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

  1. Tsikata Apenyo
  2. Antonio Elias Vera-Urbina
  3. Khansa Ahmad
  4. Tracey H. Taveira
  5. Wen-Chih Wu

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Abstract

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-6 th -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.

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  1. Version published to 10.1371/journal.pone.0272497
  2. ScreenIT

    SciScore for 10.1101/2021.02.03.21251075: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 18 All data used in this study were publicly available; therefore, the study met the criteria for exemption by the Providence Veterans Affairs Medical Center Institutional Review
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using STATA/SE version 11.2 software (StataCorp LP, College Station, TX).
    STATA/SE
    suggested: None
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations and Strengths: This is a nationwide study, that utilized representative data of US communities suitable to assess outcomes as it relates to policy. Study limitations include its observational design, inability to conclude causality and the potential for residual confounding despite our careful control of known confounders. Although some states adopted Medicaid expansion into their state constitution during 2020 (Missouri and Oklahoma), none of them achieved implementation stage during 2020.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.02.03.21251075v1 on medRxiv