Population Studies Center, Department of Sociology, University of Pennsylvania, 3718 Locust Walk, Rm 239, Philadelphia, PA 19104, United States.
Soc Sci Med. 2017 Mar;177:205-212. doi: 10.1016/j.socscimed.2017.01.043. Epub 2017 Jan 24.
This article examines lasting mortality improvements associated with availability of Medicaid at time and place of birth. Using the US Vital Statistics (1959-2010), I exploit the variation in when each of the 50 states adopted Medicaid to estimate overall infant mortality improvements that coincided with Medicaid participation. 0.23 less infant deaths per 1000 live births was associated with states' Medicaid implementation. Second, I find lasting associations between Medicaid and mortality improvements across the life-course. I build state-specific cohort life-tables and regress age-specific mortality on availability of Medicaid in their states at time of birth. Cohorts born after Medicaid adoption had lower mortality rates throughout childhood and into adulthood. Being born after Medicaid was associated with between 2.03 and 3.64 less deaths per 100,000 person-years in childhood and between 1.35 and 3.86 less deaths per 100,000 person-years in the thirties. The association between Medicaid at birth and mortality was the strongest in the oldest age group (36-40) in this study.
本文考察了在出生时和出生地点可获得医疗补助(Medicaid)与持久死亡率改善之间的关联。利用美国生命统计数据(1959-2010 年),我利用每个州何时采用医疗补助的差异来估计与医疗补助参与相一致的整体婴儿死亡率改善情况。每 1000 例活产中,婴儿死亡数减少 0.23 例与各州实施医疗补助有关。其次,我发现医疗补助与整个生命过程中的死亡率改善之间存在持久的关联。我建立了州特定的队列生命表,并根据出生时各州医疗补助的可用性,回归了各年龄段的死亡率。在医疗补助采用之后出生的队列在整个儿童期和成年期的死亡率都较低。在儿童期,与每 10 万人中有 2.03 至 3.64 人死亡相比,在三十多岁时,与每 10 万人中有 1.35 至 3.86 人死亡相比,出生后接受医疗补助与死亡率的关联更强。在本研究中,在最年长的年龄组(36-40 岁)中,出生时的医疗补助与死亡率之间的关联最强。