Date on Master's Thesis/Doctoral Dissertation

8-2024

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Little, Bertis

Committee Member

Karimi, Seyed

Committee Member

Goldsby, Michael

Committee Member

Kong, Maiying

Author's Keywords

COVID-19; mechanical ventilation; mortality; medicaid; beneficiaries; stay-at-home order

Abstract

OBJECTIVES: To investigate patient- and county-level disparities in COVID-19-related mechanical ventilation use and mortality by SDOH factors and comorbidities among Medicaid non-pregnant adult beneficiaries in Kentucky. Additionally, to compare the association of COVID-19-related infections and mortality with social mobility and weather between Indiana and Kentucky during the stay-at-home period (March 1 to May 15, 2020). METHODS: In chapter 2, an administrative claims-based retrospective cohort study was conducted using the Kentucky Health Facility and Services database. Medicaid beneficiaries who were hospitalized during 2020–2021 in Kentucky were considered in the logistic regression and the Cox regression model to estimate the risk of COVID-19-related mechanical ventilation use and mortality, respectively, adjusted for SDOH factors (age, sex, race, rural status), and comorbidities (chronic obstructive pulmonary disease [COPD], diabetes, overweight/obesity [OW/OB], chronic kidney disease [CKD], chronic heart failure [CHF], atrial fibrillation [A-Fib]. In chapter 3, a geospatial cross-sectional study was conducted using the county aggregated chapter 2 data. In ordinary least-squares (OLS) regression and multiscale geographically weighted regression (MGWR), SDOH factors, comorbidities, and social deprivation index (SDI) scores were regressed against COVID-19 mortality per 1000 among Medicaid beneficiaries. In chapter 4, COVID-19 infection and mortality risks were estimated, controlling for social mobility and weather using Cox regression models. RESULTS: COVID-19-positive Medicaid beneficiaries, who are aged 45-64, males, rural residents, and diagnosed with COPD, CKD, and A-Fib, were at higher risk of mechanical ventilation use and in-hospital mortality. The MGWR model suggested an increased risk of COVID-19 mortality in rural and Appalachian counties, particularly among patients with COPD, CHF, and mechanical ventilation use (96 hrs. plus). In chapter 4, Indiana residents were at higher risk of COVID-19 infection and mortality compared to Kentucky residents by 18% and 59%, respectively. These differences may be associated with the enforcement of and adherence to stay-at-home orders between Indiana and Kentucky. CONCLUSIONS: This dissertation provides evidence for policymakers to develop preventative measures to decrease the disease burden and healthcare expenses among Medicaid beneficiaries. Also, an understanding of the impact of Kentucky's stay-at-home policy on COVID-19 infection and mortality could aid in the development and implementation of future stay-at-home orders.

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