investigation is needed to examine how rurality and poverty potentially impact healthcare utilization and health-related outcomes in pediatric oncology.

Racial And Ethnic Disparities In Dental Services Use Declined After Medicaid Adult Dental Coverage Expansions

Racial and ethnic disparities in adults' access to dental care have persisted for decades. We examined how recent Affordable Care Act Medicaid expansions that included coverage of dental services for adults affected racial and ethnic disparities in dental services use. Using Medical Expenditure Panel Survey data from the period 2011-18, we compared changes in dental services use for low-income non-Hispanic Black and Hispanic adults with changes in use for low-income non-Hispanic White adults. We found that expansions including extensive dental benefits were associated with narrowed racial and ethnic disparities in dental care visits and use of preventive and treatment services. For non-Hispanic Black and Hispanic adults, after Medicaid expansion with extensive dental benefits there was an 8-percentage-point increase in their likelihood of dental visits in a given year when compared with non-Hispanic White adults. This represents a reduction from preexpansion disparities by 75 percent for non-Hispanic Black adults and 50 percent for Hispanic adults. This disparity decline is due to both an increase in dental services use among non-Hispanic Black and Hispanic adults and little change occurring among non-Hispanic White adults. In contrast, no decline in disparities was seen in states with less generous dental benefits. Overall, rates of dental care among low-income adults continue to be low across racial and ethnic groups, indicating other key access barriers to dental care and persistent unmet oral health needs.