Heart disease and chronic lower respiratory illnesses are major causes of death for individuals under the age of 65 in the United States. SARS-CoV-2, the virus that causes COVID-19, is known to cause not only lung damage and can also lead to serious heart problems. During the first year of the COVID-19 pandemic there was an increase in the number of cardiovascular related deaths, and research has found an increase of heart-attack related deaths among people ages 25 to 44.
Medicaid is the United States’s public health insurance program that offers coverage to low-income Americans. In 2021, approximately one in six adults and four in 10 children were covered by Medicaid. Prior research has found that adults with Medicaid coverage have higher rates of cardiovascular and respiratory diseases compared to uninsured adults. This research project aimed to answer whether there was an association between state Medicaid per non-senior enrollee spending and heart/respiratory related mortality rates for non-seniors.
For this analysis, we used three different datasets : CDC WONDER Mortality (from the CDC WONDER, Wide-ranging Online Data for Epidemiologic Research), CDC WONDER Population, and KFF CMS Medicaid summary (Center for Medicare Services and KFF). All three datasets are for the United States and about US populations, disaggregated by age and state. The CDC mortality data are from 2021 and the KFF Medicaid data is from 2019. While all three datasets include information for individuals of all ages, in for this analysis we focused on those under the age of 65, since the majority (90%) of the Medicaid population is under the age of 65.
This dataset contains the state populations for 50 states &
District of Columbia for 2021. It has been cleaned to show the total
population of people under the age of 65 per state and now contains only
two columns, state and population.
This dataset contains causes of death in all 50 states & District
of Columbia for 2021. It has been cleaned to show the number of heart
and respiratory related causes of death for those under the age of 65
and now contains only two columns, state and
heart_respiratory_deaths. The conditions included under the
heart_respiratory_deaths are listed in the data dictionary
appendix at the end of this brief.
This dataset contains non-senior enrollment in Medicaid, non-senior
spending for Medicaid, and the spending per non-senior for all 50 states
& District of Columbia for 2019. It has been cleaned to show the
number of spending per state and now contains only four columns,
state, non_senior_enrollment,
non_senior_spending, and
spending_per_non_senior.
This data set merges together the KFF Medicaid data, the CDC Wonder
Mortality data, and the CDC Wonder population data. This also includes
two new variables: mortality_rate, that shows the mortality
rate for heart and respiratory deaths for all 50 states per 100,000
non-seniors, and mortality_to_spending which shows the
number of deaths per medicaid dollar spent.
A Pearson’s correlation test showed no significant correlation between average state Medicaid spending per non-senior and mortality rates for heart and respiratory related deaths per 100,000 non-seniors, with a correlation of -0.145 and p-value of 0.315 (Figure 1).
The five states with the highest number of heart and respiratory deaths per Medicaid dollar spent were Alabama, West Virginia, South Carolina, Mississippi, and Georgia, in that order (Table1). In Alabama, there were about four times as many heart and respiratory deaths per medicaid dollar spent compared to the U.S. as a whole (Figure 2), with a mortality to spending ratio of .79 compared to the national ratio of 0.21. Alabama, West Virginia, and Mississippi also had the highest heart and respiratory mortality rates among non-seniors in the U.S.; West Virginia had 158.06 deaths per 100,000 people compared to the national rate of 75.91.
The table above shows the top 10 states with the highest number of deaths per medicaid dollar spent. The table shows population, respiratory/heart deaths, mortality rate, Medicaid enrollment, spending per Medicaid enrollee, and mortality to spending ratio.
The scatter plot shows each state’s medicaid spending and mortality rate per non-senior, including the five highlighted states which have the highest number of deaths per Medicaid dollar spent among non-seniors. There appears to be no significant correlation between average state Medicaid spending per non-senior and mortality rates for heart and respiratory related deaths per 100,000 non-seniors (r = -0.145, p-value = .315).
The bar graph supplements the information in the scatterplot by “zooming in” on the 5 states with the highest number of deaths per medicaid dollar spent.
While the results did not show a correlation between average state Medicaid spending per non-senior and mortality rates for heart and respiratory related deaths per 100,000 non-seniors, our preliminary plots and analysis suggest there is a drastic difference between the five states with the highest number of deaths per medicaid dollar spent compared to the rest of the country (Figure 2). Given these plots and preliminary analyses, it appears both West Virginia and Alabama are examples of states that would benefit from increased spending in Medicaid programs, as witnessed by their rates compared to the rest of the country.
Future research should look more broadly into other diseases and perhaps overall mortality rates to see if there is any significance, as well as adjust for potential confounding variables Our analysis looked specifically at Medicaid spending rather than Medicare; for future studies, it would be interesting to see if there is a difference between Medicaid and Medicare spending and mortality rate.
| Variable Name | Variable Type | Description |
|---|---|---|
state |
Character | Includes all 50 states & DC |
non_senior_spending |
Numeric | Total state spending for children and adults under the age of 65. |
non_senior_enrollment |
Numeric | Total state enrollment for children and adults under the age of 65. |
spending_per_non_senior |
Numeric | non_senior_spending divided by
non_senior_enrollment |
heart_respiratory_deaths |
Numeric | Number of deaths occurring in each state due to heart or respiratory-related causes. Causes included under this category include:
|
Population |
Numeric | Total state population of those under the age of 65. |
mortality_rate |
Numeric | Mortality rate heart and respiratory related deaths per 100,000 non-seniors |
mortality_to_spending |
Numeric | Number of heart or respiratory-related deaths per medicaid dollar spent |