Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality

Eliason, Erica L.

doi:10.1016/j.whi.2020.01.005

Cited by 90 publications

(92 citation statements)

References 14 publications

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“…Over the past decade, studies have shown that in the states that expanded Medicaid coverage, there were improvements in diagnosis, management and mortality of chronic conditions. [7][8][9][10][27][28][29] Further studies have also investigated the impact on disease mortality rates in Medicaid expansion states on a nationwide scale. 30,31 In end-stage renal disease, patients had improved 1-year survival rates in Medicaid expansion states.…”

Section: Discussionmentioning

confidence: 99%

“Association between Median Household Income, State Medicaid Expansion Status, and COVID-19 Outcomes Across US Counties”

Apenyo

Vera-Urbina

Ahmad

et al. 2021

Preprint

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Objective: The relationship between socioeconomic status and its interaction with State Medicaid-expansion policies on COVID-19 outcomes across United States (US) counties are uncertain. To determine the association between median-household-income and its interaction with State Medicaid-expansion status on COVID-19 incidence and mortality in US counties Methods: Longitudinal, retrospective analysis of 3142 US counties (including District of Columbia) to study the relationship between County-level median-household-income (defined by US Census Bureau Small-Area-Income-and-Poverty-Estimates) and COVID-19 incidence and mortality per 100000 of the population in US counties from January 20, 2020 through December 6, 2020. County median-household-income was log-transformed and stratified by quartiles. Medicaid-expansion status was defined by US State Medicaid-expansion adoption as of first reported US COVID-19 infection, January 20, 2020. Multilevel mixed-effects generalized-linear-model with negative binomial distribution and log link function compared quartiles of median-household-income and COVID-19 incidence and mortality, reported as incidence-risk-ratio (IRR) and mortality-risk-ratio (MRR), respectively. Models adjusted for county socio-demographic and comorbidity conditions, population density, and hospitals, with a random intercept for states. Multiplicative interaction tested for Medicaid-expansion*income quartiles on COVID-19 incidence and mortality. Results: There was no significant difference in COVID-19 incidence across counties by income quartiles or by Medicaid expansion status. Conversely, significant differences exist between COVID-19 mortality by income quartiles and by Medicaid expansion status. The association between income quartiles and COVID-19 mortality was significant only in counties from non-Medicaid-expansion states but not significant in counties from Medicaid-expansion states (P<0.01 for interaction). For non-Medicaid-expansion states, counties in the lowest income quartile had a 41% increase in COVID-19 mortality compared to counties in the highest income quartile (MRR 1.41, 95% CI: 1.25-1.59). Conclusions and Relevance: Median-household-income was not related to COVID-19 incidence but negatively related to COVID-19 mortality in US counties of states without Medicaid-expansion. It was unrelated to COVID-19 mortality in counties of states that adopted Medicaid-expansion. These findings suggest that expanded healthcare coverage should be investigated further to attenuate the excessive COVID-19 mortality risk associated with low-income communities.

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Section: Discussionmentioning

confidence: 99%

“Association between Median Household Income, State Medicaid Expansion Status, and COVID-19 Outcomes Across US Counties”

Apenyo

Vera-Urbina

Ahmad

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Structural interventions are known to decrease the number of maternal deaths and may similarly improve maternal outcomes such as GDM or HDP, although evidence is limited. For example, states that expanded Medicaid under the Affordable Care Act experienced declines in maternal mortality rates following expansion ( 28 ). Conversely, states with fewer Planned Parenthood clinics or more restrictive abortion policies have higher maternal mortality rates ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Recommended Preconception Health Behaviors and Screenings and Improvements in Cardiometabolic Outcomes of Pregnancy

Stanhope

Kramer

2021

Prev. Chronic Dis.

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Introduction Gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) are associated with increased risk of maternal and infant illness and long-term elevated cardiometabolic risk. Little information exists on the prevention of either disorder before pregnancy. Our goal was to describe the association between preconception indicators and risk of gestational diabetes and hypertensive disorders of pregnancy. Methods We used logistic regression to analyze cross-sectional data from the 2016–2017 Pregnancy Risk Assessment Monitoring System (N = 68,493) to quantify the association between 14 preconception health indicators (across domains of health care, nutrition and physical activity, tobacco and alcohol, chronic conditions, mental health, and emotional and social support) and, separately, GDM and HDP. We accounted for sampling weights and controlled for maternal age, race/ethnicity, prepregnancy insurance, prepregnancy body mass index, and report of a check-up in the year before pregnancy. Results Prepregnancy obesity was the strongest predictor of both HDP (adjusted odds ratio [aOR], 3.1; 95% CI, 2.8–3.5) and GDM (aOR, 3.1; 95% CI, 2.7–3.5). Individual behaviors (eg, exercise, attending a check-up) were not associated with either HDP or GDM. A diagnosis of diabetes before pregnancy predicted HDP (aOR, 2.3; 95% CI, 1.7–3.0). Conclusion Prepregnancy chronic disease and obesity predicted pregnancy complications (ie, GDM and HDP). Given the challenges in reversing these conditions in the year before pregnancy, efforts to improve preconception health may be best directed broadly to expand access to primary care for all women.

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“…Although some women are able to successfully transition to other sources of coverage at this time, many are left in the untenable and unsafe position of being uninsured shortly after a major medical event. Achieving maternal health equity will require broad policy and practice change, including dismantling implicit bias and racism in the health care system (Howell, 2018;Scott, Britton, & McLemore, 2019), but reducing churn in the postpartum period can help to decrease disparities in outcomes (Eliason, 2020 Given the increasing number of maternal deaths occurring beyond 60 days postpartum, it is not surprising that MMRCs are advocating for this policy change. Indeed, according to the Texas Maternal Mortality and Morbidity Task Force, 56% of all maternal deaths in Texas occurred more than 60 days after the end of pregnancy.…”

Section: Medicaid Coverage Disruptionsmentioning

confidence: 99%

Section: Medicaid Coverage Disruptionsmentioning

confidence: 99%