Geospatial Analysis of the Association Between Medicaid Expansion, Minimum Wage Policies, and Alzheimer’s Disease Dementia Prevalence in the United States

Abstract

Previous studies indicate that increased healthcare access through Medicaid expansion and alleviation of socioeconomic stressors via higher minimum wages improved health outcomes. This study investigates the spatial relationships between the Medicaid expansion, minimum wage policy, and Alzheimer’s Disease (AD) dementia prevalence across the US. We used county-level AD dementia prevalence adjusted for age, sex, race/ethnicity, and education. Social Vulnerability Index (SVI) data, Medicaid expansion status, and state minimum wage law status were incorporated from CDC, Kaiser Family Foundation, and US Department of Labor sources, respectively. We employed the Getis-Ord Gi* statistic to identify hotspots and cold spots of AD dementia prevalence at the county level. We compared these locations with the overall SVI scores using univariate analyses. We also assessed the proportion of hot and cold spots at the state level based on Medicaid expansion and minimum wage status using the logistic regression model. The most vulnerable SVI quartile (Q4) had the highest number of hotspots (n = 311, 64.8%), while the least vulnerable quartile (Q1) had the fewest hotspots (n = 22, 4.6%) (χ2 = 307.41, p p p p p < 0.01). Our findings suggest significant disparities in AD dementia prevalence related to socioeconomic and policy factors and lay the groundwork for future causal analyses.

Keywords

• Alzheimer’s disease dementia
• Medicaid expansion
• minimum wage policy
• social vulnerability index
• spatial analysis