Double vulnerability? Examining the effect of living in nonmetropolitan areas within non-expansion Medicaid states on health status among working-age adults in the United States, 2022–2024

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health Pub Date : 2025-04-05 DOI:10.1016/j.ssmph.2025.101798

Michael D. Segovia , P. Johnelle Sparks , Alexis R. Santos-Lozada

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引用次数: 0

Abstract

Objective

To examine whether living in nonmetropolitan areas within a state that has not expanded Medicaid is associated with poor/fair self-reported health status among working-age adults in the United States.

Methods

We analyzed data from the 2022–2024 Current Population Survey (n = 220, 601, ages 25–64). Self-reported health was dichotomized as having reported poor/fair or good/very good/excellent health status. We produced a four-level measure of the overlap between residential and policy contexts indicating whether the respondent lived in a metropolitan or nonmetropolitan area within a state that had or had not expanded Medicaid coverage by 2023. Multilevel logistic regression models were fit to examine the association between our measure of residence-policy overlaps and poor/fair self-reported health status while accounting for individual and state-level characteristics.

Results

About 3.7 % of respondents resided in nonmetropolitan areas within non-expansion states. Approximately 11.4 % of respondents reported poor/fair self-reported health, with respondents living in nonmetropolitan areas within non-expansion states having the highest rates of poor/fair self-reported health status (18.1 %). Living in a nonmetropolitan area within non-expansion states was associated with higher odds of poor/fair self-reported health status for the overall population and by sex.

Conclusion

In this nationally representative and racially diverse sample, we found that individuals residing in nonmetropolitan areas in non-expansion Medicaid states were more likely to report poor/fair self-reported health status. This effect was present for the majority of the population subgroups. Our findings underscore the double vulnerability faced by populations living in these residence-policy overlaps and the need for targeted interventions.

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双重漏洞?研究2022-2024年美国非扩张医疗补助州非大都市地区生活对工作年龄成年人健康状况的影响

目的研究在美国工作年龄的成年人中，居住在没有扩大医疗补助的州内的非大都市地区是否与自我报告的健康状况差/公平有关。方法分析美国2022-2024年流动人口调查数据（n = 220, 601，年龄25-64岁）。自我报告的健康状况分为报告的健康状况差/一般或良好/非常好/极好。我们对居住和政策背景之间的重叠进行了四级测量，表明受访者是否居住在一个到2023年已经或没有扩大医疗补助覆盖范围的州内的大都市或非大都市地区。在考虑个人和州一级特征的情况下，多水平逻辑回归模型适合于检验我们的居住政策重叠测量与不良/公平自我报告健康状况之间的关联。结果约3.7%的受访者居住在非扩张州的非大都市地区。大约11.4%的答复者自报健康状况差/一般，居住在非扩张州的非大都市地区的答复者自报健康状况差/一般的比率最高（18.1%）。生活在非扩张州内的非大都市地区，总体人口和性别自我报告的健康状况较差/一般的几率较高。在这个具有全国代表性和种族多样性的样本中，我们发现居住在非大都市地区的个人在非扩大医疗补助州更有可能报告较差/公平的自我报告健康状况。这种效应在大多数人口亚群中都存在。我们的研究结果强调了生活在这些居住政策重叠地区的人口所面临的双重脆弱性，以及有针对性干预的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ssm-Population Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

2.10%

发文量

298

审稿时长

101 days

期刊介绍： SSM - Population Health. The new online only, open access, peer reviewed journal in all areas relating Social Science research to population health. SSM - Population Health shares the same Editors-in Chief and general approach to manuscripts as its sister journal, Social Science & Medicine. The journal takes a broad approach to the field especially welcoming interdisciplinary papers from across the Social Sciences and allied areas. SSM - Population Health offers an alternative outlet for work which might not be considered, or is classed as ''out of scope'' elsewhere, and prioritizes fast peer review and publication to the benefit of authors and readers. The journal welcomes all types of paper from traditional primary research articles, replication studies, short communications, methodological studies, instrument validation, opinion pieces, literature reviews, etc. SSM - Population Health also offers the opportunity to publish special issues or sections to reflect current interest and research in topical or developing areas. The journal fully supports authors wanting to present their research in an innovative fashion though the use of multimedia formats.