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Geospatial Analysis of the Association Between Medicaid Expansion, Minimum Wage Policies, and Alzheimer’s Disease Dementia Prevalence in the United States
Abolfazl Mollalo, Sara Knox, Jessica Meng, Andreana M. Benitez, Leslie Andrew Lenert, Alexander V. Alekseyenko. Information, 2024-11-01
Topic: Risk, prevention and care in population studies
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 < 0.01). States that adopted Medicaid expansion had a significantly lower proportion of hotspots compared to non-adopting states (p < 0.05), and the non-adopting states had significantly higher odds of having hotspots 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 hotspots than states with a minimum wage above the federal level (OR = 1.94, 95% CI: 1.51–2.49, 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.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Mollalo, A., Knox, S., Meng, J., Benitez, A. M., Lenert, L. A., & Alekseyenko, A. V. (2024). Geospatial Analysis of the Association Between Medicaid Expansion, Minimum Wage Policies, and Alzheimer’s Disease Dementia Prevalence in the United States. Information. https://doi.org/10.3390/info15110688
Vancouver
Mollalo A, Knox S, Meng J, Benitez AM, Lenert LA, Alekseyenko AV. Geospatial Analysis of the Association Between Medicaid Expansion, Minimum Wage Policies, and Alzheimer’s Disease Dementia Prevalence in the United States. Information. 2024. doi:10.3390/info15110688.
BibTeX
@article{mollalo2024-fdc69201,
author = {Mollalo, Abolfazl and Knox, Sara and Meng, Jessica and Benitez, Andreana M. and Lenert, Leslie Andrew and Alekseyenko, Alexander V.},
title = {{Geospatial Analysis of the Association Between Medicaid Expansion, Minimum Wage Policies, and Alzheimer’s Disease Dementia Prevalence in the United States}},
journal = {Information},
year = {2024},
doi = {10.3390/info15110688},
url = {https://doi.org/10.3390/info15110688}
}
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Key findings
- Previous studies indicate that increased healthcare access through Medicaid expansion and alleviation of socioeconomic stressors via higher minimum wages improved health outcomes.
- We compared these locations with the overall SVI scores using univariate analyses.
- States that adopted Medicaid expansion had a significantly lower proportion of hotspots compared to non-adopting states (p < 0.05), and the non-adopting states had significantly higher odds of having hotspots 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 hotspots than states with a minimum wage above the federal level (OR = 1.94, 95% CI: 1.51–2.49, p < 0.01).
Why it matters
Counties in the most vulnerable Social Vulnerability Index quartile had the most Alzheimer's disease dementia hotspots, and states that adopted Medicaid expansion had a significantly lower proportion of hotspots than non-adopting states. These are geographic associations between policy and prevalence, so the study cannot show that Medicaid expansion or minimum wage changes prevent dementia.
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Study details
- Participants311
- Effect size64.8%; 4.6%; OR = 2.58
- Evidence strengthLow
How this study scored 45/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Information) |
| Journal's citation record | 1 / 4 | Information: journal h-index 113 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 311 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.5 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 2 / 6 | Cited 1.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Alexander V. Alekseyenko: h-index 38 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Medical University of South Carolina: institution h-index 715 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 45 / 100 | — |
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