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

Previous studies indicate that improved 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 AD dementia prevalence across the US. 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 social vulnerability index (SVI) scores and assessed the proportion of hot and cold spots at the state level based on Medicaid expansion and minimum wage status. 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%) (Chis-squared=967;R2=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.