Rogers Christopher K, Zhang Ning Jackie
Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University , South Orange, New Jersey.
Popul Health Manag. 2017 Oct;20(5):348-356. doi: 10.1089/pop.2016.0113. Epub 2017 Feb 13.
Cardiovascular disease (CVD) is one of the most prevalent chronic diseases nationally and disproportionately affects low-income individuals. There are substantial disparities on CVD outcomes that stem from the lack of health insurance among low-income populations. The Affordable Care Act expands Medicaid health insurance to low-income populations, and aims to increase the utilization of health, social, and economic preventive services to reduce health disparities and prevent chronic diseases. The authors analyzed data from the 2014 Behavioral Risk Factor Surveillance System to understand the potential impact of Medicaid expansion on disparities in CVD among low-income populations. Logistic regression models examined the association between CVD self-reported outcomes among low-income adults with incomes at or below 138% of the federal poverty level in states that have chosen to expand Medicaid and those states choosing not to expand, controlling for socioeconomic, demographic, behavioral, social, and health variables that affect CVD. Overall, the results show that adults in Medicaid expansion states have significantly lower odds of experiencing poor heart health compared to those in non-Medicaid expansion states (odds ratio = 0.767, 95% confidence interval 0.667-0.882). Additionally, significant findings were found between the association of CVD and demographic, socioeconomic, health, and health behavioral covariates. Policy makers should consider policies, systems, and interventions that increase access to a comprehensive set of preventive, population health, and socioeconomic services targeting the key determinants of CVD and other outcomes when expanding Medicaid and designing state plans and waivers.
心血管疾病（CVD）是美国最普遍的慢性病之一，且对低收入人群的影响尤为严重。低收入人群因缺乏医疗保险，在心血管疾病治疗结果方面存在巨大差异。《平价医疗法案》将医疗补助健康保险扩大到低收入人群，旨在提高健康、社会和经济预防服务的利用率，以减少健康差异并预防慢性病。作者分析了2014年行为风险因素监测系统的数据，以了解医疗补助扩大对低收入人群心血管疾病差异的潜在影响。逻辑回归模型检验了在选择扩大医疗补助的州和未选择扩大的州中，收入在联邦贫困水平138%及以下的低收入成年人自我报告的心血管疾病结果之间的关联，并控制了影响心血管疾病的社会经济、人口统计学、行为、社会和健康变量。总体而言，结果表明，与未扩大医疗补助的州相比，扩大医疗补助州的成年人心脏健康状况不佳的几率显著更低（优势比=0.767，95%置信区间0.667-0.882）。此外，在心血管疾病与人口统计学、社会经济、健康和健康行为协变量之间的关联方面也发现了显著结果。政策制定者在扩大医疗补助以及设计州计划和豁免条款时，应考虑制定相关政策、体系和干预措施，以增加获得针对心血管疾病及其他结果的关键决定因素的一系列全面预防、人群健康和社会经济服务的机会。
