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

• Published in: PloS one Vol. 17; no. 8; p. e0272497
• Main Authors: Apenyo, Tsikata, Vera-Urbina, Antonio Elias, Ahmad, Khansa, Taveira, Tracey H, Wu, Wen-Chih
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 11.08.2022; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Comorbidity; Coronaviruses; COVID-19; Diabetes; Disease control; Disease transmission; Economic aspects; Evaluation; Family income; Generalized linear models; Government programs; Health insurance; Health risks; Households; Income; Insurance coverage; Low income groups; Medicaid; Medicine and Health Sciences; Mortality; Obesity; Personal income; Population density; Quartiles; Review boards; Social Sciences; Socioeconomic factors; Uninsured people; Veterans; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272497

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. 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.sup.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. 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. 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.