Tekin Zehra, Saygili Meryem
Endocrinology, Diabetes and Metabolism, Christus Trinity Clinic, Tyler, USA.
Social Sciences/Economics, The University of Texas at Tyler, Tyler, USA.
Cureus. 2022 Oct 24;14(10):e30631. doi: 10.7759/cureus.30631. eCollection 2022 Oct.
Background and objective Diabetic ketoacidosis (DKA) is a potentially fatal complication of uncontrolled diabetes and remains a significant source of morbidity and mortality even though it is considered preventable. Diabetes is a chronic illness that requires constant monitoring and regular check-ups. Delaying or foregoing necessary diabetes care due to a lack of health insurance can result in severe complications. The Affordable Care Act (ACA) Medicaid expansion is intended to increase access to healthcare and improve health outcomes. This study aimed to examine the relationship between the ACA Medicaid expansion and hospitalizations with DKA. Methods This retrospective cross-sectional study used discharge records from 2010 to 2017 for hospitals in Texarkana, located on the border of Texas and Arkansas. The study employed a difference-in-differences method. Patients from Arkansas, which expanded Medicaid in 2014, constituted the treatment group, while those from Texas, which did not adopt the expansion, were the control group. A triple difference methodology was used to compare the impact of the expansion on patients with different socioeconomic backgrounds. The main outcome measure was DKA per 1000 discharges. Results A total of 89,184 inpatient discharges from Texarkana hospitals were analyzed; 43,286 patients were from Arkansas (48.54%) and 45,898 (51.46%) were from Texas. Even though DKA cases increased from pre-expansion (2010-2013) to post-expansion (2014-2017) period among patients from Arkansas (by a mean of 4.33) and Texas (by a mean of 8.28), the increase was milder among Arkansas patients with an adjusted decrease of 4.17 per 1000 discharges (95% CI: -5.04 to -3.31; p<0.001), implying a 42% lower risk of hospitalizations with DKA compared to the baseline averages. The triple difference analysis suggested that the decrease in incidences was more pronounced for patients from low-income areas with an adjusted decrease of 13.47 per 1000 discharges (95% CI: -22.45 to -4.49; p=0.003). Conclusions Based on our findings, Medicaid expansion decreases hospitalizations with DKA, presumably due to better monitoring and care of diabetes made possible by increasing access to healthcare among individuals with low incomes.
背景与目的 糖尿病酮症酸中毒（DKA）是糖尿病控制不佳时可能出现的一种致命并发症，即便其被认为是可预防的，但仍是发病和死亡的一个重要原因。糖尿病是一种慢性病，需要持续监测和定期检查。因缺乏医疗保险而推迟或放弃必要的糖尿病护理可能会导致严重并发症。《平价医疗法案》（ACA）的医疗补助扩大计划旨在增加医疗服务可及性并改善健康状况。本研究旨在探讨ACA医疗补助扩大计划与DKA住院之间的关系。方法 这项回顾性横断面研究使用了得克萨斯州和阿肯色州边境城市特克萨卡纳各医院2010年至2017年的出院记录。该研究采用了双重差分法。来自2014年扩大了医疗补助的阿肯色州的患者构成治疗组，而来自未采用该扩大计划的得克萨斯州的患者为对照组。采用三重差分法来比较该扩大计划对不同社会经济背景患者的影响。主要结局指标是每1000例出院患者中的DKA病例数。结果 共分析了特克萨卡纳各医院的89184例住院出院病例；其中43286例患者来自阿肯色州（48.54%），45898例（51.46%）来自得克萨斯州。尽管阿肯色州（平均增加4.33例）和得克萨斯州（平均增加8.28例）患者中DKA病例数从扩大计划实施前（2010 - 2013年）到实施后（2014 - 2017年）有所增加，但阿肯色州患者的增加幅度较小，每1000例出院患者中经调整后减少了4.17例（95%置信区间：-5.04至-3.31；p<0.001），这意味着与基线平均值相比，DKA住院风险降低了42%。三重差分分析表明，低收入地区患者的发病率下降更为明显，每1000例出院患者中经调整后减少了13.47例（95%置信区间：-22.45至-4.49；p = 0.003）。结论 根据我们的研究结果，医疗补助扩大计划减少了DKA住院病例，这可能是由于增加了低收入人群的医疗服务可及性，从而使糖尿病得到了更好的监测和护理。
