医疗补助扩大与婴儿死亡率：一项差分分析。
Medicaid expansion and infant mortality, revisited: A difference-in-differences analysis.
机构信息
Department of Biology, University of Dayton, Dayton, Ohio.
Program in Epidemiology, University of Delaware, Newark, Delaware.
出版信息
Health Serv Res. 2020 Jun;55(3):393-398. doi: 10.1111/1475-6773.13286. Epub 2020 Mar 20.
OBJECTIVE
To determine the association between Medicaid expansion and infant mortality rate (IMR) in the United States.
DATA SOURCES
State-level aggregate data on US IMR, race, and sex were abstracted from the US Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research.
STUDY DESIGN
The association between Medicaid expansion and IMR adjusted for race and sex was assessed with multiple linear regression models using difference-in-differences estimation and Huber-White robust standard errors.
PRINCIPAL FINDINGS
Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017 (Coef. = 0.04; 95% CI: -0.39, 0.46). However, among Hispanics, the program was found to be associated with reduction in IMR (Diff-in-Diff Coef. = -0.53; 95% CI: -1.02, -0.03).
CONCLUSIONS
Overall, the Affordable Care Act-induced Medicaid expansion was not associated with IMR reduction in expansion states relative to nonexpansion states. However, the program was associated with a significant IMR decline among Hispanics.
目的
在美国，确定医疗补助计划扩大与婴儿死亡率（IMR）之间的关联。
数据来源
从美国疾病控制与预防中心的广泛在线流行病学研究数据集中提取了关于美国 IMR、种族和性别的州级汇总数据。
研究设计
使用差分法和 Huber-White 稳健标准误差的多元线性回归模型评估了医疗补助计划扩大与经种族和性别调整后的 IMR 变化之间的关联。
主要发现
差分回归发现，2010 年至 2017 年期间，医疗补助计划扩大与全国 IMR 变化之间没有关联（系数=0.04；95%置信区间：-0.39，0.46）。然而，在西班牙裔中，该计划与 IMR 降低相关（差异中的差异系数=-0.53；95%置信区间：-1.02，-0.03）。
结论
总体而言，与非扩张州相比，平价医疗法案引起的医疗补助计划扩张与扩张州的 IMR 降低无关。然而，该计划与西班牙裔人群中 IMR 的显著下降有关。
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