Geospatial Analysis of the Association between Medicaid Ex-pansion, Minimum Wage Policies, and Alzheimer's Disease Dementia Prevalence in the United States

BackgroundPrevious studies indicate that improved healthcare access through Medicaid expansion and the alleviation of socioeconomic stressors via higher minimum wages lead to improved health outcomes. However, a significant gap remains in examining the distribution of Alzheimers disease (AD) dementia in the context of these policies. Thus, this study investigates the spatial relationships between the Medicaid expansion, minimum wage policy, and AD dementia prevalence across the US. MethodsWe employed the Getis-Ord Gi* statistic to identify hot spots and cold spots of AD dementia prevalence at the county level across the US. We compared these locations with the county-level overall social vulnerability index (SVI) scores. Moreover, we assessed the proportion of hot and cold spots at the state level based on Medicaid expansion and minimum wage status. ResultsOur analysis revealed that the most vulnerable SVI quartile (Q4) had the highest number of hot spots (n=311, 64.8%), while the least vulnerable quartile (Q1) had the fewest hot spots (n=22, 4.6%) ({chi}2=307.41, P<0.01). Additionally, Q4 had the fewest cold spots (n=54, 11.7%). States that adopted Medicaid expansion had a significantly lower proportion of hot spots compared to non-adopting states (P<0.05), and the non-adopting states had significantly higher odds of having hot spots than adopting states (OR=2.58, 95% CI: 2.04-3.26, P<0.001). Conversely, the non-adopting states had significantly lower odds of having cold spots compared to the adopting states (OR=0.24, 95% CI: 0.19-0.32, P<0.01). States with minimum wage levels at or below the federal level showed significantly higher odds of having hot spots than states with a minimum wage above the federal level (OR=1.94, 95% CI: 1.51-2.49, P<0.01). DiscussionOur findings suggest significant disparities in AD dementia prevalence related to socioeconomic and policy factors and lay the groundwork for future causal analyses to examine whether these policies have impacted disparities in healthcare access for people with AD dementia across the US.