Both authors are with Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami.
Am J Public Health. 2018 Apr;108(4):565-567. doi: 10.2105/AJPH.2017.304218. Epub 2018 Jan 18.
To explore the effect of Medicaid expansion on US infant mortality rate.
We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity.
Mean infant mortality rate in non-Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non-Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non-Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non-Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).
Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival.
探索医疗补助计划扩大覆盖范围对美国婴儿死亡率的影响。
我们分析了 2010 年至 2016 年和 2014 年至 2016 年的数据，比较了接受《平价医疗法案》医疗补助计划扩大覆盖范围的州和华盛顿特区（医疗补助计划扩大覆盖范围州）与未接受该计划的州（非医疗补助计划扩大覆盖范围州）的婴儿死亡率，并按种族/族裔对数据进行分层。
非医疗补助计划扩大覆盖范围州的婴儿死亡率从 2014 年至 2016 年上升（从 6.4 升至 6.5），但在医疗补助计划扩大覆盖范围州则下降（从 5.9 降至 5.6）。医疗补助计划扩大覆盖范围州与非医疗补助计划扩大覆盖范围州的婴儿死亡率差值从 2014 年的 0.573（P=0.08）增加到 2016 年的 0.838（P=0.006），这是因为非医疗补助计划扩大覆盖范围州（11.0%）的降幅小于医疗补助计划扩大覆盖范围州（15.2%）。在医疗补助计划扩大覆盖范围州，非裔美国婴儿的婴儿死亡率从 11.7%降至 10.0%，降幅为 14.5%，是在非医疗补助计划扩大覆盖范围州（6.6%：从 12.2%降至 11.4%；P=0.012）的两倍多。
医疗补助计划扩大覆盖范围州的婴儿死亡率下降幅度更大，其中非裔美国婴儿的下降幅度更大。未来的研究应探讨医疗补助计划扩大覆盖范围的哪些方面可能提高婴儿的生存率。
