Low-income Individuals Research Articles

Does Abolishing a Copayment Increase Doctor Visits? A Comparative Case Study

Abstract Insurance coverage increases health care consumption, but less is known whether moderate copayments affect adults’ primary care utilization in a system characterized by gatekeeping. We analyze whether abolishing a 14-euro copayment for visits to general practitioners (GP) in Helsinki, the capital of Finland, increased the number of GP visits among adults and especially among low-income individuals. Using a difference-in-differences (DD) design and combining several administrative registers from 2011 to 2014, we find that the abolition is associated with only a small increase in GP visits (+0.04 visits annually, or +4.4 %, for all adults). The increase is driven by low-income adults (+0.06 visits, or +4.5 %, at the bottom 40 %). Although the point estimates are rather robustly positive, the conclusions regarding the statistical significance are sensitive to how we account for clustering in a setting characterized by only one treated cluster and a finite number of comparison clusters.

Racial and Ethnic Differences in Hospice Use Among Medicaid-Only and Dual-Eligible Decedents

Hospice care enhances quality of life for people with terminal illness and is most beneficial with longer length of stay (LOS). Most hospice research focuses on the Medicare-insured population. Little is known about hospice use for the racially and ethnically diverse, low-income Medicaid population. To compare hospice use and hospice LOS by race and ethnicity among Medicaid-only individuals and those with dual eligibility for Medicare and Medicaid (duals) in the Connecticut Medicaid program who died over a 4-year period. This retrospective population-based cohort study used Medicaid and traditional Medicare enrollment and claims data for 2015 to 2020. The study included Connecticut Medicaid recipients with at least 1 of 5 most common hospice diagnoses who died from 2017 to 2020. Race and ethnicity. Hospice use (yes/no) and hospice LOS (1-7 days vs ≥8 days.) Covariates included sex, age, and nursing facility stay within 60 days of death. Overall, 2407 and 23 857 duals were included. Medicaid-only decedents were younger (13.8% ≥85 vs 52.5%), more likely to be male (50.6% vs 36.4%), more racially and ethnically diverse (48.7% non-Hispanic White vs 79.9%), and less likely to have a nursing facility stay (34.9% vs 56.1%). Race and ethnicity were significantly associated with hospice use and LOS in both populations: non-Hispanic Black and Hispanic decedents had lower odds of using hospice than non-Hispanic White decedents, and Hispanic decedents had higher odds of a short LOS. In both populations, older age and female sex were also associated with more hospice use. For duals only, higher age was associated with lower odds of short LOS. For decedents with nursing facility stays, compared with those without, Medicaid-only decedents had higher odds of using hospice (odds ratio [OR], 1.49; 95% CI, 1.24-1.78); duals had lower odds (OR, 0.60; 95% CI, 0.57-0.63). Compared with decedents without nursing facility stays, duals with a nursing facility stay had higher odds of short LOS (OR, 2.63; 95% CI, 2.43-2.85). Findings raise concerns about equity and timing of access to hospice for Hispanic and non-Hispanic Black individuals in these understudied Medicaid populations. Knowledge about, access to, and acceptance of hospice may be lacking for these low-income individuals. Further research is needed to understand barriers to and facilitators of hospice use for people with nursing facility stays.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010–2016

IntroductionMental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This...

Abstract C131: Disparities in breast cancer screening resumption among health plan enrollees in the US following the COVID-19 pandemic: Are all groups back on track?

Abstract Purpose: The COVID-19 pandemic disproportionately impacted racial/ethnic minority and low-income individuals and resulted in significant disruptions in preventive care for all groups. While severe declines in routine cancer screening were observed during pandemic shutdown periods, it is unclear whether return-to-screening rates following healthcare reopening are consistent across all groups. In this study we examine rates of breast cancer screening pre- and post- pandemic shutdown periods across race/ethnicity, age, and income among health plan enrollees in the United States (US) to inform screening catch-up strategies after COVID-19 disruptions. Methods: We conducted a retrospective analysis of breast cancer screening claims (including codes for mammography, breast MRI, digital breast tomography, and breast imaging) from Optum Clinformatics Data Mart among female enrollees from 2019-2021. Eligible enrollees included women, ages 40-75 with continuous enrollment 12 months prior to screening index month. Screening volume was calculated each calendar month during the three-year period, with January 2019-February 2020 as the pre-pandemic period, March 2020 through June 2020 as the pandemic closure period, and July 2020-December 2021 as the post-closure (reopening) pandemic period. We conducted an event study to calculate group-level monthly predicted probabilities of screening using a linear probability model with group interactions by month, controlling for demographic variables and comorbidities. Additionally, we used difference-in-difference (DD) regressions including group interacted with a post-closure pandemic dummy. The pandemic closure period months were excluded from our DD analysis. Results: Our study included 8,378,296 health plan enrolled women. Overall mammography screening decreased significantly during the pandemic closure phase (March-June 2020) but rebounded to higher levels in the post-closure period relative to baseline (3.76% to 3.96%). Screening rates were highest among non-Hispanic White women in the pre-pandemic period compared to other racial-ethnic groups. Our DD model suggests that White-Asian disparities increased in the post-pandemic period while other race/ethnic disparities remained constant. Additionally, disparities in screening by age changed during the pandemic. Although the oldest age group (65-75) had the highest screening rates in the pre-closure phase, they were slower to return to pre-pandemic levels of screening compared to younger age groups. Implications: Return to breast cancer screening among health plan enrollees in the US was robust. However, disparities in screening rates between groups in the pre-pandemic period were again observed in the reopening period, signaling lost opportunities to revamp structural inequities in care delivery following the pandemic. Further monitoring of return-to-screening disparities, particularly among more medically underserved groups, will be critical in informing interventions to address the long-term consequences resulting from the disruption of COVID-19 on cancer care. Citation Format: Jennifer Tsui, Sarah Axeen, John Thacker, Sonali Saluja, Laura Solano, Willow Pastard, Chun Nok Lam, Todd Schneberk, Cameron Kaplan. Disparities in breast cancer screening resumption among health plan enrollees in the US following the COVID-19 pandemic: Are all groups back on track? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C131.

Abstract A016: Reducing the growing disparity of colorectal cancer screening among underserved populations in rural health clinics: The PRIME-CRC trial

Abstract Introduction: Colorectal cancer (CRC), the third leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low-income individuals, adults with low literacy and those living in rural areas. These groups all have screening completion rates below 50%. Purpose of Study: To assess the effectiveness of a patient-centered, shared decision making, health literacy strategy to promote longer-term adherence to colorectal cancer (CRC) screening in resource-limited, rural health clinics via colonoscopy or annual fecal immunochemical test (FIT). Methods Used: A two-arm randomized control trial implemented in 6 rural community clinics. Clinics reported CRC baseline screening rates of 17% to 38%. Eligible patients, age 45-75, who were not up to date on CRC screening were recruited. Clinic based RAs screened and consented patients. They collected baseline data and then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet developed by the authors (4th grade level). The RA used shared decision-making techniques to aid patients in selecting the test they prefer and that met their needs – colonoscopy or FIT. All patients who selected the FIT kit were given simplified instructions (3rd grade level) and a demonstration of how to use it and those who chose colonoscopy were given simplified colonoscopy prep instructions and had a referral made to GI clinic. Patients were randomized into intervention (INT) arm or enhanced usual care (EUC) arm. Those in INT who selected the FIT (and had not returned it) at 4, 8 and 12 weeks received an automated follow-up call or text from a provider at their clinic using plain language and motivational messages encouraging patients to complete the FIT (colonoscopy INT patients received reminder calls prior to appointment to remind them about prepping for procedure and their appointment). Summary of Results: 734 patients have been enrolled to date: 361 in INT arm and 373 in EUC arm; 64.1% are African American, 60.3% women; 38% have limited literacy; 71.8% highest level of education completed was high school or less; only 5.6% have annual incomes > $50,000. 72.4% of patients had heard of tests to screen for CRC and 75.4% had a doctor or nurse recommend screening for CRC in the past. With regard to screening tests, 5.6% of patients have chosen a colonoscopy and 94.4% have selected a FIT. Screening to date in Year 1: 56.0% completed screening by FIT in INT arm versus 54.2% in EUC arm; only 20% have completed screening by colonoscopy to date. Conclusions: Simplified instructions accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding with a follow-up automated text message or call if needed, facilitated completion rates of all patients, particularly those with limited literacy. This has not been effective to date with colonoscopy. Citation Format: Connie L. Arnold, Joseph Dean, James Morris, Elise Reed, Laura Curtis, Terry Davis. Reducing the growing disparity of colorectal cancer screening among underserved populations in rural health clinics: The PRIME-CRC trial [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A016.

Abstract A090: Association between breast cancer screening adherence and food insecurity in women with low income from California

Abstract Background: Food insecurity has been associated with delayed breast cancer screening among low-income individuals and communities in the United States (US). However, it is unclear if this association is due to poverty and related factors more generally (e.g., education, access to health care) or food insecurity specifically. Hence, we tested the association of food insecurity with being up-to-date with breast cancer screening recommendations in women with low-income from California. Methods: Individual-level information on breast cancer screening and food security status from females ages 50-74 years with an annual household income below 200% of the federal poverty level (FPL) was obtained from 2015-2016 California Health Interview Survey publicly available data. Bivariate and multivariate weighted logistic regression models were employed to test the association between breast cancer screening adherence and food insecurity, factoring in sociodemographic covariates including age, race/ethnicity, English use and proficiency, poverty level (dichotomized as 0-99% vs. 100-199% FPL), educational attainment, marital status, health insurance status, usual source of care, working status, and rurality. Results: The total sample included 3598 women with low-income from California, the majority of whom reported to be ages 50-59 years old (46.6%), Hispanic (50.5%), have health insurance (89.0%) and a usual source of health care (84.5%), live in an urban area (91.6%), and identify as food secure (51.1%). Most women reported being up-to-date with breast cancer screening (78.3%), of which 52.8% had food security and 47.2% experienced food insecurity. In comparison, among women not up-to-date with screening (21.7%), only 44.9% had food security while a majority of 55.1% experienced food insecurity. In the multivariable model, food insecurity was associated with lower odds of being up-to-date with breast cancer screening (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.44–1.07) at a suggestive level of statistical significance. This observed difference may be explained by the correlation between food insecurity and other important factors known to be associated with screening behavior, including history of cancer and other socioeconomic metrics such as income amount, financial security, and housing instability. Conclusions: Food insecurity was inversely associated with being up-to-date with breast cancer screening. There is an imperative need to address breast cancer screening among low-income women in California, especially those who experience food insecurity. Impact: Future studies should combine food insecurity and breast cancer screening interventions to improve screening rates. Citation Format: Charlotte L. Bergheimer, Laura Fejerman. Association between breast cancer screening adherence and food insecurity in women with low income from California [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A090.

Abstract B148: Colorectal cancer screening uptake and test use for individuals with diabetes in the U.S.: Implications for health equity

Abstract Purpose: Individuals with diabetes mellitus have an estimated 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from health disparities populations. This study examined associations of race and ethnicity and CRC screening uptake and CRC test type used among individuals with diabetes to identify factors to consider in targeting CRC screening efforts to promote health equity. Methods: Merged Medical Expenditures Panel Survey Household Component (2012-2018) and National Health Interview Survey data sets were used to identify individuals with diabetes (non-Hispanic White (NHW) n=223,046; Hispanic n=54,791; Non-Hispanic Black (NHB) n=54,791). The main outcomes were self-reported up-to-date CRC screening based on United States Preventive Services Taskforce guidelines and screening test used (i.e., blood-stool test or direct visualization). The main independent variable of interest was race and ethnicity. Logistic regression models included socio-demographic and health-related co-variates. Results: Among individuals with diabetes 62.6% reported being up-to-date (UTD) with CRC screening, among the screened 5.8% used blood stool tests only and 56.8% used direct visualization tests. In the final logistic model comparing relative risk of UTD screening to being unscreened, NHBs were more likely to be UTD for CRC screening [RR: 1.3, 95% CI: 1.13-1.53, p=0.001] compared to NHWs. Individuals with no high school degree [RR: 0.8, 95% CI: 0.65-0.99, p=0.3] were less likely to be UTD compared to college educated individuals. Individuals receiving recommended diabetes care were less likely to be unscreened [RR: 0.84, 95% CI: 0.76-0.94, p=0.002]. Among screened individuals, race and ethnicity were insignificant in final models. Low-income individuals were less likely to be screened with direct visualization [RR: 0.73, 95% CI: 0.55-0.97, p=0.03] compared to high-income individuals. Overweight individuals (BMI 26-29) were less likely to be screened with direct visualization [RR:0.75, 95% CI:0.57-0.99, p=0.41] compared to individuals with BMI ≤25. Individuals with five or more comorbidities were more likely to be screened using direct visualization [RR: 3.45, 95% CI: 1.86, 6.43, p<0.001] compared to individuals with 1-2 comorbidities. Conclusions: Among individuals with diabetes, social determinants and health factors associated with UTD and testing type differed. Race, education, and diabetes care quality were determinants of receipt of any UTD CRC testing. Among those screened, lower income and overweight individuals were more likely to use stool-based testing and those with greater comorbidity burdens were more likely to be screened with direct visualization. Efforts to improve CRC screening for patients with diabetes, specifically those in the primary care safety-net, should consider these factors when tailoring CRC prevention and early detection efforts. Citation Format: Denalee M. O'Malley, Pamela Ohman-Strickland, Tracy Andrews, Cilgy Abraham, Benjamin F. Crabtree, Shawna V. Hudson, Anita Y. Kinney. Colorectal cancer screening uptake and test use for individuals with diabetes in the U.S.: Implications for health equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B148.

거동 불편한 저소득 노인의 식품안전행동 영향요인에 관한 연구

Healthy eating in terms of nutrition and food safety is crucial for preserving an older adult’s quality of life when their immune systems start to decline. However, it has not gotten the same attention as other age groups. In order to map out a path for secure food safety in later life, this study provided meal services to low-income older adults with limited mobility and examined the determinants impacting their food safety behavior. In Seoul, a pre- and post-test survey was done on 104 older people who had used a healthy meal delivery service, and the results were compared and reviewed with survey data collected from 38 older people who had not used the service. The six-month subscription to the healthy meal delivery service includes daily nutritional monitoring, nutrition delivery, frequent counseling and educational services from a dietician, as well as lunch boxes customized to the customers' health state. The study revealed that older individuals in the experimental group had higher levels of the food safety behavior index after using the service. The index for the older individuals in the comparison group remained unchanged. The use of healthy meal delivery services including nutrition and food safety education was the only factor, according to regression analysis, that had a statistically significant impact on the older people's behaviors related to food safety when socio-demographic variables were controlled. These results show that regular information exchange and dietitian counseling have a positive influence on the food safety practices of elderly low-income individuals with limited mobility. Future legislative and practical initiatives will be required to provide regular dietitian monitoring and intervention to ensure food safety for elderly low-income individuals with limited mobility.

Leveraging financial personality for inclusive credit scoring amidst global uncertainty

The Ukraine war, high inflation and rising interest rates are jeopardising people's ability to afford essential items such as food and energy, causing a widespread sense of vulnerability worldwide. Consequently, access to finance has become increasingly challenging for vulnerable consumer groups, including young adults without established credit histories, senior citizens with fixed incomes, start-up entrepreneurs, sole traders, single parents, immigrants in Western markets. To address this issue, this study explores the potential use of individuals' financial personality for inclusive credit scoring in these uncertain environments. Examining a sample of low-income individuals in the USA and the Netherlands, our psychometric scoring models (PSMs) demonstrate that late payments can be attributed to factors such as financial capability, materialistic tendencies, impulsive buying behaviour, social desirability and attitudes towards debt. These findings provide evidence that PSMs offer a viable solution to advance financial inclusion for vulnerable customer segments amidst global uncertainty.

A CONCEPTUAL MFARM BUSINESS MODEL: MOSQUE AS A SUSTAINABLE FARMING CENTRE, RESKILLING AND NURTURING B40 AS AGRO-PRENEURS

This business model paper explores the potential of utilising mosque space for farming with the aim of assisting low-income and B40 communities. The purpose of this paper is to develop a conceptual business model including a digital platform and application as well as to assess the feasibility of this concept and address the growing demand for locally grown and organic produce, while also providing an opportunity for the mosque to generate additional revenue streams. The paper outlines the methodology used, which is Design Thinking, by conducting literature review (LR), benchmarking and survey to further understand the problem that later helps in creating our own business case model (BMC) and Value Proposition Canvas (VPC). It also highlights the potential social and environmental benefits of this model, such as increased community engagement and the reduction of carbon footprints through localised food production. The proposed business model aims to create a new paradigm for sustainable food production, with mosques serving as community hubs for education, training, and innovation in the field of urban farming. The paper concludes by outlining the potential challenges and risks involved in this venture and proposes strategies to mitigate them. Ultimately, this business paper represents an exciting opportunity for mosques to become leaders in sustainable food production and community engagement. This conceptual business model would also provide educational opportunities for members of the community to learn about urban farming, nutrition, and healthy eating habits. By focusing on serving low-income and B40 communities, the business aims to address food insecurity and promote equitable access to healthy, locally grown produce. This would help to improve the overall health and well-being of the community, while also providing economic opportunities for low-income individuals to participate in the farming and distribution of produce.

Perinatal health outcomes of international migrant women in Brazil: A nationwide data linkage study of the CIDACS birth cohort (2011–2018)

BackgroundWe investigated perinatal outcomes among live births from international migrant and local-born mothers in a cohort of low-income individuals in Brazil. MethodsWe linked nationwide birth registries to mortality records and socioeconomic data from the CIDACS Birth Cohort and studied singleton live births of women aged 10–49 years from 1st January 2011 to 31st December 2018. We used logistic regressions to investigate differences in antenatal care, adverse pregnancy outcomes, and neonatal (i.e., ≤28 days) mortality among international migrants compared to non-migrants in Brazil; and explored the interaction between migration, race/ethnicity and living in international border municipalities. ResultsWe studied 10,279,011 live births, of which 9469 (0.1 %) were born to international migrants. Migrant women were more likely than their Brazilian-born counterparts to have a previous foetal loss (ORadj: 1.16, 1.11–1.22), a delayed start of antenatal care (i.e., beyond 1st trimester) (1.22, 95%CI:1.16–1.28), a newborn who is large for gestational age (1.29, 1.22–1.36), or a newborn with congenital anomalies (1.37, 1.14–1.65). Conversely, migrant women were less likely to deliver prematurely (0.89, 0.82–0.95) or have a low birth weight infant (0.74, 0.68–0.81). There were no differences in neonatal mortality rates between migrants and non-migrants. Our analyses also showed that, when disparities in perinatal outcomes were present, disparities were mostly concentrated among indigenous mothers in international borders and among live births of Black mothers in non-borders. ConclusionAlthough live births of international migrants generally have lower rates of adverse birth outcomes, our results suggest that indigenous and Black migrant mothers may face disproportionate barriers to accessing antenatal care.

Evaluating the impact of social housing policies: Measuring accessibility changes when individuals move to social housing projects

Addressing housing deficits and inequalities remains a key challenge for cities in promoting more sustainable urban development. In response to these challenges, governments around the world, particularly in the Global South, have made substantial investments in housing policies for middle- and low-income individuals. Nevertheless, while these initiatives increase housing provision, they often face criticism for not adequately considering the location of new residences. This oversight has far-reaching effects on the accessibility to essential facilities, which play a pivotal role in determining spatial advantages and disadvantages, and consequently, in the degree of inclusion of individuals in both the city and society. Addressing this critical role of accessibility, this paper introduces a methodology for assessing the potential impact of housing policies on the lives of their beneficiaries, by quantifying changes in cumulative accessibility levels between individuals' former house locations and the location of the housing projects into which they moved. Accessibility is calculated for three distinct transport modes: walking, cycling, and public transport, using unimodal and multimodal urban network models. A case study was conducted in Natal, northeastern Brazil, on the implementation of the Minha Casa, Minha Vida (My House, My Life, MCMV) housing policy, initiated in 2009 and still active today. The results of the study revealed a significant decrease in accessibility across all transportation modes when individuals moved to the new housing estates. The decline was particularly pronounced among individuals with lower incomes, potentially raising their regular expenses after relocation and, ultimately, leading to spatial isolation and social exclusion. These findings demonstrate the contribution of the methodology to capturing the impacts of housing policies on the everyday accessibility of their beneficiaries, while emphasizing the importance of re-evaluating these policies with a particular focus on fostering the social and urban inclusion of beneficiaries.

Metabolite Signature of Life's Essential 8 and Risk of Coronary Heart Disease Among Low-Income Black and White Americans.

Life's essential 8 (LE8) is a comprehensive construct of cardiovascular health. Yet, little is known about the LE8 score, its metabolic correlates, and their predictive implications among Black Americans and low-income individuals. In a nested case-control study of coronary heart disease (CHD) among 299 pairs of Black and 298 pairs of White low-income Americans from the Southern Community Cohort Study, we estimated LE8 score and applied untargeted plasma metabolomics and elastic net with leave-one-out cross-validation to identify metabolite signature (MetaSig) of LE8. Associations of LE8 score and MetaSig with incident CHD were examined using conditional logistic regression. The mediation effect of MetaSig on the LE8-CHD association was also examined. The external validity of MetaSig was evaluated in another nested CHD case-control study among 299 pairs of Chinese adults. Higher LE8 score was associated with lower CHD risk (standardized odds ratio, 0.61 [95% CI, 0.53-0.69]). The MetaSig, consisting of 133 metabolites, showed significant correlation with LE8 score (r=0.61) and inverse association with CHD (odds ratio, 0.57 [0.49-0.65]), robust to adjustment for LE8 score and across participants with different sociodemographic and health status ([odds ratios, 0.42-0.69]; all P<0.05). MetaSig mediated a large portion of the LE8-CHD association: 53% (32%-80%). Significant associations of MetaSig with LE8 score and CHD risk were found in validation cohort (r=0.49; odds ratio, 0.57 [0.46-0.69]). Higher LE8 score and its MetaSig were associated with lower CHD risk among low-income Black and White Americans. Metabolomics may offer an objective measure of LE8 and its metabolic phenotype relevant to CHD prevention among diverse populations.

1527. Assessment of Human Immunodeficiency Virus Testing in Underinsured Persons

Abstract Background Among those living with HIV, nearly 13% are unaware of their diagnosis and approximately 40% of new HIV infections are transmitted from those lacking a formal diagnosis. Thus, determination of populations at high risk of not having HIV testing completed are essential to reduce transmissions. A barrier to obtaining an HIV test within low-income individuals that do not qualify for Medicaid, or underinsured persons, is the rising cost of healthcare in the US. Thus, it is essential to determine if further resources should be dedicated to underinsured populations with the aim of increasing access to HIV testing. Methods This is a retrospective cross-sectional study utilizing the 2021 Behavior Risk Factor Surveillance System conducted by the US CDC to determine if individuals that do not qualify for Medicaid yet live in a household with an income of &amp;gt;138% but ≤200% of the US federal poverty line (FPL) had increased odds of not having an HIV test when compared to individuals that live in a household with an income of ≤138% of the FPL, and thus qualify for Medicaid. A multivariable logistic regression model was created to determine the adjusted odds ratio for not having an HIV test in those who did not qualify for Medicaid. Results This study analyzed data from 33,431 respondents that were age 18 – 64, living in a Medicaid expansion state, and had a household income of ≤200% the FPL. Among these persons, 65.1% of respondents qualified for Medicaid. Univariate analysis revealed that non-Medicaid eligible persons were more likely to not have an HIV test when compared to Medicaid eligible persons with 54% and 48.6% not having an HIV test, respectively. After adjusting for the confounding variables, persons who were not eligible for Medicaid had 1.26 (95% CI:1.21 - 1.32) times the odds of not having an HIV test compared to those who were eligible for Medicaid.(Table) Conclusion After adjusting for confounding variables, the odds that a person did not have an HIV test were higher among individuals that lived in a household with an income that was &amp;gt;138% but ≤200% of the FPL. These data reveal that underinsured persons are a potential group that may benefit from further resource allocation to bolster HIV screening. Disclosures Andrew M. Skinner, MD, Academy for Continued Healthcare Learning: Honoraria|American Society of Healthcare Pharmacists: Honoraria|Ferring Pharmaceuticals: Honoraria|MJH Life Sciences: Honoraria

Ride-hailing and transit accessibility considering the trade-off between time and money

Ride-hailing services can expand access to opportunities in urban areas, but out-of-pocket costs may limit its benefits for low-income individuals. This paper examines how ride-hailing shapes spatial and socioeconomic differences in access to opportunities while accounting for the trade-off between travel time and monetary costs. Using one year of aggregate Uber trip data for Rio de Janeiro in 2019 and a new multi-objective routing algorithm, we analyze the potential for ride-hailing services to improve employment accessibility when used as a standalone transportation mode and in conjunction with transit as a first-mile connection. We find that, compared to transit, standalone ride-hailing can significantly expand accessibility as a standalone mode for short trips, and as a first-mile feeder to transit in trips longer than 30 min. However, the accessibility benefits of ride-hailing accrue mostly to high-income groups due to affordability barriers. These findings suggest that policy efforts to integrate rideshare with transit are likely not going to benefit low-income communities without some form of subsidized fare discounts to alleviate affordability barriers. The paper also highlights how accounting for trade-offs between travel-time and monetary costs can importantly influence the results of transportation accessibility and equity studies.

Economic framework to assess the impact of banning pesticides, with application to sulfuryl fluoride for drywood termites (Blattodea: Kalotermitidae) in California.

Sulfuryl fluoride (SF) is a fumigant used to eliminate drywood termites (DWT: Kalotermitidae; Froggatt) and other structural pests. Because of its global warming potential, it has been suggested that SF be restricted as a greenhouse gas (GHG). We present an economic model to assess the net social cost of restricting SF. We consider 3 approaches to address DWT control- no treatment, allowing SF fumigation and localized treatments, and only local treatment. Each approach generates private and public benefits and costs. We estimate that the annual damage and home equity loss by DWT in California is US$4.5-16.8 billion without treatment. If fumigation is used on 20% of the houses and local treatments on the others, the combined social cost of treatment, damage, and GHG emissions are between US$1-US$2 billion annually. The annual cost of local treatments only would be between US$3.2 and US$4.9 billion. If the application of SF is severely restricted or banned, the social costs will increase between US$1.43 and US$4.31 billion annually. The implied cost per ton of CO2 eliminated is between US$624 and US$1,465, much above the price range of CO2 in other applications. The restriction/ban has significant equity and environmental effects, impacting low-income individuals living in rented properties and replacing damaged wood in housing will increase GHG emissions. We further recommend the continued use of SF until a comparable whole-structure alternative is developed that fits the parameters of our model.

Medicaid Expansion States See Long-Term Improvement in Colorectal Cancer Screening Uptake Among Low-Income Individuals

Medicaid Expansion States See Long-Term Improvement in Colorectal Cancer Screening Uptake Among Low-Income Individuals

The impact of subsidies on house prices in Mexico's mortgage market for low-income households 2008–2019

We estimate the effect of Mexico's primary house-purchase subsidy program for low-income individuals on house prices between 2008 and 2019, using administrative records from Infonavit, the nation's largest mortgage originator. We employ a fuzzy regression discontinuity design that leverages the existence of a threshold on the borrower's income that determined access to the subsidy program to identify the effect on house prices. Our estimations yield statistically significant evidence that the subsidy led to an average increase in house prices of 863 US dollars for the program participants at the threshold during those years. This effect represents 28.9 % of the average subsidy amount and 5.4 % of the average house price. The estimations control for individual, house, and location characteristics. Furthermore, we find evidence that when an intermediary is involved in the mortgage application process, there is a statistically significant price difference of 867 dollars for subsidy recipients. On the contrary, this impact disappears when no external broker is involved. These intermediaries are primarily real estate developers that build and sell the houses associated with the mortgages. These findings shed light on how market structure could have nonnegligible impacts on equilibrium outcomes and on the welfare effects of economic policy.

Determinants of Microfinance Adoption, Challenges Encountered, and Principal Solutions: An Empirical Analysis Using Theory of Planned Behaviour

Microfinance refers to the provision of financial services to low-income individuals and businesses, serving as a financial tool to reduce poverty and provide financial support to low-income groups. This study aims to determine the factors influencing customers' intentions towards microfinance in Kathmandu Valley. The study employs an explanatory research design in conjunction with the Theory of Planned Behavior framework. Primary data from 303 respondents were collected using the KOBO toolbox. Purposive sampling, a non-probability sampling technique, was employed for data collection. Descriptive and inferential data analysis was carried out using MS-Excel and SMART PLS 4.0. The majority of respondents consisted of married middle-aged women actively engaged in their own business ventures. Common challenges encountered by microfinance customers included high-interest rates, insufficient security, and limited financial knowledge. The principal solutions identified included the establishment of robust microfinance policies, the integration of innovation and new technologies, the provision of financial training, and the facilitation of enhanced loan repayment strategies. The study revealed that, among the three primary factors examined, both subjective norms and perceived behavioral control had a significant impact on customers' intentions to adopt microfinance. On the other hand, attitude was found to have an insignificant impact on customers' intentions to embrace microfinance. The findings of this study suggest that microfinance can be a valuable tool for poverty reduction and financial inclusion. However, it is important to address the challenges that microfinance customers face in order to maximize its potential impact. The solutions identified in this study can help make microfinance more accessible and affordable for low-income individuals and businesses.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos