Budgetary Consequences of High Medical Spending Across Age and Social Status: Evidence from the Consumer Expenditure Surveys.

BACKGROUND AND OBJECTIVES: This study examines high medical spending among younger, midlife, and older households. RESEARCH DESIGN AND METHODS: We investigate high medical spending using data from the 2010 through March 2018 Consumer Expenditures Surveys (n = 92,951). We classify and describe high medical spenders relative to others within three age groups (household heads age 25-44, 45-64, and 65+) using finite mixture models and multinomial logistic regression, respectively. We then use hierarchical linear models to estimate the effects of high medical spending on nonmedical spending. RESULTS: Among younger households, high medical spending is positively associated with higher education and increased spending on housing and food. Among older households, high medical spending is associated with lower education and decreased nonmedical spending. DISCUSSION AND IMPLICATIONS: Earlier in the life course, high medical spending is more likely to indicate an investment in future household well-being, while at older ages, high medical spending is likely to indicate medical consumption.

U.S. Immigration Policy Regimes and Physical Disability Trajectories Among Mexico-U.S. Immigrants.

OBJECTIVES: Although immigration policies have shifted dramatically over the course of U.S. history, few have examined their role as a source of health heterogeneity among immigrants. We address this gap by evaluating whether exposure to U.S. Immigration Policy Regimes (IPRs) corresponds with later-life disability disparities among Mexico-U.S. migrant women and men, and assess the degree to which observed differences may also be associated with immigration policies and occupational composition. METHOD: We analyze 8 waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (3,044 individuals and 14,474 observations from 1993/1994-2013). Using hierarchical linear models, we estimate trajectories of physical disability associated with gender, occupation, and IPR. RESULTS: We find differences in disability trajectories by IPR. Associations are not different between men and women, and are not mediated by occupational composition. We also observe an additive effect for certain occupations among women, but not among men. DISCUSSION: Findings demonstrate that exposure to different IPRs is associated with disparate disability trajectories among Mexico-U.S. migrants. Future research is needed to contextualize the role of IPRs amid other mechanisms of gendered racialization that powerfully contribute to cumulative health differences across the life course.