Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Room 6042, 46202, Indianapolis, IN, USA.
BMC Public Health. 2023 Nov 8;23(1):2200. doi: 10.1186/s12889-023-17087-4.
A quarter of United States (US) postpartum women still report unmet health care needs and health care unaffordability. We aimed to study associations between receipt of health insurance coverage and poverty status/receipt of government financial support and determine coverage gaps overall and by social factors among US postpartum women in poverty.
This study design is a cross-sectional study using secondary data. We included women who gave birth within the last 12 months from 2019 American Community Survey Public Use Microdata Sample. Poverty was defined as having an income-to-poverty ratio of less than 100%. We explored Medicaid/government medical assistance gaps among women in poverty. To examine the associations between Medicaid/government medical assistance (exposures) and poverty/government financial support (outcomes), we used age-, race-, and multivariable-adjusted logistic regression models. We also evaluated the associations of state, race, citizenship status, or language other than English spoken at home (exposures) with receipt of Medicaid/government medical assistance (outcomes) among women in poverty through multivariable-adjusted logistic regression.
It was notable that 35.6% of US postpartum women in poverty did not have Medicaid/government medical assistance and only a small proportion received public assistance income (9.8%)/supplementary security income (3.1%). Women with Medicaid/government medical assistance, compared with those without the coverage, had statistically significantly higher odds of poverty [adjusted odds ratio (aOR): 3.15, 95% confidence interval (95% CI): 2.85-3.48], having public assistance income (aOR: 24.52 [95% CI: 17.31-34.73]), or having supplementary security income (aOR: 4.22 [95% CI: 2.81-6.36]). Also, among postpartum women in poverty, women in states that had not expanded Medicaid, those of Asian or other race, non-US citizens, and those speaking another language had statistically significantly higher odds of not receiving Medicaid/government medical assistance [aORs (95% CIs): 2.93 (2.55-3.37); 1.30 (1.04-1.63); 3.65 (3.05-4.38); and 2.08 (1.86-2.32), respectively].
Our results showed that the receipt of Medicaid/government medical assistance is significantly associated with poverty and having government financial support. However, postpartum women in poverty still had Medicaid/government medical assistance gaps, especially those who lived in states that had not expanded Medicaid, those of Asian or other races, non-US citizens, and other language speakers.
四分之一的美国产后女性仍存在未满足的医疗保健需求和医疗保健负担能力问题。我们旨在研究获得医疗保险覆盖范围与贫困状况/获得政府财政支持之间的关联，并确定美国贫困产后女性的整体和社会因素的覆盖范围差距。
本研究设计是一项使用二次数据的横断面研究。我们纳入了 2019 年美国社区调查公共使用微观数据样本中在过去 12 个月内分娩的女性。贫困定义为收入与贫困比率低于 100%。我们探讨了贫困女性中医疗补助/政府医疗援助的差距。为了研究医疗补助/政府医疗援助（暴露因素）与贫困/政府财政支持（结局）之间的关联，我们使用了年龄、种族和多变量调整的逻辑回归模型。我们还评估了州、种族、公民身份状况或在家中讲英语以外的其他语言（暴露因素）与贫困女性获得医疗补助/政府医疗援助（结局）之间的关联，通过多变量调整的逻辑回归。
值得注意的是，35.6%的美国贫困产后女性没有医疗补助/政府医疗援助，只有一小部分人获得公共援助收入（9.8%）/补充保障收入（3.1%）。与没有获得医疗保险的女性相比，获得医疗补助/政府医疗援助的女性贫困的可能性显著更高[调整后的优势比（aOR）：3.15，95%置信区间（95%CI）：2.85-3.48]，获得公共援助收入（aOR：24.52 [95%CI：17.31-34.73]）或补充保障收入（aOR：4.22 [95%CI：2.81-6.36]）。此外，在贫困的产后女性中，没有扩大医疗补助的州、亚裔或其他种族、非美国公民以及讲其他语言的女性没有获得医疗补助/政府医疗援助的可能性显著更高[调整后的优势比（aORs）（95%CI）：2.93（2.55-3.37）；1.30（1.04-1.63）；3.65（3.05-4.38）；和 2.08（1.86-2.32）]。
我们的结果表明，获得医疗补助/政府医疗援助与贫困和获得政府财政支持显著相关。然而，贫困的产后女性仍然存在医疗补助/政府医疗援助差距，尤其是那些生活在没有扩大医疗补助的州、亚裔或其他种族、非美国公民和讲其他语言的人。
