{"doi":"10.1016/j.ssmph.2025.101798","title":"Double vulnerability? Examining the effect of living in nonmetropolitan areas within non-expansion Medicaid states on health status among working-age adults in the United States, 2022–2024","abstract":"Objective: To examine whether living in nonmetropolitan areas within a state that has not expanded Medicaid is associated with poor/fair self-reported health status among working-age adults in the United States. Methods: We analyzed data from the 2022-2024 Current Population Survey (n = 220, 601, ages 25-64). Self-reported health was dichotomized as having reported poor/fair or good/very good/excellent health status. We produced a four-level measure of the overlap between residential and policy contexts indicating whether the respondent lived in a metropolitan or nonmetropolitan area within a state that had or had not expanded Medicaid coverage by 2023. Multilevel logistic regression models were fit to examine the association between our measure of residence-policy overlaps and poor/fair self-reported health status while accounting for individual and state-level characteristics. Results: About 3.7 % of respondents resided in nonmetropolitan areas within non-expansion states. Approximately 11.4 % of respondents reported poor/fair self-reported health, with respondents living in nonmetropolitan areas within non-expansion states having the highest rates of poor/fair self-reported health status (18.1 %). Living in a nonmetropolitan area within non-expansion states was associated with higher odds of poor/fair self-reported health status for the overall population and by sex. Conclusion: In this nationally representative and racially diverse sample, we found that individuals residing in nonmetropolitan areas in non-expansion Medicaid states were more likely to report poor/fair self-reported health status. This effect was present for the majority of the population subgroups. Our findings underscore the double vulnerability faced by populations living in these residence-policy overlaps and the need for targeted interventions.","journal":"SSM - Population Health","year":2025,"id":536079,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7823,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1420271,"name":"P. Johnelle Sparks","orcid":"0000-0003-0594-3799","position":1,"is_corresponding":false},{"id":872498,"name":"Alexis R. Santos‐Lozada","orcid":"0000-0002-8437-4493","position":2,"is_corresponding":false},{"id":1420270,"name":"Michael Segovia","orcid":"0000-0003-3743-1018","position":0,"is_corresponding":true}],"reference_count":70,"raw_metadata":null,"created_at":"2026-07-19T02:52:00.885532Z","pmid":"40264548","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}