Datta Biplab Kumar, Coughlin Steven S, Moore Justin Xavier, Chen Jie
Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.
Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA.
Res Health Serv Reg. 2024 Sep 4;3(1):13. doi: 10.1007/s43999-024-00049-7.
Medical financial hardship in the United States is a growing public health concern. This study aims to assess the south vs. non-south disparities in medical financial hardship among US adults of different generations - Boomers (born between 1946 and 1964), Generation X (born between 1965 and 1980), and the Millennials (born between 1981 and 1996) across periods pre- and post- Affordable Care Act (ACA).
This observational study utilizes data from multiple waves of the National Health Interview Survey (NHIS) split into three periods: pre-ACA (2011-2013), ii) post ACA (2015-2018), and iii) COVID-19 pandemic (2021-2022). Multivariable logistic regressions were fitted, separately for each generation in each period, to compare the extent of medical financial hardship among those from South to rest of the US, and Karlson-Holm-Breen (KHB) decomposition was applied to analyze whether there was a mediating impact of health insurance coverage.
Adults living in the South were more likely to experience medical financial hardship in all three periods. Residing in the South was associated with 1.7 to 2.6% points (pp) higher probability of medical financial hardship among boomers, 1.8 to 4.0 pp among generation Xers, and 1.7 to 2.8 pp among millennials. The relationship was robust after accounting for chronic comorbidities, sociodemographic and socioeconomic attributes and was partially mediated through differences in health insurance coverage.
The problem of medical financial hardship has been deeply rooted in the South across generations, which was partly attributable to the regional differences in health insurance coverage.
美国的医疗财务困境日益成为公共卫生领域关注的问题。本研究旨在评估不同代际的美国成年人（婴儿潮一代，出生于1946年至1964年；X一代，出生于1965年至1980年；千禧一代，出生于1981年至1996年）在《平价医疗法案》（ACA）实施前后各时期，南方与非南方地区在医疗财务困境方面的差异。
这项观察性研究利用了多轮国家健康访谈调查（NHIS）的数据，分为三个时期：ACA实施前（2011 - 2013年）、ii）ACA实施后（2015 - 2018年）以及iii）新冠疫情期间（2021 - 2022年）。针对每个时期的每一代人群，分别进行多变量逻辑回归，以比较南方人群与美国其他地区人群在医疗财务困境方面的程度，并应用卡尔森 - 霍尔姆 - 布林（KHB）分解法分析医疗保险覆盖情况是否存在中介作用。
在所有三个时期，居住在南方的成年人更有可能经历医疗财务困境。居住在南方使婴儿潮一代面临医疗财务困境的概率提高1.7至2.6个百分点（pp），X一代提高1.8至4.0个百分点，千禧一代提高1.7至2.8个百分点。在考虑慢性合并症、社会人口统计学和社会经济属性后，这种关系依然稳健，并且部分是通过医疗保险覆盖差异介导的。
医疗财务困境问题在南方各代人中根深蒂固，部分原因是医疗保险覆盖的地区差异。
