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Park S, Berkowitz SA. Social Isolation, Loneliness, and Quality of Life Among Food-Insecure Adults. Am J Prev Med 2024; 67:120-123. [PMID: 38331116 DOI: 10.1016/j.amepre.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Food insecurity is associated with adverse health outcomes, but may also have a detrimental effect on social relationships, potentially exacerbating social isolation and loneliness, and consequently affecting health-related quality of life. This study examined the associations of food insecurity with social isolation, loneliness, and health-related quality of life among U.S. adults. METHODS A retrospective cohort study was conducted using panel data from the 2020-2021 Medical Expenditure Panel Survey. Regression models were used to assess the associations of food insecurity in 1 year with the outcomes of interest in the subsequent year while adjusting for baseline individual-level characteristics. Analysis was conducted in December 2023. RESULTS Experiencing food insecurity in 2020 was significantly associated with increased reports of social isolation (3.1 percentage points [95% CI: 1.2-5.1]) and loneliness (9.7 percentage points [95% CI: 1.0-18.3]) in 2021. Additionally, food insecurity in 2020 was significantly associated with lower self-reported good mental health (-2.9 percentage points [95% CI: -5.1, -0.6]) and mental component summary score from the Short Form-12 Health Survey (-3.3 points [95% CI -3.8, -2.9]) in 2021. However, there were no or small associations with physical health-related quality of life. CONCLUSIONS Food insecurity is associated with worse social and mental well-being among U.S. adults. This suggests that food insecurity interventions should not focus too narrowly on nutrition, but instead give holistic consideration to the multiple ways food insecurity harms health-not only via lower quality diets, but through worse mental health and impairing the ability to participate in social life.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea.
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Park S, Meyers DJ, Trivedi AN. Association of Medicare Advantage Enrollment With Financial Burden of Care : A Retrospective Cohort Study. Ann Intern Med 2024. [PMID: 38914004 DOI: 10.7326/m23-2480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Compared with traditional Medicare (TM), Medicare Advantage (MA) plans typically offer supplemental benefits and lower copayments for in-network services and must include an out-of-pocket spending limit. OBJECTIVE To examine whether the financial burden of care decreased for persons switching from TM to MA (TM-to-MA switchers) relative to those remaining in TM (TM stayers). DESIGN Retrospective longitudinal cohort study comparing changes in financial outcomes between TM-to-MA switchers and TM stayers. SETTING Population-based. PARTICIPANTS 7054 TM stayers and 1544 TM-to-MA switchers from the Medical Expenditure Panel Survey, 2014 to 2021. MEASUREMENTS Individual health care costs (out-of-pocket spending and cost sharing), financial burden (high and catastrophic), and subjective financial hardship (difficulty paying medical bills, paying medical bills over time, and inability to pay medical bills). RESULTS Compared with TM stayers, TM-to-MA switchers had small differences in out-of-pocket spending ($168 [95% CI, -$133 to $469]) and proportions of total health expenses paid out of pocket (cost sharing) (0.2 percentage point [CI, -1.3 to 1.7 percentage points]), families with out-of-pocket spending greater than 20% of their income (high financial burden) (0.3 percentage point [CI, -2.5 to 3.0 percentage points]), families reporting out-of-pocket spending greater than 40% of their income (catastrophic financial burden) (0.7 percentage point [CI, -0.1 to 1.6 percentage points]), families reporting paying medical bills over time (-0.2 percentage point [CI, -1.7 to 1.4 percentage points]), families having problems paying medical bills (-0.4 percentage point [CI, -2.7 to 1.8 percentage points]), and families reporting being unable to pay medical bills (0.4 percentage point [CI, -1.3 to 2.0 percentage points]). LIMITATION Inability to account for all medical care and cost needs and variations across MA plans, small baseline differences in out-of-pocket spending, and potential residual confounding. CONCLUSION Differences in financial outcomes between beneficiaries who switched from TM to MA and those who stayed with TM were small. Differences in financial burden ranged across outcomes and did not have a consistent pattern. PRIMARY FUNDING SOURCE The National Research Foundation of Korea.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Korea (S.P.)
| | - David J Meyers
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island (D.J.M.)
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, and Center of Innovation for Long-term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island (A.N.T.)
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Park S, Berkowitz SA. Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With and Without Food Insecurity. J Gen Intern Med 2024:10.1007/s11606-024-08798-4. [PMID: 38755470 DOI: 10.1007/s11606-024-08798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Compared to traditional Medicare (TM), Medicare Advantage (MA) plans impose out-of-pocket cost limits and offer extra benefits, potentially providing financial relief for MA enrollees, especially for those with food insecurity. OBJECTIVE To examine whether the prevalence of food insecurity differs between TM and MA enrollees at baseline and then examine whether MA enrollment in a baseline year is associated with less financial hardships in the following year, relative to TM enrollment, especially for those experiencing food insecurity. DESIGN We conducted a retrospective longitudinal cohort study. PARTICIPANTS Our analysis included 2807 Medicare beneficiaries (weighted sample size, 23,963,947) who maintained continuous enrollment in either TM or MA in both 2020 and 2021 from the Medical Expenditure Panel Survey. MAIN MEASURES We assessed outcomes related to financial hardships in health care and non-health care domains (measured in 2021). Our primary independent variables were food insecurity and MA enrollment (measured in 2020). RESULTS The point estimate of food insecurity prevalence was greater among MA enrollees than TM enrollees, but the difference was not statistically significant (1.1 percentage points [95% CI, - 1.0, 3.4]). Furthermore, there is evidence that compared to TM enrollment, MA enrollment did not mitigate the risk of financial hardship, particularly for food-insecure enrollees. Rather, food-secure MA enrollees faced greater financial hardship in the following year than food-secure TM enrollees (11.2% [8.9-13.6] and 7.6% [6.9-8.3] for problems paying medical bills and 5.5% [4.6-6.4] and 2.8% [2.1-3.6] for paying medical bills over time). Moreover, the point estimate of financial hardship was higher among food-insecure MA enrollees than food-insecure TM enrollees (21.5% [5.4-37.5] and 11.2% [4.1-18.4] and 23.7% [9.6-37.9] and 6.9% [0.5-13.3]) despite the lack of statistical significance. CONCLUSION These findings suggest that the promise of financial protection offered by MA plans has not been fully realized, particularly for those with food insecurity.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea.
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Park S, Ortega AN, Chen J, Mortensen K, Bustamante AV. Association of food insecurity with health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic. Public Health 2024; 230:183-189. [PMID: 38565064 DOI: 10.1016/j.puhe.2024.02.028] [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: 01/21/2024] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the associations between food insecurity and health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic and examine whether the associations were less pronounced among adults with safety nets. STUDY DESIGN We conducted a retrospective longitudinal cohort study using the 2020-2021 Medical Expenditure Panel Survey. METHODS Linear probability models were used to assess the associations between food insecurity in one year and the outcomes of interest in the following year while adjusting for baseline characteristics. We performed the analyses for the entire population and then conducted stratified analyses for adults with and without Supplemental Nutrition Assistance Program (SNAP) benefits or Medicaid coverage. RESULTS Compared with food-secure adults, food-insecure adults were 9.1 percentage points less likely to report life satisfaction and 9.9, 10.2, and 13.2 percentage points more likely to experience delays in getting medical care, postpone or forgo medical care because of cost, and struggle with paying medical bills. Food-insecure adults were 30.4, 27.2, and 23.5 percentage points more likely to face challenges in affording necessities, paying utility bills, and meeting rent or mortgage payments on time than food-secure adults. Notably, the strengths of these associations were attenuated among adults with SNAP benefits or Medicaid coverage. CONCLUSIONS Food insecurity was associated with poor health, limited access to and affordability of care, and a greater financial burden of care among US adults during the pandemic. Nevertheless, safety net programs can play a critical role in alleviating adverse consequences.
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Affiliation(s)
- S Park
- Department of Health Policy and Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; Department of Healthcare Sciences, Graduate School, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - A N Ortega
- Thompson School of Social Work and Public Health, University of Hawai'i at Manoa, 2430 Campus Rd, Honolulu, HI, 96822, USA.
| | - J Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA.
| | - K Mortensen
- Department of Health Management and Policy, Hebert Business School, University of Miami, 5250 University Dr, Coral Gables, FL 33146, USA.
| | - A V Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, UCLA Latino Policy and Politics Institute, 650 Charles Young Dr. S., Los Angeles, CA, 90095, USA.
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Zangeneh SZ, Skalland T, Yuhas K, Emel L, Tapsoba JDD, Reed D, Amos CI, Donnell D, Moore A, Justman J. Adaptive Time-Location Sampling for COMPASS: A SARS-CoV-2 Prevalence Study in Fifteen Diverse Communities in the United States. Epidemiology 2024; 35:389-397. [PMID: 38079239 DOI: 10.1097/ede.0000000000001705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND COVID-19 has placed a disproportionate burden on underserved racial and ethnic groups, community members working in essential industries, those living in areas of high population density, and those reliant on in-person services such as transportation. The goal of this study was to estimate the cross-sectional prevalence of SARS-CoV-2 (active SARS-CoV-2 or prior SARS-CoV-2 infection) in children and adults attending public venues in 15 sociodemographically diverse communities in the United States and to develop a statistical design that could be rigorously implemented amidst unpredictable stay-at-home COVID-19 guidelines. METHODS We used time-location sampling with complex sampling involving stratification, clustering of units, and unequal probabilities of selection to recruit individuals from selected communities. We safely conducted informed consent, specimen collection, and face-to-face interviews outside of public venues immediately following recruitment. RESULTS We developed an innovative sampling design that adapted to constraints such as closure of venues, changing infection hotspots, and uncertain policies. We updated both the sampling frame and the selection probabilities over time using information acquired from prior weeks. We created site-specific survey weights that adjusted sampling probabilities for nonresponse and calibrated to county-level margins on age and sex at birth. CONCLUSIONS Although the study itself was specific to COVID-19, the strategies presented in this article could serve as a case study that can be adapted for performing population-level inferences in similar settings and could help inform rapid and effective responses to future global public health challenges.
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Affiliation(s)
- Sahar Z Zangeneh
- From the RTI International, Research Triangle, NC
- Fred Hutchinson Cancer Center, Seattle, WA
- University of Washington, Seattle, WA
| | | | | | - Lynda Emel
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | - Deborah Donnell
- Fred Hutchinson Cancer Center, Seattle, WA
- University of Washington, Seattle, WA
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Decker SL, Zuvekas SH. A Nationally Representative Summary of 2020 Changes in the Use of Health Care in the United States. J Ambul Care Manage 2024; 47:64-83. [PMID: 38345888 DOI: 10.1097/jac.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The COVID-19 pandemic produced an unprecedented shock to the U.S. health care system. Prior literature documenting 2020 changes has been limited to certain types of care or subsets of patients. We use the nationally representative Medical Expenditure Panel Survey to summarize changes in all types of health care from 2018 through 2020. Outpatient visits, emergency department visits, and inpatient admissions each fell about 35% in April 2020. Dental visits fell over 80%. Ophthalmology visits declined 71% and mammograms 82%. Psychiatric visits rose slightly (1.6%). By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than 2019.
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Affiliation(s)
- Sandra L Decker
- Author Affiliations: U.S. Agency for Healthcare Research and Quality, Rockville, MD (Drs Decker and Zuvekas)
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Park S, Meyers DJ, Jimenez DE, Gualdrón N, Cook BL. Health Care Spending, Use, and Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With Mental Health Symptoms. Am J Geriatr Psychiatry 2024:S1064-7481(24)00014-9. [PMID: 38267358 DOI: 10.1016/j.jagp.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We examined the differences in health care spending and utilization, and financial hardship between Traditional Medicare (TM) and Medicare Advantage (MA) enrollees with mental health symptoms. DESIGN Cross-sectional study. PARTICIPANTS We identified Medicare beneficiaries with mental health symptoms using the Patient Health Questionnaire-2 and the Kessler-6 Psychological Distress Scale in the 2015-2021 Medical Expenditure Panel Survey. MEASUREMENTS Outcomes included health care spending and utilization (both general and mental health services), and financial hardship. The primary independent variable was MA enrollment. RESULTS MA enrollees with mental health symptoms were 2.3 percentage points (95% CI: -3.4, -1.2; relative difference: 16.1%) less likely to have specialty mental health visits than TM enrollees with mental health symptoms. There were no significant differences in total health care spending, but annual out-of-pocket spending was $292 (95% CI: 152-432; 18.2%) higher among MA enrollees with mental health symptoms than TM enrollees with mental health symptoms. Additionally, MA enrollees with mental health symptoms were 5.0 (95% CI: 2.9-7.2; 22.3%) and 2.5 percentage points (95% CI: 0.8-4.2; 20.9%) more likely to have difficulty paying medical bills over time and to experience high financial burden than TM enrollees with mental health symptoms. CONCLUSION Our findings suggest that MA enrollees with mental health symptoms were more likely to experience limited access to mental health services and high financial hardship compared to TM enrollees with mental health symptoms. There is a need to develop policies aimed at improving access to mental health services while reducing financial burden for MA enrollees.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management (SP), College of Health Science, Korea University, Seoul, Republic of Korea; BK21 FOUR R&E Center for Learning Health Systems (SP), Korea University, Seoul, Republic of Korea.
| | - David J Meyers
- Department of Health Services, Policy, and Practice (DJM), School of Public Health, Brown University, Providence, RI, USA
| | - Daniel Enrique Jimenez
- Department of Psychiatry and Behavioral Sciences (DEJ), Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nattalie Gualdrón
- Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Department of Community Health (NG), School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Benjamin Le Cook
- Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Center for Health Equity (BLC), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry (BLC), Harvard Medical School, Cambridge, MA, USA
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Nelson DB, Goldman AL, Zhang F, Yu H. Continuous Medicaid coverage during the COVID-19 public health emergency reduced churning, but did not eliminate it. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad055. [PMID: 38223316 PMCID: PMC10786332 DOI: 10.1093/haschl/qxad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Preserving insurance coverage in the wake of pandemic-related job loss was a priority in early 2020. To this end, the Families First Coronavirus Response Act implemented a continuous coverage policy in Medicaid to shore up access to health insurance. Prior to the pandemic, Medicaid enrollees experienced frequent coverage disruptions, known as "churning." The effect of the continuous coverage policy on churning during the COVID-19 public health emergency (PHE) is unknown. We performed a difference-in-differences analysis of nonelderly Medicaid enrollees using longitudinal national survey data to compare a 2019-2020 cohort exposed to the policy with a control cohort in 2018-2019. We found that the policy led to reduced transitions to uninsurance among adults, although not among children. The policy prevented over 300 000 transitions to uninsurance each month. However, disenrollment from Medicaid persisted at a low rate, despite the continuous coverage policy. As the PHE unwinds, policymakers should consider long-term continuous coverage policies to minimize churning in Medicaid.
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Affiliation(s)
- Daniel B. Nelson
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Anna L. Goldman
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
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Hou CH, Shih SF, Pu C. Adherence of those With Self-Reported Glaucoma in the United States to Eye Examination Visits. J Glaucoma 2023; 32:885-890. [PMID: 36971614 DOI: 10.1097/ijg.0000000000002213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
PRCIS The adherence of American patients with self-reported glaucoma to the follow-up recommendations is extremely low. Estimated adherence rate is lower than that obtained by previous studies that did not use a US nationally representative sample. PURPOSE To evaluate adherence to ophthalmic outpatient follow-up visits and vision examinations in the American population aged 40 years or above. METHODS The percentage of American patients aged≥40 years who adhered to glaucoma treatment guidelines was estimated using 2015-2019 Medical Expenditure Panel Survey (MEPS) data. Adherence was defined according to the International Council of Ophthalmology guidelines. We also compared individuals with and without self-reported glaucoma who have made at least one ophthalmic outpatient visit and at least 1 vision examination visit within a year. Differences in means and percentages were estimated to account for the covariance due to the complex sampling design. RESULTS Approximately 4.4 million people aged or above 40 years had self-reported glaucoma in 2019 (3.21%). The rate of prevalence significantly differed with race, with Black people having the highest prevalence in all studied years. Only 7.1% (95% CI: 0.049-0.102) and 2.67% (95% CI: 0.0137-0.0519) of this population underwent at least 1 ophthalmic outpatient examination or 1 vision examination per year. Older age, never married status, higher education, eye conditions, and diabetes were significantly associated with a higher probability of ophthalmic health care use. CONCLUSIONS Adherence to follow-up among patients with self-reported glaucoma in this population-level study was lower than that in previously reported American, non-nationally representative studies. Barriers to adherence at the population level should be assessed to inform the design of future policy or program interventions.
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Affiliation(s)
- Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
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Jacobs PD, Moriya AS. Changes In Health Coverage During The COVID-19 Pandemic. Health Aff (Millwood) 2023; 42:721-726. [PMID: 37126753 DOI: 10.1377/hlthaff.2022.01469] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The COVID-19 pandemic had the potential to alter patterns of health insurance coverage in the US. Using data from the Medical Expenditure Panel Survey, we found increased stability of Medicaid coverage for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3 percent) than in 2018-19 (7.8 percent).
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Affiliation(s)
- Paul D Jacobs
- Paul D. Jacobs , Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Asako S Moriya
- Asako S. Moriya, Agency for Healthcare Research and Quality
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Zangeneh SZ, Skalland T, Yuhas K, Emel L, De Dieu Tapsoba J, Reed D, Amos CI, Donnell D, Moore A, Justman J. ADAPTIVE TIME LOCATION SAMPLING FOR COMPASS, A SARS-COV-2 PREVALENCE STUDY IN FIFTEEN DIVERSE COMMUNITIES IN THE UNITED STATES. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.10.23284400. [PMID: 36711739 PMCID: PMC9882424 DOI: 10.1101/2023.01.10.23284400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The COVPN 5002 (COMPASS) study aimed to estimate the prevalence of SARS-CoV-2 (active SARS-CoV-2 or prior SARS-CoV-2 infection) in children and adults attending public venues in 15 socio-demographically diverse communities in the United States. To protect against potential challenges in implementing traditional sampling strategies, time-location sampling (TLS) using complex sampling involving stratification, clustering of units, and unequal probabilities of selection was used to recruit individuals from neighborhoods in selected communities. The innovative design adapted to constraints such as closure of venues; changing infection hotspots; and uncertain policies. Recruitment of children and the elderly raised additional challenges in sample selection and implementation. To address these challenges, the TLS design adaptively updated both the sampling frame and the selection probabilities over time using information acquired from prior weeks. Although the study itself was specific to COVID-19, the strategies presented in this paper could serve as a case study that can be adapted for performing rigorous population-level inferences in similar settings and could help inform rapid and effective responses to future global public health challenges.
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Affiliation(s)
- Sahar Z Zangeneh
- RTI International, Research Triangle NC, U.S.A
- Fred Hutchinson Cancer Center, Seattle WA, U.S.A
- University of Washington, Seattle WA, U.S.A
| | | | - Krista Yuhas
- Fred Hutchinson Cancer Center, Seattle WA, U.S.A
| | - Lynda Emel
- Fred Hutchinson Cancer Center, Seattle WA, U.S.A
| | | | | | | | - Deborah Donnell
- Fred Hutchinson Cancer Center, Seattle WA, U.S.A
- University of Washington, Seattle WA, U.S.A
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