West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA.
West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA.
Soc Sci Med. 2023 Nov;336:116249. doi: 10.1016/j.socscimed.2023.116249. Epub 2023 Sep 20.
Community-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations.
Data were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses.
County-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor.
Findings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.
社区层面的社会经济差异对个人的健康和整体幸福感有重大影响。然而，目前用于评估社区社会经济地位的贫困线估计值并没有考虑生活成本差异或地理位置的可变性。本研究的目的是比较地理县级在贫困和工作贫困家庭获得医疗保健方面的重叠和差距。
从联合之路的有资产限制、收入受限、就业（ALICE）家庭中获取了 21 个美国大陆州的数据，时间为 2021 年。原始数据包含联邦贫困线家庭的百分比、ALICE 设计家庭（工作贫困）的百分比和县级家庭的总数。进行局部 Moran's I 检验以识别贫困和 ALICE 家庭的空间自相关聚类。这些聚类与从关键接入医院物理地址 30 分钟车程的时间进行了叠加。
ALICE（工作贫困）家庭的县级聚类与贫困家庭的聚类发生在不同的地区。特别值得注意的是，到关键护理的 30 分钟车程与 ALICE 或贫困聚类的重叠程度因州而异。总体而言，ALICE 和贫困的聚类与到关键护理的 30 分钟车程的重叠度在 46%至 90%之间。然而，关注贫困家庭与关注工作贫困家庭的分析中，获得医疗保健机会的差异显著的具体州不同。
研究结果突出了在社会经济地位范围内平等包容个人方面的差异。此外，这表明，当前支持低收入社会经济群体的公共卫生计划和福利可能会遗漏一个工作家庭的弱势亚群体。需要进一步研究以更好地了解如何解决面临经济困难的个人的健康差距，这些个人的收入高于贫困线，但仍难以满足基本需求。
