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Altman CE, Hamilton C, Dondero M. The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants. J Racial Ethn Health Disparities 2023; 10:2195-2206. [PMID: 36036841 DOI: 10.1007/s40615-022-01399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.
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Affiliation(s)
- Claire E Altman
- Department of Health Sciences and Truman School of Government and Public Affairs, University of Missouri, 304 Clark Hall, Columbia, MO, 65211, USA.
| | - Christal Hamilton
- Center on Poverty and Social Policy, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Molly Dondero
- Department of Sociology, American University, 4400 Massachusetts Avenue NW, Washington D.C., 20016, USA
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Readhead A, Flood J, Barry P. Health insurance, healthcare utilization and language use among populations who experience risk for tuberculosis, California 2014–2017. PLoS One 2022; 17:e0268739. [PMID: 35609051 PMCID: PMC9129044 DOI: 10.1371/journal.pone.0268739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background California tuberculosis (TB) prevention goals include testing more than ten million at-risk Californians and treating two million infected with tuberculosis. Adequate health insurance and robust healthcare utilization are crucial to meeting these goals, but information on these factors for populations that experience risk for TB is limited. Methods We used data from the 2014–2017 California Health Interview Survey (n = 82,758), a population-based dual-frame telephone survey to calculate survey proportions and 95% confidence intervals (CI) stratified by country of birth, focusing on persons from countries of birth with the highest number of TB cases in California. Survey proportions for recent doctor’s visit, overall health, smoking, and diabetes were age-adjusted. Results Among 18–64 year-olds, 27% (CI: 25–30) of persons born in Mexico reported being uninsured in contrast with 3% (CI: 1–5) of persons born in India. Report of recent doctor’s visit was highest among persons born in the Philippines, 84% (CI: 80–89) and lowest among Chinese-born persons, 70% (CI: 63–76). Persons born in Mexico were more likely to report community clinics as their usual source of care than persons born in China, Vietnam, or the Philippines. Poverty was highest among Mexican-born persons, 56% (CI: 54–58) and lowest among Indian-born persons, 9% (CI: 5–13). Of adults with a medical visit in a non-English language, 96% (CI: 96–97) were non-U.S.-born, but only 42% (CI: 40–44) of non-U.S.-born persons had a visit in a non-English language. Discussion Many, though not all, of the populations that experience risk for TB had health insurance and used healthcare. We found key differences in usual source of care and language use by country of birth which should be considered when planning outreach to specific providers, clinic systems, insurers and communities for TB prevention and case-finding.
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Affiliation(s)
- Adam Readhead
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Jennifer Flood
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
| | - Pennan Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
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Maru S, Glenn L, Belfon K, Birnie L, Brahmbhatt D, Hadler M, Janevic T, Reynolds S. Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016-2018. J Urban Health 2021; 98:711-726. [PMID: 34811699 PMCID: PMC8688674 DOI: 10.1007/s11524-021-00584-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016-2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.
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Affiliation(s)
- Sheela Maru
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- New York City Health + Hospitals/Elmhurst, New York, NY, USA
| | - Lily Glenn
- Center for Health Equity and Community Wellness, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
| | - Kizzi Belfon
- Center for Health Equity and Community Wellness, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Lauren Birnie
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | | | - Max Hadler
- Independent Consultant, Brooklyn, NY, USA
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone Reynolds
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Safavi AR, Brook CD, Sakai O, Setty BN, Zumwalt A, Gonzalez Md M, Platt MP. Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries. Otolaryngol Head Neck Surg 2021; 166:80-85. [PMID: 33940963 DOI: 10.1177/01945998211008384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. STUDY DESIGN 3B case control study. STUDY SETTING Tertiary academic medical center. METHODS A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. RESULTS Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. CONCLUSIONS Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.
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Affiliation(s)
- Arash R Safavi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christopher D Brook
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Osamu Sakai
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Bindu N Setty
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Ann Zumwalt
- Boston Medical Center, Boston, Massachusetts, USA
| | - Mauricio Gonzalez Md
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael P Platt
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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