scholarly journals Depressive Symptoms in Older African Immigrants: A Descriptive Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Manka Nkimbeng ◽  
Zachary Baker ◽  
Janiece Taylor ◽  
Sarah Szanton ◽  
Tetyana Shippee ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Insurance Coverage ◽  
Severe Depression ◽  
Secondary Data ◽  
African Immigrants ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Study ◽  
Related Factors ◽  
Significant Difference

Abstract In FY 2018-2019, the National Institutes of Health devoted $2,387,505,711 to projects studying depression. Before and following their arrival into the United States stressful life circumstances may render African immigrants particularly at risk for depression. The objective of this study is to provide an estimate and identify correlates of depressive symptoms in older (≥50 years) African immigrants. We performed secondary data analyses of the Older African Immigrant Health study (n = 148). Bivariate analyses evaluated associations between depressive symptoms and sociodemographic and immigration-related factors. Depressive symptoms were measured with the PHQ-8 scale and scores of ≥ 5 were considered indicative of depressive symptoms. The mean age of participants was 62 years (SD:8.2), 61% were female, 30% had less than high school education, and 58% reported having health insurance coverage. Thirty percent of the sample had depressive symptoms (PHQ-8 score of ≥ 5) but only one individual would be classified as having moderately severe or severe depression (PHQ-8 ≥15). Depressive symptoms did not differ by age, marital status, education, or income. There was a statistically significant difference in depressive symptoms by reason for migration, recruitment location, and employment status. Although only one participant would be classified as severely depressive, a large proportion of this sample had depressive symptoms. Mental health concerns were reported as a significant health problem for African immigrants visiting a community service organization in New York. More research is needed to examine the prevalence, immigration-related correlates, predictors, and health ramifications of depression in older African immigrants.

Health Insurance Coverage and Physician Use Among Children With Disabilities: Findings From Probability Samples in Five Metropolitan Areas

PEDIATRICS ◽  
1987 ◽  
Vol 79 (1) ◽  
pp. 89-98
Author(s):  
John A. Butler ◽  
Judith D. Singer ◽  
Judith S. Palfrey ◽  
Deborah K. Walker
Keyword(s):  
Health Insurance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Children With Disabilities ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physician Visits ◽  
Significant Difference ◽  
Privately Insured

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that (1) health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P < .05); (2) Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P < .001), but there was no similar statistically significant difference between blacks and whites; and (3) wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various lowprevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Data Processing Improvements for Estimates of Health Insurance Coverage in the Current Population Survey Annual Social and Economic Supplement

2021 ◽  
pp. 107755872110008
Author(s):  
Edward R. Berchick ◽  
Heide Jackson
Keyword(s):  
Health Insurance ◽  
Data Processing ◽  
Current Population Survey ◽  
Population Survey ◽  
Insurance Coverage ◽  
Processing System ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Insurance Data ◽  
Current Population

Estimates of health insurance coverage in the United States rely on household-based surveys, and these surveys seek to improve data quality amid a changing health insurance landscape. We examine postcollection processing improvements to health insurance data in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), one of the leading sources of coverage estimates. The implementation of updated data extraction and imputation procedures in the CPS ASEC marks the second stage of a two-stage improvement and the beginning of a new time series for health insurance estimates. To evaluate these changes, we compared estimates from two files that introduce the updated processing system with two files that use the legacy system. We find that updates resulted in higher rates of health insurance coverage and lower rates of dual coverage, among other differences. These results indicate that the updated data processing improves coverage estimates and addresses previously noted limitations of the CPS ASEC.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

scholarly journals Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

2021 ◽  
pp. bmjsrh-2020-200966
Author(s):  
Heidi Moseson ◽  
Laura Fix ◽  
Caitlin Gerdts ◽  
Sachiko Ragosta ◽  
Jen Hastings ◽  
...  
Keyword(s):  
United States ◽  
Clinical Supervision ◽  
Online Survey ◽  
Clinical Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physical Trauma ◽  
Abortion Care ◽  
And Gender

BackgroundTransgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.MethodsIn 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.ResultsOf 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.ConclusionsThese data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

Abstract P193: High Density Lipoprotein is Superior to Triglyceride as a Biomarker of Physiologic Stress in African Immigrants: The Africans in America Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Rafeal L Baker ◽  
Jean N Utumatwishima ◽  
Stephanie T Chung ◽  
Anne E Sumner
Keyword(s):  
High Density Lipoprotein ◽  
Allostatic Load ◽  
Density Lipoprotein ◽  
African Immigrants ◽  
Cardiac Risk ◽  
The United States ◽  
High Density ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction: For Africans living in the United States, the extent to which stress-induced physiologic dysfunction varies by reason for immigration is unknown. Allostatic load score (ALS) is used to assess physiologic stress. ALS has biomarkers in 3 domains: cardiovascular, metabolic and immune. However, there are many ALS equations and the number of biomarkers in each domain varies. In the cardiac domain of ALS, equations use either triglyceride (TG) or high density lipoprotein (HDL). A specific problem for African descent populations is that HDL may be superior to TG as a marker of insulin resistance and cardiac risk. Objective: Our primary goal in 95 African immigrants (71% male, age 42±10, (mean±SD), range 22-62y) was to determine if ALS varied by reason for immigration. Our secondary goal was to evaluate 4 different ALS equations to determine if there was a difference in ALS performance depending on whether HDL or TG was the included biomarker. Methods and Results: For all 4 equations, the reasons for immigration from lowest to highest ALS were: family reunification, lottery for self and immediate family, marriage, asylum, work and study (Figure 1). As the first 3 reasons for immigration promoted family unity, they were grouped together (Group 1). The Africans who came for other reasons were grouped together (Group 2). Equations 1 and 2 included HDL as a biomarker. For these equations, ALS in Group 1 vs. Group 2 were: 1.7±1.3 vs. 2.8±1.7, P <0.01 and 1.4±1.2 vs. 2.3±1.7, P <0.01 resp. Equations 3 and 4 used TG. For these two equations ALS in Group 1 vs. Group 2 were: 2.2±1.6 vs. 2.9±2.0, P =0.08 and 2.1±1.4 vs. 2.9±2.0, P =0.03 resp. In Equations 1 and 2, when HDL was replaced by TG, the significant difference in ALS between groups declined. In Equations 3 and 4, when TG was replaced by HDL, the significant difference in ALS between groups increased. Conclusions: ALS varies by reason for immigration and is easier to detect in ALS equations which use HDL rather than TG.

scholarly journals Union Effects on Health Insurance Provision and Coverage in the United States

ILR Review ◽  
2002 ◽  
Vol 55 (4) ◽  
pp. 610-627 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
John Dinardo ◽  
Robert G. Valletta
Keyword(s):  
United States ◽  
Health Insurance ◽  
Survey Data ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Union Density ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Coverage ◽  
Private Sector Union

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983–97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee “take-up” of offered insurance, and that declining unionization explains 20–35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion

2014 ◽  
Vol 40 (2-3) ◽  
pp. 237-252
Author(s):  
Jean C. Sullivan ◽  
Rachel Gershon
Keyword(s):  
Low Income ◽  
Insurance Coverage ◽  
Supreme Court Decision ◽  
Health Insurance Coverage ◽  
The United States ◽  
Primary Objective ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Assistance Program ◽  
Social Security Act

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.

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