Early-life Medicaid Coverage and Intergenerational Economic Mobility

O’Brien, Rourke; Robertson, Cassandra

doi:10.1177/0022146518771910

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…Finally, recent work suggests that the association between economic opportunity and health over the course of the lifecycle might be bidirectional. 3 , 4 , 39 Further elucidating these complex, reinforcing links may provide important insights into how disparities in health and welfare evolve over time and across generations.…”

Section: Discussionmentioning

confidence: 99%

Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study

Venkataramani

Brigell

O’Brien

et al. 2016

The Lancet Public Health

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Summary Background Inequality of opportunity, defined as differences in the prospects for upward social mobility, might have important consequences for health. Diminished opportunity can lower the motivation to invest in future health by reducing economic returns to health investments and undermining hope. We estimated the association between county-level economic opportunity and individual-level health in young adults in the general US population. Methods In this population-based cross-sectional study, we used individual-level data from the 2009–12 United States Behavioral Risk Factor Surveillance Surveys. Our primary outcomes were current self-reported overall health and the number of days of poor physical and mental health in the last month. Economic opportunity was measured by the county-averaged national income rank attained by individuals born to families in the lowest income quartile. We restricted our sample to adults aged 25–35 years old to match the data used to assign exposure. Multivariable ordinary least squares and probit models were used to estimate the association between the outcomes and economic opportunity. We adjusted for a range of demographic and socioeconomic characteristics, including age, sex, race, education, income, access to health care, area income inequality, segregation, and social capital. Findings We assessed nearly 147 000 individuals between the ages of 25 years and 35 years surveyed from 2009 to 2012. In models adjusting for individual-level demographics and county-level socioeconomic characteristics, increases in county-level economic opportunity were associated with greater self-reported overall health. An interdecile increase in economic opportunity was associated with 0·76 fewer days of poor mental health (95% CI −1·26 to −0·25) and 0·53 fewer days of poor physical health (−0·96 to −0·09) in the last month. The results were robust to sensitivity analyses. Interpretation Economic opportunity is independently associated with self-reported health and health behaviours. Policies seeking to expand economic opportunities might have important spillover effects on health. Funding Robert Wood Johnson Foundation Health and Society Scholars Program.

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Section: Discussionmentioning

confidence: 99%

Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study

Venkataramani

Brigell

O’Brien

et al. 2016

The Lancet Public Health

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“…Evidence from randomized and natural experiments demonstrates that investments made before the age of 5 can lead to improved economic and health outcomes in adulthood [92][93][94]. Policies that provide early-life access to high-quality preschool and healthcare (e.g., through expansions of the Medicaid program) and reduce early exposure to pollution have also been shown to improve educational attainment, income, and health in adulthood [95][96][97][98][99][100]. Investments made later in childhood, adolescence, and young adulthood can also have large impacts on economic and health outcomes.…”

Section: Evidence To Datementioning

confidence: 99%

Economic influences on population health in the United States: Toward policymaking driven by data and evidence

et al. 2020

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• The United States is in the midst of a 40-year-long population health crisis. Life expectancy has declined since 2014, an unprecedented event that has followed on the heels of a decades-long slowing in secular gains in longevity in the US relative to peer countries. These adverse population health trends appear to be primarily driven by worsening health among working-age individuals of lower socioeconomic status. • A growing body of research suggests that worsening economic outcomes-e.g., fading employment opportunities and increasing economic insecurity-may be a primary causal driver of adverse health trends among low-income and less-educated workingage US residents.

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“…47 Examples of successful programs that have achieved both objectives include Head Start, the Carolina Abecedarian Project, 48 and the Perry Preschool program. 49 Other early-life interventions, such as nurse-family partnerships 50 and Medicaid expansions to young children, [51][52][53] have also been shown to raise lifetime social mobility and improve health outcomes in adulthood.…”

Section: Discussionmentioning

confidence: 99%

Association of Social Mobility With the Income-Related Longevity Gap in the United States

2020

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IMPORTANCE Despite substantial research, the drivers of the widening gap in life expectancy between rich and poor individuals in the United States-known as the longevity gap-remain unknown. The hypothesis of this study is that social mobility may play an important role in explaining the longevity gap.OBJECTIVE To assess whether social mobility is associated with income-related differences in life expectancy in the United States. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional, ecological study used data from 1559 counties in the United States to assess the association of social mobility with average life expectancy at age 40 years by sex and income quartile among adult men and women over the period of January 2000 through December 2014. Bayesian generalized linear multilevel regression models were used to estimate the association, with adjustment for a range of socioeconomic, demographic, and health care system characteristics.EXPOSURES County-level social mobility, here operationalized as the association of the income rank of individuals born during the period of January 1980 through December 1982 (based on tax record data, averaged over the period January 2010 through December 2012) with the income ranks of their parents (averaged over the period January 1996 through December 2000) using the location where the parent first claimed the child as a dependent at age 15 years to identify counties. MAIN OUTCOMES AND MEASURESThe main outcome was life expectancy at age 40 years by sex and income quartile. RESULTSThe sample consisted of 1559 counties, which represented 93% of the US population in 2000. Each 1-SD increase in social mobility-equivalent to the difference between a low-mobility state, such as Alabama (ranked 49th on this measure), and a higher-mobility state, such as Massachusetts (ranked 23rd on this measure)-was associated with a 0.38-year (95% credible interval [CrI], 0.29-0.47) and a 0.29-year (95% CrI, 0.21-0.38) increase in county-level life expectancy among men and women, respectively, in the lowest income quartile. Estimates for life expectancies among county residents in the highest income quartile were smaller in magnitude and not robust to covariate adjustment (men: 0.10-year [95% CrI, −0.02 to 0.22] increase; women: 0.08-year [95% CrI, −0.05 to 0.20] increase). Increasing social mobility in all counties to the value of the highest social mobility county was associated with decreases in the life expectancy gap between the highest and lowest income quartiles by 1.4 (95% CrI, 0.7-2.1) years for men and 1.1 (95% CrI, 0.5-1.6) years for women nationally, representing a 20% decrease. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, higher county-level social mobility was associated with smaller county-level gaps in life expectancy by income. These findings motivate further investigation of causal relationships between policies that shift social mobility and health outcomes.

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Early-life Medicaid Coverage and Intergenerational Economic Mobility

Cited by 16 publications

References 42 publications

Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study

Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study

Economic influences on population health in the United States: Toward policymaking driven by data and evidence

Association of Social Mobility With the Income-Related Longevity Gap in the United States

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