Marino Miguel, Angier Heather, Fankhauser Katie, Valenzuela Steele, Hoopes Megan, Heintzman John, DeVoe Jennifer, Moreno Laura, Huguet Nathalie
Department of Family Medicine, Division of Biostatistics, Oregon Health & Science University.
School of Public Health, Oregon Health & Science University-Portland State University.
Med Care. 2020 Jun;58 Suppl 6 Suppl 1(Suppl 6 1):S31-S39. doi: 10.1097/MLR.0000000000001257.
Racial and ethnic minorities are disproportionately affected by diabetes and at greater risk of experiencing poor diabetes-related outcomes compared with non-Hispanic whites. The Affordable Care Act (ACA) was implemented to increase health insurance coverage and reduce health disparities.
Assess changes in diabetes-associated biomarkers [hemoglobin A1c (HbA1c) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group.
Retrospective cohort study of community health center (CHC) patients.
Patients aged 19-64 with diabetes living in 1 of 10 Medicaid expansion states with ≥1 CHC visit and ≥1 HbA1c measurement in both the pre-ACA and the post-ACA time periods (N=13,342).
Linear mixed effects and Cox regression modeled outcome measures.
Overall, 33.5% of patients were non-Hispanic white, 51.2% Hispanic, and 15.3% non-Hispanic black. Newly insured Hispanics and non-Hispanic whites post-ACA exhibited modest reductions in HbA1c levels, similar benefit was not observed among non-Hispanic black patients. The largest reduction was among newly insured Hispanics versus newly insured non-Hispanic whites (P<0.05). For the subset of patients who had uncontrolled HbA1c (HbA1c≥9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbA1c (hazard ratio=2.27; 95% confidence interval, 1.10-4.66) relative to the continuously insured group.
The impact of the ACA Medicaid expansion on health disparities is multifaceted and may differ across racial/ethnic groups. This study highlights the importance of CHCs for the health of minority populations.
与非西班牙裔白人相比，少数族裔受糖尿病影响的比例更高，且出现糖尿病相关不良后果的风险更大。《平价医疗法案》（ACA）的实施旨在扩大医疗保险覆盖范围并减少健康差距。
评估在《平价医疗法案》医疗补助扩大前24个月至扩大后24个月期间，按种族/族裔和保险组别划分的糖尿病相关生物标志物[糖化血红蛋白（HbA1c）和低密度脂蛋白]的变化。
对社区卫生中心（CHC）患者进行回顾性队列研究。
年龄在19 - 64岁之间、患有糖尿病且居住在10个医疗补助扩大州之一的患者，在《平价医疗法案》实施前和实施后均有≥1次社区卫生中心就诊记录且≥1次糖化血红蛋白测量值（N = 13342）。
采用线性混合效应模型和Cox回归模型对结果指标进行分析。
总体而言，33.5%的患者为非西班牙裔白人，51.2%为西班牙裔，15.3%为非西班牙裔黑人。《平价医疗法案》实施后，新参保的西班牙裔和非西班牙裔白人糖化血红蛋白水平略有下降，非西班牙裔黑人患者未观察到类似益处。下降幅度最大的是新参保的西班牙裔患者与新参保的非西班牙裔白人患者相比（P < 0.05）。对于在《平价医疗法案》医疗补助扩大后3个月内糖化血红蛋白未得到控制（糖化血红蛋白≥9%）的患者亚组，新参保的非西班牙裔黑人患者相对于持续参保组获得糖化血红蛋白控制的比例最高（风险比 = 2.27；95%置信区间，1.10 - 4.66）。
《平价医疗法案》医疗补助扩大对健康差距的影响是多方面的，且可能因种族/族裔群体而异。本研究强调了社区卫生中心对少数族裔人群健康的重要性。
