Akande Manzilat, Minneci Peter C, Deans Katherine J, Xiang Henry, Chisolm Deena J, Cooper Jennifer N
Department of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
J Surg Res. 2018 Aug;228:42-53. doi: 10.1016/j.jss.2018.02.058. Epub 2018 Mar 26.
Racial/ethnic and socioeconomic disparities in trauma care and outcomes among young adults are well documented. As the Patient Protection and Affordable Care Act Medicaid expansion has increased insurance coverage among young adults, we aimed to investigate its impact on disparities in insurance coverage and outcomes among hospitalized young adult trauma patients.
We used the healthcare cost and utilization project state inpatient databases to examine changes in insurance coverage and risk-adjusted outcomes from before (2012-2013) to after (2014) Medicaid expansion among young adults (age 19-44) hospitalized for injury across 11 Medicaid expansion states. Changes were compared across racial/ethnic and community-level income groups. We also compared changes in disparities between three expansion and three nonexpansion states in the US south.
In the first year of Medicaid expansion, non-Hispanic black trauma patients experienced a large decrease in uninsurance (34.3%-14.2%, P < 0.01), reducing the disparity in uninsurance between non-Hispanic black and non-Hispanic white patients (P < 0.05). There were no differences across racial/ethnic groups in changes in in-hospital mortality, failure to rescue, discharge to rehabilitation, or 30-d unplanned readmissions. Socioeconomic disparities in discharge to rehabilitation decreased (1.63% versus 0.06% increase among patients from the lowest and highest income communities, P < 0.05). In contrast, in the selected southern states, Medicaid expansion was associated with the introduction of a disparity in discharge to inpatient rehabilitation between Hispanics and non-Hispanic whites.
Medicaid expansion, in its first year, decreased racial and socioeconomic disparities in uninsurance and socioeconomic disparities in access to rehabilitation.
青年成年人创伤护理及预后方面的种族/族裔和社会经济差异已有充分记录。随着《患者保护与平价医疗法案》中医疗补助计划的扩大增加了青年成年人的保险覆盖范围，我们旨在调查其对住院青年成年创伤患者保险覆盖差异及预后的影响。
我们利用医疗保健成本与利用项目州住院数据库，研究11个医疗补助计划扩大州中因伤住院的青年成年人（19 - 44岁）在医疗补助计划扩大前（2012 - 2013年）至扩大后（2014年）保险覆盖情况及风险调整后预后的变化。比较了不同种族/族裔和社区层面收入群体的变化。我们还比较了美国南部三个扩大州和三个未扩大州之间差异的变化。
在医疗补助计划扩大的第一年，非西班牙裔黑人创伤患者的未参保率大幅下降（从34.3%降至14.2%，P < 0.01），缩小了非西班牙裔黑人和非西班牙裔白人患者之间的未参保差异（P < 0.05）。不同种族/族裔群体在住院死亡率、抢救失败率、出院至康复机构以及30天内非计划再入院率的变化方面没有差异。出院至康复机构的社会经济差异有所减小（最低和最高收入社区患者的增幅分别为1.63%和0.06%，P < 0.05）。相比之下，在选定的南部各州，医疗补助计划的扩大导致西班牙裔和非西班牙裔白人在出院至住院康复机构方面出现差异。
医疗补助计划扩大的第一年，减少了未参保方面的种族和社会经济差异以及获得康复服务方面的社会经济差异。
