Division of Cardiac Anesthesiology, Los Angeles, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA, USA.
J Racial Ethn Health Disparities. 2023 Dec;10(6):2783-2791. doi: 10.1007/s40615-022-01455-8. Epub 2022 Nov 16.
The aim of this study was to examine the effect of implementation of the Affordable Care Act's Medicaid expansion on access to and outcomes after coronary artery bypass grafting (CABG) surgery.
Retrospective observational study utilizing the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2011 to 2016. The southern region of the USA was used as a control and the western region as the implementation group. Univariate regression models and interrupted time series models were created to evaluate and assess the impact of the Affordable Care Act's Medicaid expansion on mortality after CABG with respect to patient race.
From 2011 to 2016, a total of 117,819 isolated CABG operations were identified in the specified regions using the HCUP NIS. Of these, 89,918 were performed in the southern region, and the remainder were performed in the western region. The proportion of African American patients with Medicaid increased significantly in the western region after the ACA Medicaid expansion, from 13.1 to 17.6%, p = 0.034. There was no significant increase seen in the number of African American patients with Medicaid in the southern region. We found that overall, Black patients had higher mortality after CABG as compared to white patients (OR 1.15, p = 0.02); however, when broken down by region we found higher mortality among African American patients in the southern region only, with no statistically significant difference in mortality between white and Black patients in the western region.
Implementation of the Affordable Care Act increased access to Medicaid among Black Americans but did not necessarily decrease the disparity in access to CABG or mortality after CABG between Black and white patients. When it comes to racial disparities in mortality after CABG, there are significant regional and geographic variations which have not been previously described. This finding has important implications for the development of policy and other strategies that aim to reduce these disparities.
本研究旨在探讨平价医疗法案（ACA）扩大医疗补助计划对冠状动脉旁路移植术（CABG）后获得治疗的机会和治疗结果的影响。
利用 2011 年至 2016 年美国医疗保健成本和利用项目（HCUP）国家住院患者样本（NIS）进行回顾性观察性研究。将美国南部地区作为对照组，西部地区作为实施组。采用单变量回归模型和中断时间序列模型，评估和评估平价医疗法案扩大医疗补助对 CABG 术后死亡率的影响，同时考虑患者种族因素。
在指定地区使用 HCUP NIS 共确定了 2011 年至 2016 年间 117819 例单独 CABG 手术。其中 89918 例在南部地区进行，其余在西部地区进行。ACA 扩大医疗补助后，西部地区有医疗补助的非裔美国患者比例从 13.1%显著增加到 17.6%，p=0.034。南部地区有医疗补助的非裔美国患者数量没有显著增加。我们发现，总体而言，与白人患者相比，黑人患者 CABG 术后死亡率更高（OR 1.15，p=0.02）；然而，按地区细分后，仅在南部地区发现非裔美国患者死亡率较高，而在西部地区，白人和黑人患者的死亡率之间没有统计学差异。
平价医疗法案的实施增加了非裔美国人获得医疗补助的机会，但不一定能减少黑人和白人患者获得 CABG 治疗机会的差异或 CABG 术后死亡率的差异。在 CABG 术后死亡率方面的种族差异方面，存在先前未描述的显著的区域和地理差异。这一发现对制定旨在减少这些差异的政策和其他策略具有重要意义。
