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Objectives. To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the association between rates of police-related deaths and neighborhood residential segregation (by income, race/ethnicity, or both combined) in the United States. Methods. We identified police-related deaths that occurred in the United States (2015–2016) using a data set from the Guardian newspaper. We used census data to estimate expected police-related death counts for all US census tracts and to calculate the Index of Concentration at the Extremes as a segregation measure. We used multilevel negative binomial models for the analyses. Results. Overall, police-related death rates were highest in neighborhoods with the greatest concentrations of low-income residents (vs high-income residents) and residents of color (vs non-Hispanic White residents). For non-Hispanic Blacks, however, the risk was greater in the quintile of neighborhoods with the highest concentration of non-Hispanic White residents than in certain neighborhoods with relatively higher concentrations of residents of color (the third and fourth quintiles). Conclusions. Neighborhood context matters—beyond individual race/ethnicity—for understanding, preventing, and responding to the occurrence of police-related deaths. Public Health Implications. Efforts to monitor, prevent, and respond to police-related deaths should consider neighborhood context, including levels of segregation by income and race/ethnicity. [ABSTRACT FROM AUTHOR]

Objectives. We examined the effects of market income inequality (income inequality before taxes and transfers) and income redistribution via taxes and transfers on inequality in longevity. Methods. We used life tables to compute Gini coefficients of longevity inequality for all individuals and for individuals who survived to at least 10 years of age. We regressed longevity inequality on market income inequality and income redistribution, and we controlled for potential confounders, in a cross-sectional time-series sample of up to 28 predominantly Western developed countries and up to 37 years (1974-2011). Results. Income inequality before taxes and transfers was positively associated with inequality in the number of years lived; income redistribution (the difference between market income inequality and income inequality after taxes and transfers were accounted for) was negatively associated with longevity inequality. Conclusions. To the extent that our estimated effects derived from observational data are causal, governments can reduce longevity inequality not only via public health policies, but also via their influence on market income inequality and the redistribution of incomes from the relatively rich to the relatively poor. [ABSTRACT FROM AUTHOR]

Objectives. To determine the prevalence trends of osteoarthritis (OA), rheumatoid arthritis (RA), and other types of arthritis in the United States from 1999 to 2014. Methods. We analyzed data on 43 706 community-dwelling adults aged 20 years and older who participated in the 1999–2014 National Health and Nutrition Examination Surveys. We accounted for survey design and sampling weights so that estimates were nationally representative. We assessed temporal trends in age-standardized arthritis prevalence by using joinpoint regression. Results. Age-adjusted prevalence of arthritis was 24.7% (OA = 9.7%; RA = 4.2%; other arthritis = 2.8%; “don’t know” type = 8.0%). Prevalence of OA increased from 6.6% to 14.3%, whereas RA prevalence decreased from 5.9% to 3.8%. Increase in OA prevalence was significant in both genders; in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics; and in people with high socioeconomic status. Decrease in RA prevalence was more pronounced in men, non-Hispanic Blacks, and participants with low income or obesity. Conclusions. Between 1999 and 2014, nearly one quarter of American adults reported arthritis. The prevalence of OA has more than doubled over time, whereas RA prevalence has declined. [ABSTRACT FROM AUTHOR]

Objectives. To determine enrollment rates and predictors of enrollment for newly eligible low-income adults in California following the Affordable Care Act's (ACA's) Medicaid expansion. Methods. We used data from the 2014 to 2015 California Health Interview Survey to examine post-ACA Medicaid enrollment rates and multivariable logistic regression to assess the association of demographic factors, income, and health with enrollment. Results.Wefound a 78.5% enrollment rate for the newly eligible Medicaid population, translating to 3.8 million adults enrolled and 1.1 million adults who were eligible but did not enroll. Significant predictors of enrollment were participating in a public welfare program (odds ratio [OR] = 6.59; 95% confidence interval [CI] = 3.09, 14.04), having heart disease (OR = 4.03; 95% CI = 1.34, 12.15), being in the top quartile of income (OR = 3.59; 95% CI = 1.64, 7.85), enrolling in 2015 (OR = 3.28; 95% CI = 1.94, 5.56), being unemployed (OR = 2.10; 95% CI = 1.15, 3.82), and being female (OR = 1.71; 95% CI = 1.03, 2.85).Wedid not find significant disparities across race/ethnicity, education level, or geography. Conclusions. Repeal of Medicaid expansion would have a substantial effect on health insurance coverage among California's low-income adults, many of whom report chronic health conditions and no alternative sources of affordable coverage. Future research should examine the mechanisms explaining the higher enrollment rates among California's Medicaid expansion population. [ABSTRACT FROM AUTHOR]

Objectives. We sought to update income-specific secular trends in obesity in Brazil to assess the hypothesis that the disease burden is shifting toward the poor. Methods. We compared overall and income-specific obesity prevalence rates estimated for Brazilian men and women from national surveys conducted in 1975, 1989, and 2003. We calculated age-adjusted prevalence ratios to assess time trends. Results. In the first 14-year period examined (1975-1989), obesity rates among men and women increased by 92% and 63%, respectively, and increases were relatively higher among individuals in lower income groups. In the second 14-year period (1989-2003), there were further increases in obesity among men, and again increases were larger among the poor. In this second period, the obesity rate remained virtually stable in the overall female population, but it increased by 26% among women in the 2 lower income quintiles and decreased by 10% among women in the 3 higher income quintiles. Conclusions. The burden of obesity is shifting toward the poor and can no longer be considered a disease of the socioeconomic elite. Policymakers need to design policy and programs that reach all members of society, but especially the poor. (Am J Public Health. 2007;97:1808-1812. doi:10.2105/AJPH.2006.099630) [ABSTRACT FROM AUTHOR]

Abstract: Using data from the National Survey of Family Growth. Cycle II, the per ¢ of women without a Pap test in 1973-76 is shown according to race, residence, and income, updating an earlier report based on 1973 data. Poor women and nonmetropolitan women continued to be significantly less likely than other women to have had a Pap test. (Am J Public Health 1981:71:851-852.) [ABSTRACT FROM AUTHOR]