28 research outputs found
Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL
Estimates state and national cost increases from the 2010 health reform law's expansion of Medicaid to adults under age 65 with incomes up to 133 percent of the federal poverty line in relation to enrollment increases under two outreach scenarios
The Cost of Failure to Enact Health Reform: Implications for States
Estimates the impact of not enacting health reforms on each state's insurance coverage, public spending, employers' share of premiums, and families' premiums and out-of-pocket costs in 2014 and 2019, under three scenarios for income and healthcare costs
Health Reform: The Cost of Failure
Estimates the intermediate and long-term implications of not enacting healthcare reform. Simulates the effects on employer-sponsored insurance, private non-group coverage, and Medicaid and State Children's Health Insurance Programs under three scenarios
The Coverage and Cost Impacts of Expanding Medicaid
Estimates the drop in the number of uninsured and the rise in government costs from not limiting Medicaid eligibility for adults to the disabled and those with dependent children but basing it on income level, under two scenarios. Discusses implications
Neighborhood Typology and Cardiometabolic Pregnancy Outcomes in the Maternal Adiposity Metabolism and Stress Study.
ObjectiveThis study aimed to assess associations between neighborhood typologies classified across multiple neighborhood domains and cardiometabolic pregnancy outcomes and determine variation in effectiveness of a mindfulness-based stress-reduction intervention on outcomes across neighborhood types.MethodsNeighborhoods of participants in the Maternal Adiposity Metabolism and Stress (MAMAS) intervention (n = 208) were classified across dimensions of socioeconomic, food, safety, and service/resource environments using latent class analysis. The study estimated associations between neighborhood type and three cardiometabolic pregnancy outcomes-glucose tolerance (GT) during pregnancy, excessive gestational weight gain, and 6-month postpartum weight retention (PPWR)-using marginal regression models. Interaction between neighborhood type and intervention was assessed.ResultsFive neighborhood types differing across socioeconomic, food, and resource environments were identified. Compared with poor, well-resourced neighborhoods, middle-income neighborhoods with low resources had higher risk of impaired GT (relative risk [RR]: 4.1; 95% confidence Interval [CI]: 1.1, 15.5), and wealthy, well-resourced neighborhoods had higher PPWR (beta: 3.9 kg; 95% CI: 0.3, 7.5). Intervention effectiveness varied across neighborhood type with wealthy, well-resourced and poor, moderately resourced neighborhoods showing improvements in GT scores. PPWR was higher in intervention compared with control groups within wealthy, well-resourced neighborhoods.ConclusionsConsideration of multidimensional neighborhood typologies revealed important nuances in intervention effectiveness on cardiometabolic pregnancy outcomes
Advancing Community Engaged Approaches to Identifying Structural Drivers of Racial Bias in Health Diagnostic Algorithms
Much attention and concern has been raised recently about bias and the use of
machine learning algorithms in healthcare, especially as it relates to
perpetuating racial discrimination and health disparities. Following an initial
system dynamics workshop at the Data for Black Lives II conference hosted at
MIT in January of 2019, a group of conference participants interested in
building capabilities to use system dynamics to understand complex societal
issues convened monthly to explore issues related to racial bias in AI and
implications for health disparities through qualitative and simulation
modeling. In this paper we present results and insights from the modeling
process and highlight the importance of centering the discussion of data and
healthcare on people and their experiences with healthcare and science, and
recognizing the societal context where the algorithm is operating. Collective
memory of community trauma, through deaths attributed to poor healthcare, and
negative experiences with healthcare are endogenous drivers of seeking
treatment and experiencing effective care, which impact the availability and
quality of data for algorithms. These drivers have drastically disparate
initial conditions for different racial groups and point to limited impact of
focusing solely on improving diagnostic algorithms for achieving better health
outcomes for some groups.Comment: 2020 International System Dynamics Conference, Honorable Mention
Award, 28 pages, 8 figure
Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight
OBJECTIVES: Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. METHODS: Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2)) ] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n=6849 pregnancies; range=1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. RESULTS: Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p-value=0.08). Normal weight Black (Risk Ratio (RR)=1.34, 95% confidence interval (CI): 1.18, 1.52) and Hispanic women (RR=1.33, 95%CI: 1.15, 1.54) and underweight Black women (RR=1.38; 95% CI: 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. CONCLUSIONS: The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG