Roch A Nianogo, Fan Zhao, Stephen Li, Akihiro Nishi, Sanjay Basu
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引用次数: 0
Abstract
Background: Studies have suggested Medicaid expansion enacted in 2014 has resulted in a reduction in overall cardiovascular disease (CVD) mortality in the United States. However, it is unknown whether Medicaid expansion has a similar effect across race-ethnicity and sex. We investigated the effect of Medicaid expansion on CVD mortality across race-ethnicity and sex.
Methods: Data come from the behavioral risk factor surveillance system and the US Centers for Disease Control's Wide-ranging Online Data for Epidemiologic Research, spanning the period 2000-2019. We used the generalized synthetic control method, a quasi-experimental approach, to estimate effects.
Results: Medicaid expansion was associated with -5.36 (mean difference [MD], 95% confidence interval [CI] = -22.63, 11.91) CVD deaths per 100,000 persons per year among Blacks; -4.28 (MD, 95% CI = -30.08, 21.52) among Hispanics; -3.18 (MD, 95% CI = -8.30, 1.94) among Whites; -5.96 (MD, 95% CI = -15.42, 3.50) among men; and -3.34 (MD, 95% CI = -8.05, 1.37) among women. The difference in mean difference (DMD) between the effect of Medicaid expansion in Blacks compared with Whites was -2.18; (DMD, 95% CI = -20.20, 15.83); between that in Hispanics compared with Whites: -1.10; (DMD, 95% CI = -27.40, 25.20) and between that in women compared with men: 2.62; (DMD, 95% CI = -7.95, 13.19).
Conclusions: Medicaid expansion was associated with a reduction in CVD mortality overall and in White, Black, Hispanic, male, and female subpopulations. Also, our study did not find any difference or disparity in the effect of Medicaid on CVD across race-ethnicity and sex-gender subpopulations, likely owing to imprecise estimates.
背景:研究表明,2014 年颁布的《医疗补助计划》(Medicaid)的扩展降低了美国心血管疾病(CVD)的总体死亡率。然而,医疗补助计划的扩大是否对不同种族和性别产生了类似的影响,目前尚不得而知。我们研究了扩大医疗补助计划对不同种族和性别的心血管疾病死亡率的影响:数据来自行为风险因素监测系统和美国疾病控制中心的广泛流行病学研究在线数据,时间跨度为 2000-2019 年。我们使用广义合成控制法(一种准实验方法)来估计效果:结果:扩大医疗补助计划后,黑人每年每 10 万人的心血管疾病死亡人数为-5.36(平均差 [MD],95% 置信区间 [CI] = -22.63,11.91);黑人每年每 10 万人的心血管疾病死亡人数为-4.28(MD,95% CI = -30.08,21.52);白人-3.18(MD,95% CI = -8.30,1.94);男性-5.96(MD,95% CI = -15.42,3.50);女性-3.34(MD,95% CI = -8.05,1.37)。与白人相比,扩大医疗补助计划对黑人的影响的平均差异(DMD)为-2.18;(DMD,95% CI = -20.20,15.83);与白人相比,对西班牙裔的影响的平均差异为-1.10;(DMD,95% CI = -27.40,25.20);与男性相比,对女性的影响的平均差异为 2.62;(DMD,95% CI = -7.95,13.19):医疗补助计划的扩大与心血管疾病死亡率的总体下降有关,也与白人、黑人、西班牙裔、男性和女性亚人群的心血管疾病死亡率下降有关。此外,我们的研究没有发现医疗补助计划对心血管疾病的影响在不同种族-民族和性别-性别亚人群中存在任何差异或差距,这可能是由于估算不精确造成的。
期刊介绍:
Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.