Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH.
Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH.
J Am Coll Surg. 2021 Dec;233(6):776-793.e16. doi: 10.1016/j.jamcollsurg.2021.08.694. Epub 2021 Oct 14.
Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income.
Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years.
Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD -16.5 percentage points; 95% CI, -17.1 to -15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD -0.4 percentage points; 95% CI, -0.8 to -0.1 percentage points).
The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.
低收入的年轻成年人不成比例地经历创伤性损伤和不良创伤结局。本研究旨在评估平价医疗法案（ACA）的医疗补助扩展在最初的 4 年内对年轻成年人的创伤护理和结局的影响，总体上以及按种族、族裔和 ZI 码级别中位数收入进行评估。
使用来自实施和未实施医疗补助扩展的 5 个州的全州医院出院数据进行差异分析（DD）。在医疗补助扩展和开放注册前后（2011-2013 年至 2014-2017 年），对年龄在 19 至 44 岁的创伤患者的保险覆盖范围和结局进行检查。
医疗补助扩展与未参保患者的比例下降（DD-16.5%；95%CI，-17.1%至-15.9%）相关。与白人患者相比，黑人患者和西班牙裔患者的降幅更大，而收入较低的 ZI 码患者的降幅更大（所有 P<0.05）。医疗补助扩展与出院至住院康复的比例增加相关（DD0.6%；95%CI，0.2%至 0.9%）。与收入最高的 ZI 码患者相比，收入最低的 ZI 码患者的增幅更大（P<0.05）。医疗补助扩展与整体住院死亡率或再入院率或返回急诊就诊率的变化无关，但与黑人患者的住院死亡率下降相关（DD-0.4%；95%CI，-0.8%至-0.1%）。
在最初的 4 年内，平价医疗法案的医疗补助扩展增加了年轻成年创伤患者的保险覆盖范围和康复机会。它还减少了住院康复机会的社会经济差异以及黑人和白人患者之间的住院死亡率差异。
