From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA.
California Center for Population Research, UCLA, Los Angeles, CA.
Epidemiology. 2024 Mar 1;35(2):263-272. doi: 10.1097/EDE.0000000000001691. Epub 2023 Jan 30.
Studies have suggested Medicaid expansion enacted in 2014 has resulted in a reduction in overall cardiovascular disease (CVD) mortality in the United States. However, it is unknown whether Medicaid expansion has a similar effect across race-ethnicity and sex. We investigated the effect of Medicaid expansion on CVD mortality across race-ethnicity and sex.
Data come from the behavioral risk factor surveillance system and the US Centers for Disease Control's Wide-ranging Online Data for Epidemiologic Research, spanning the period 2000-2019. We used the generalized synthetic control method, a quasi-experimental approach, to estimate effects.
Medicaid expansion was associated with -5.36 (mean difference [MD], 95% confidence interval [CI] = -22.63, 11.91) CVD deaths per 100,000 persons per year among Blacks; -4.28 (MD, 95% CI = -30.08, 21.52) among Hispanics; -3.18 (MD, 95% CI = -8.30, 1.94) among Whites; -5.96 (MD, 95% CI = -15.42, 3.50) among men; and -3.34 (MD, 95% CI = -8.05, 1.37) among women. The difference in mean difference (DMD) between the effect of Medicaid expansion in Blacks compared with Whites was -2.18; (DMD, 95% CI = -20.20, 15.83); between that in Hispanics compared with Whites: -1.10; (DMD, 95% CI = -27.40, 25.20) and between that in women compared with men: 2.62; (DMD, 95% CI = -7.95, 13.19).
Medicaid expansion was associated with a reduction in CVD mortality overall and in White, Black, Hispanic, male, and female subpopulations. Also, our study did not find any difference or disparity in the effect of Medicaid on CVD across race-ethnicity and sex-gender subpopulations, likely owing to imprecise estimates.
研究表明，2014 年实施的医疗补助计划扩大，导致美国整体心血管疾病（CVD）死亡率下降。然而，目前尚不清楚医疗补助计划扩大是否对不同种族和性别有类似的影响。我们调查了医疗补助计划扩大对不同种族和性别人群 CVD 死亡率的影响。
数据来自行为风险因素监测系统和美国疾病控制与预防中心的广泛在线流行病学研究数据，时间跨度为 2000-2019 年。我们使用广义综合控制法，一种准实验方法，来估计效果。
医疗补助计划扩大与黑人每 10 万人每年 CVD 死亡人数减少 5.36 人（平均差异[MD]，95%置信区间[CI] = -22.63，11.91）；西班牙裔每 10 万人每年 CVD 死亡人数减少 4.28 人（MD，95% CI = -30.08，21.52）；白人每 10 万人每年 CVD 死亡人数减少 3.18 人（MD，95% CI = -8.30，1.94）；男性每 10 万人每年 CVD 死亡人数减少 5.96 人（MD，95% CI = -15.42，3.50）；女性每 10 万人每年 CVD 死亡人数减少 3.34 人（MD，95% CI = -8.05，1.37）。医疗补助计划扩大对黑人的影响与对白人的影响之间的平均差异（DMD）为-2.18；（DMD，95% CI = -20.20，15.83）；对西班牙裔的影响与对白人的影响之间的 DMD 为-1.10；（DMD，95% CI = -27.40，25.20）；对女性的影响与对男性的影响之间的 DMD 为 2.62；（DMD，95% CI = -7.95，13.19）。
医疗补助计划扩大与 CVD 死亡率的总体下降以及白人、黑人、西班牙裔、男性和女性亚人群的死亡率下降有关。此外，我们的研究没有发现医疗补助计划对不同种族和性别群体的 CVD 影响存在任何差异或差距，这可能是由于估计不精确所致。
