Association between median household income, state Medicaid expansion status, and COVID-19 outcomes across US counties

Abstract

Objective To study the relationship between county-level COVID-19 outcomes (incidence and mortality) and county-level median household income and status of Medicaid expansion of US counties. Methods Retrospective analysis of 3142 US counties was conducted to study the relationship between County-level median-household-income and COVID-19 incidence and mortality per 100,000 people in US counties, January-20th-2021 through December-6th-2021. County median-household-income was log-transformed and stratified by quartiles. Multilevel-mixed-effects-generalized-linear-modeling adjusted for county socio-demographic and comorbidities and tested for Medicaid-expansion-times-income-quartile interaction on COVID-19 outcomes. Results There was no significant difference in COVID-19 incidence-rate across counties by income quartiles or by Medicaid expansion status. Conversely, for non-Medicaid-expansion states, counties in the lowest income quartile had a 41% increase in COVID-19 mortality-rate compared to counties in the highest income quartile. Mortality-rate was not related to income in counties from Medicaid-expansion states. Conclusions Median-household-income was not related to COVID-19 incidence-rate but negatively related to COVID-19 mortality-rate in US counties of states without Medicaid-expansion.

Socioeconomic disparities associated with mortality in patients hospitalized for COVID-19 in Colombia

“…Multiple mechanisms have been postulated that may explain why this population had a higher risk of dying during this pandemic. Sharma et al ( 31 ), Hussey et al ( 32 ), and Apenyo et al ( 33 ), mentioned that the marginalized populations during the restrictive public health measures implemented, were forced to mobilize due to economic pressure, which increased the risk of infection and consequently a greater risk of death. It is also believed that the poorest population has a greater burden of comorbidities.…”

“…The lack of access to high-complexity healthcare centers and tests that allow prioritization of high-risk cases cause patients to quickly lead to serious conditions or death. Also, the population with a lack of access to public services and with suboptimal housing conditions will be more exposed not only to COVID-19 but also to other infectious diseases, and indeed, to a greater risk of death ( 14 , 31 , 33 – 35 ). Finally, we observed a gradual reduction in the risk of mortality from COVID-19 from the first wave to the fifth wave, in the highest poverty levels of the CMPI, similar than in the studies by Hussey et al, Leveau et al, and Bastos et al This may be explained by some increase in herd immunity and vaccination efforts in the population ( 32 , 36 ).…”