Primary Submission Category: Health equity
Mapping Intersectional Inequities in Mental Health Over Time: Can State EITC Policies Mitigate Disparities?
Authors: Kieran Blaikie Steve Mooney Isaac Rhew Heather Hill Anjum Hajat
Presenting Author: Kieran Blaikie*
Background:
Mental distress is a leading cause of disease burden in the United States, yet our understanding of how this burden has changed over time, varied across social groups, and correlated with social assistance policies is limited. To address this need and advance health equity, we quantify how complex social inequities in mental distress have varied over recent decades, and examine whether State Earned Income Tax Credit (EITC) policies modify these inequities.
Methods:
Using information on 7 million working-age adults from the 1993-2019 Behavioral Risk Factor Surveillance System (BRFSS), we calculate age-standardised past-month prevalences of frequent mental distress (FMD, defined as ≥14 mentally unhealthy days in the past month) at the national level overall and stratifying individually and intersectionally by gender, race and ethnicity, educational attainment, and household poverty status. For each year, we calculate absolute and relative inequities in FMD comparing each social group to the national average prevalence. To examine effect modification by State EITC policies, we repeat all analyses stratifying by State EITC availability, generosity, and likely individual eligibility.
Results:
Compared against 1993, FMD prevalence has risen overall (Prevalence, 95% CI: 1993: 8.9%, 8.5% to 9.2%. 2019: 14.9%, 14.6% to 15.2%) and in most social groups defined individually and intersectionally. Nationally, inequities in FMD have remained broadly constant in size, except by race and ethnicity where Hispanics have shown improvements relative to the national average over time, having 7% higher FMD prevalence in 1993 (95% CI: -5% to +20%) and 11% lower FMD prevalence in 2019 (95% CI: -16% to -7%). Compared to states without State EITC polices, FMD prevalence has risen to a lesser extent over time in states with State EITC policies and social inequities in FMD have narrowed, particularly by educational attainment.
Conclusions:
At the national level, mental distress has become more prevalent over recent decades while social inequities in mental distress have remained stable. States with State EITC policies however have fared better, with social inequities in mental distress often narrowing.