Shadowen Hannah, Marks Sarah J, Obembe Olufemi, Mitchell Andrew, Bachireddy Chethan, Hines Anika, Sabo Roy, Cunningham Peter, Krist Alex, Barnes Andrew
Department of Health Policy, School of Public Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Virginia Department of Medical Assistance Services, Richmond, Virginia, USA.
Health Serv Res. 2025 Apr;60 Suppl 2(Suppl 2):e14416. doi: 10.1111/1475-6773.14416. Epub 2024 Dec 5.
To understand relationships between healthcare use and food and housing insecurity in Medicaid expansion members, as well as whether these relationships differ by rurality or residential segregation.
Database of Virginia Medicaid expansion members from the Department of Medical Assistance Services. Sample included individuals who enrolled January-June 2019, were aged 19-64 years, remained continuously enrolled for 12 months, and completed a Medicaid Member Health Screening (MMHS) conducted within the first 3 months of enrollment (n = 14,735).
Retrospective cohort study. Outcomes included any primary care visits (PC) and any emergency department (ED) visits in the first 12 months of enrollment. The MMHS sample was weighted to represent all Medicaid expansion members (n = 234,296). Separate multivariable linear probability models regressed having any PC or ED visits on food and housing insecurity controlling for individual and neighborhood characteristics. Models were then stratified by rurality and racial residential segregation.
None.
Food insecurity was negatively associated with having any PC visit (-2.9 percentage points (PP); p-value <0.01) and positively associated with having any ED visit (7.0 PP; p-value <0.001). No significant relationships between PC or ED visits and housing insecurity were found. Suburban and urban individuals with food insecurity were significantly less likely to have any PC visit (p < 0.05 each). Medicaid expansion members living in disproportionately low-income or mixed-income neighborhoods experiencing food insecurity were also less likely to have any PC visits (p < 0.05), and the same was not true for those living in disproportionately high-income neighborhoods.
Food insecurity among Medicaid expansion members is associated with less primary care and more emergency department use, but these relationships differ by the neighborhoods in which members live. Medicaid agency efforts that coordinate medical and social service benefits and also consider local context may further increase access to necessary and appropriate care.
了解医疗补助扩大计划参保者的医疗服务使用情况与粮食及住房不安全状况之间的关系，以及这些关系在农村地区或居住隔离方面是否存在差异。
弗吉尼亚医疗补助扩大计划参保者数据库，来自医疗救助服务部。样本包括2019年1月至6月参保、年龄在19 - 64岁之间、连续参保12个月且在参保的前3个月内完成了医疗补助参保者健康筛查（MMHS）的个体（n = 14,735）。
回顾性队列研究。结局包括参保的前12个月内的任何初级保健就诊（PC）和任何急诊科（ED）就诊。MMHS样本经过加权以代表所有医疗补助扩大计划参保者（n = 234,29）。分别采用多变量线性概率模型，在控制个体和邻里特征的情况下，将是否有任何PC或ED就诊情况对粮食及住房不安全状况进行回归分析。然后按农村地区和种族居住隔离情况进行分层分析。
无。
粮食不安全与任何PC就诊呈负相关（-2.9个百分点（PP）；p值<0.01），与任何ED就诊呈正相关（7.0个百分点；p值<0.001）。未发现PC或ED就诊与住房不安全之间存在显著关系。有粮食不安全问题的郊区和城市个体进行任何PC就诊的可能性显著较低（均p < 0.05）。生活在低收入或混合收入社区且面临粮食不安全问题的医疗补助扩大计划参保者进行任何PC就诊的可能性也较低（p < 0.05）；而生活在高收入社区的参保者情况并非如此。
医疗补助扩大计划参保者中的粮食不安全状况与较少的初级保健利用和较多的急诊科就诊相关，但这些关系因参保者居住的社区而异。医疗补助机构协调医疗和社会服务福利并考虑当地情况的努力，可能会进一步增加获得必要和适当医疗服务的机会。
