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Annual Review of Public Health Apr 2021Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been... (Review)
Review
Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been implemented around the world to increase financial resources. We refer to these as cash transfers. In this article, we discuss theory and evidence on whether, how, for whom, and to what extent purposeful cash transfers improve health. Evidence suggests that cash transfers produce positive health effects, but there are many complexities and variations in the outcomes. Continuing research and policy innovation-for example, universal basic income and universal Child Development Accounts-are likely to be productive.
Topics: Health; Humans; Public Assistance; Randomized Controlled Trials as Topic
PubMed: 33395543
DOI: 10.1146/annurev-publhealth-090419-102442 -
JAMA Network Open Sep 2023Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for...
IMPORTANCE
Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.
OBJECTIVE
To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.
EXPOSURE
Differential state-level public assistance spending.
MAIN OUTCOME AND MEASURE
The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.
RESULTS
A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects).
CONCLUSIONS AND RELEVANCE
This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.
Topics: Adult; Aged; Female; Humans; Male; Cohort Studies; Ethnicity; Neoplasms; Public Assistance; Survival Rate; United States; Black or African American
PubMed: 37669050
DOI: 10.1001/jamanetworkopen.2023.32353 -
BMC Geriatrics Mar 2022Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have...
BACKGROUND
Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have higher risks of morbidity than non-recipients, and mental health is strongly related to frailty. We aimed to examine whether older recipients of public assistance were more likely to have depressive symptoms compared to non-recipients.
METHODS
Data were obtained from the Japan Gerontological Evaluation Study, a 2016 community-based study of older adults. Poisson regression analyses with a robust error variance using fixed effects were conducted to examine the relationship between receiving public assistance and depressive symptoms controlling for sociodemographic factors. Depressive symptoms were assessed by the Geriatric Depression Scale 15.
RESULTS
We found that the older recipients of public assistance were 1.57 times (95% confidence interval [CI]: 1.47, 1.67) more likely to have depressive symptoms compared to non-recipients. We also found that, when additionally adjusting for indicators of social participation, this relationship was slightly attenuated; however, the recipients still had worse mental health issues (Prevalence ratio: 1.33; 95% CI: 1.25, 1.42).
CONCLUSIONS
Even after controlling for sociodemographic factors, older recipients of public assistance tended to be more depressed than non-recipients. However, our findings also indicated that social participation could slightly attenuate the negative relationship between receiving public assistance and depressive symptoms. Therefore, the public assistance program needs to consider the inclusion of mental healthcare support in addition to financial support.
Topics: Aged; Cross-Sectional Studies; Depression; Humans; Japan; Public Assistance; Social Participation
PubMed: 35236284
DOI: 10.1186/s12877-022-02868-0 -
Journal of Health Care For the Poor and... 2020Rental assistance, in the form of vouchers and project-based subsidized housing, is a primary source of affordable housing for low-income Americans, given a growing and...
Rental assistance, in the form of vouchers and project-based subsidized housing, is a primary source of affordable housing for low-income Americans, given a growing and severe shortage of private-market rental units. However, due to supply constraints, fewer than one in four eligible households receive this kind of assistance. In this paper, we examine associations between receipt of rental assistance and self-rated health among a sample of 400 low-income adults in one U.S. city. We find that individuals who currently receive rental assistance have lower odds of reporting poor or fair self-rated health than individuals who are currently on rental assistance waiting lists. These relationships persist after adjusting for factors that affect access to rental assistance and are not significantly modified by criminal justice history. Our findings suggest that the current unmet need for rental assistance may contribute to poor health among low-income Americans.
Topics: Adult; Connecticut; Female; Health Status; Health Surveys; Humans; Male; Middle Aged; Public Assistance; Public Housing; Self-Assessment; Social Determinants of Health; Waiting Lists
PubMed: 32037334
DOI: 10.1353/hpu.2020.0025 -
JAMA Network Open May 2023Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer,...
IMPORTANCE
Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable.
OBJECTIVE
To examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023.
EXPOSURE
Cancer history.
MAIN OUTCOMES AND MEASURES
The main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending.
RESULTS
Of 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.
Topics: Humans; Adult; Female; Male; Health Expenditures; Cross-Sectional Studies; Income; Public Assistance; Unemployment; Neoplasms
PubMed: 37234005
DOI: 10.1001/jamanetworkopen.2023.15823 -
BMC Pediatrics May 2021Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social...
BACKGROUND
Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children's health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.
METHODS
We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients' sociodemographic factors from January 2016 and identified the incidence of childhood diseases' diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.
RESULTS
Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16-2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07-1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21-2.70), and dental diseases (IR = 1.79; 95% CI, 1.33-2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children's acute health conditions.
CONCLUSIONS
Among public assistance recipients, living in single-parent households may be a risk factor for children's chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children's health conditions, contents of medical treatments, and broader socioeconomic factors.
Topics: Adolescent; Child; Cohort Studies; Dental Caries; Humans; Japan; Public Assistance; Retrospective Studies
PubMed: 33941113
DOI: 10.1186/s12887-021-02682-4 -
ESC Heart Failure Jun 2022There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to... (Observational Study)
Observational Study
AIMS
There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance.
METHODS AND RESULTS
The Kyoto Congestive Heart Failure registry was a physician-initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow-up of 470 days, the cumulative 1 year incidences of all-cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all-cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69-1.32; P = 0.84]. Even after taking into account the competing risk of all-cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64-1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07-2.29; P = 0.02).
CONCLUSIONS
The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all-cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
Topics: Aftercare; Cohort Studies; Heart Failure; Humans; Patient Discharge; Prospective Studies; Public Assistance; Registries; Stroke Volume; Ventricular Function, Left
PubMed: 35289117
DOI: 10.1002/ehf2.13898 -
Archives of Gerontology and Geriatrics 2022Public assistance programs guarantee a minimum living standard, promoting independence for impoverished citizens. Although public assistance eligibility is mainly based...
BACKGROUND
Public assistance programs guarantee a minimum living standard, promoting independence for impoverished citizens. Although public assistance eligibility is mainly based on economic factors like poverty, psychosocial factors may be important in initiating and terminating participation. We explored factors governing commencement and termination of public assistance by the older Japanese population between 2013 and 2016.
METHODS
We used panel data from the Japan Gerontological Evaluation Study (JAGES), conducted in 2013 and 2016. Fixed-effects regression was used to examine variables in 2013 that were related to receiving public assistance in 2016. The Tokyo Metropolitan Institute of Gerontology -competence index (TMIG-CI) was used to assess higher-level activities of daily living (ADL, i.e., instrumental ADL, intellectual activity, and social role). The role of individual perceptions of community social cohesion (community trust, mutual help, and attachment), and sociodemographic factors were considered.
RESULTS
While 215 people (0.5%) started receiving public assistance between 2013 and 2016, almost 50% stopped participating. People with higher perceived mutual community help were 1.21 times (95% confidence interval [CI]: 1.02-1.46) more likely to commence public assistance three years later. Public assistance recipients who felt community attachment to their resident community, and had social roles were 1.16 (95% CI: 1.06-1.28) and 1.15 (95% CI: 1.01-1.30) times more likely to give up public assistance three years later, respectively, independent of socioeconomic statuses.
CONCLUSION
Psychosocial factors, including maintaining good relationships with community residents, could be important in accessing and terminating public assistance services.
Topics: Activities of Daily Living; Geriatrics; Humans; Japan; Longitudinal Studies; Public Assistance
PubMed: 34971872
DOI: 10.1016/j.archger.2021.104615 -
[Nihon Koshu Eisei Zasshi] Japanese... Jan 2022Objectives In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been...
Objectives In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been implemented for them. This study aimed to investigate the expectations and problems of welfare offices, as well as their requests to the central government and prefectures about the healthcare management support program for public assistance recipients, which has been mandated since 2021.Methods In November 2019, snowball sampling was used to select 23 welfare offices for sending self-administered questionnaires about the healthcare management support program. Respondents were asked open-ended questions about their expectations and problems regarding the program, as well as their requests to the central government and prefectures. A subsequent interview survey was conducted from November 2019 to February 2020, gathering additional information on the questionnaire survey.Results We received consent for the questionnaire survey and interview survey from 16 welfare offices (response rate 69.6%). It was revealed that the staff in charge of the healthcare management support program at the welfare office expected the program to improve recipients' health awareness and condition and for it to be applied to other residents in the community. They reported difficulty in developing the implementation system, setting up the indicators and target population, and retaining health professionals. They requested the central government and prefectures to clarify the indicators and the criteria for evaluation, provide reference materials, introduce precedents, communicate and coordinate with welfare offices and related organizations in the community, hold meetings to share information, and secure financial resources.Conclusion Findings from our study suggest a need to strengthen the cooperation between the central government, prefectures, and local governments and to establish a multilayered system to implement the healthcare management support program effectively in welfare offices.
Topics: Health Services Needs and Demand; Humans; Local Government; Motivation; Public Assistance; Social Welfare
PubMed: 34719539
DOI: 10.11236/jph.21-070 -
Annals of Epidemiology Feb 2017We examined if receipt of public assistance during childhood lowered risk for hypertension by mid-life in a cohort of African Americans in the Southeastern United States.
PURPOSE
We examined if receipt of public assistance during childhood lowered risk for hypertension by mid-life in a cohort of African Americans in the Southeastern United States.
METHODS
We used multiple logistic regression models to assess the relationship between receipt of public assistance during childhood and adult hypertension among 405 male and 737 female adult participants enrolled between 1988 and 2001 in the Pitt County Study, a community-based prospective cohort study of African Americans in North Carolina. Statistical analyses were adjusted for child and adult sociodemographic measures as well as adult psychosocial and lifestyle factors.
RESULTS
Women who grew up in economically disadvantaged families and who received public assistance during childhood had a 66% decreased odds of hypertension by mid-life compared with women similarly disadvantaged in childhood but who did not receive public assistance, odds ratio = 0.34; 95% confidence interval: 0.14-0.83. No association was observed for African American men.
CONCLUSIONS
Receipt of anti-poverty federal assistance during childhood was associated with reduced risk for hypertension by mid-life among African American women. It is possible that social expenditures on public assistance programs for families in need could produce long-term health benefits for children.
Topics: Adolescent; Adult; Black or African American; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Female; Humans; Hypertension; Infant; Infant, Newborn; Logistic Models; Male; Middle Aged; North Carolina; Odds Ratio; Poverty; Prospective Studies; Public Assistance; Socioeconomic Factors; Young Adult
PubMed: 28094118
DOI: 10.1016/j.annepidem.2016.11.012