JAMA Health Forum最新文献

Importance: Federal survey data collection identifies people with disabilities predominantly by using a 6-question sequence asking about different functional impairments known as the American Community Survey-6 (ACS-6). However, little is known about the specific diagnoses identified by the ACS-6 or whether they vary across demographic subgroups.

Objective: To characterize the disability diagnoses identified by the ACS-6 and assess to what extent they identify a consistent population across demographic subgroups.

Design, setting, and participants: This cross-sectional study among people with disabilities responding to the 2023 or 2024 Survey of Income and Program Participation (SIPP) assessed the prevalence of 36 different diagnosis groupings in the ACS-6 as a whole and within each of the individual questions, as well as how the identified diagnoses varied by age group, race and ethnicity, sex, and educational attainment, with further disaggregation by cognitive disability status. Data were analyzed between August 1 and September 15, 2025.

Exposure: Identification as people with disabilities using the ACS-6.

Main outcomes and measures: Diagnoses reported by survey respondents as causing the functional impairments they listed in the SIPP.

Results: A total of 13 341 people with disabilities (52.2% female; mean [SD] age, 53.0 [23.0] years) responding to the SIPP were included. Among people with disabilities aged 22 to 64 years, the most common diagnoses were anxiety or obsessive-compulsive disorders (prevalence, 15.6%; 95% CI, 14.5%-16.9%), depression (15.3%; 95% CI, 14.1%-16.5%), unspecified musculoskeletal issues (13.5%; 95% CI, 12.5%-14.6%), back or spinal problems (11.6%; 95% CI, 10.6%-12.6%), and unspecified neurologic disorders (10.8%; 95% CI, 9.8%-11.8%). The most common disability diagnoses reported by respondents identified by the ACS-6 were different across age groups but similar across demographic groups defined by sex, race and ethnicity, and educational attainment.

Conclusions and relevance: The results of this cross-sectional study suggest that the ACS-6 identifies a similar population across demographic subgroups not characterized by age but highlight substantial heterogeneity in the population of people with disabilities within these subgroups and across age groups. Contemporary debates regarding future revisions to disability data collection in federal population surveys should address the ability to account for this heterogeneity in survey design.

Importance: Housing cost burden is at an all-time high in the US and may disproportionately affect health outcomes among low-income populations. Medicaid-insured individuals and those diagnosed with cardiovascular (CV) disease, such as heart failure (HF), may be especially at increased risk of adverse health outcomes associated with housing cost burden.

Objective: To assess the association between area-level housing cost burden and the probability of CV-related hospitalization or emergency department (ED) visits among Medicaid beneficiaries aged 19 to 64 years with HF.

Design, setting, and participants: This cross-sectional study used individual-level health care utilization data obtained from the Transformed Medicaid Statistical Information System Analytic Files (2018-2019). All zip codes in the US with resident Medicaid beneficiaries aged 19 to 64 years who had a preexisting diagnosis of HF and were continuously enrolled in 2019 were included except for those in Alabama, Rhode Island, and Utah due to data quality issues. Data were analyzed from October 2024 to October 2025.

Exposure: Area-level housing cost burden was defined as the zip code-level proportion of housing units occupied by individuals with an annual household income less than $35 000 who spent 30% or more of their income on housing costs.

Main outcomes and measures: The probability of a CV-related hospitalization and of a CV-related ED visit in 2019. Generalized estimating equation models were used to evaluate the association between housing cost burden and outcomes after adjusting for individual and area-level factors.

Results: This study included 233 195 individuals (mean [SD] age, 51.5 [9.6] years, 107 447 female [46.1%]) who were living in 19 577 zip codes. The mean (SD) zip code housing cost burden was 67.4% (16.5%). In 2019, 42 886 beneficiaries (18.4%) had at least 1 CV-related hospitalization and 75 392 (32.3%) had an ED visit. After covariate adjustment, a 10-percentage point increase in housing cost burden was associated with higher odds of CV-related hospitalizations (odds ratio [OR], 1.03; 95% CI, 1.01-1.06) and ED visits (OR, 1.03; 95% CI, 1.01-1.04). There were also higher odds of HF-related hospitalizations (OR, 1.04; 95% CI, 1.01-1.07).

Conclusions and relevance: The findings of this study suggest that area-level housing cost burden may be associated with outcomes among Medicaid beneficiaries with HF and highlights the need to investigate whether strategies that address housing affordability can play a role in improving health outcomes in this population.