Association of State Medicaid Expansion Status With Rates of Suicide Among US Adults

Patel, Hetal; Barnes, Justin M.; Osazuwa‐Peters, Nosayaba; Bierut, Laura J.

doi:10.1001/jamanetworkopen.2022.17228

Cited by 12 publications

(12 citation statements)

References 42 publications

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“…This finding is consistent with prior studies which have found patients with cancers across various anatomic sites, including the head and neck, present with more advanced disease when uninsured 1,21,22 . This trend of patients expanded health care access leading to improved outcomes generalizes near‐universally to both cancer and noncancer diagnoses and outcomes, further supporting the notion that this sort of “Medicare effect” may underlie a number of other disparities in health care 23–30 …”

Section: Discussionsupporting

confidence: 89%

“…1,21,22 This trend of patients expanded health care access leading to improved outcomes generalizes near-universally to both cancer and noncancer diagnoses and outcomes, further supporting the notion that this sort of "Medicare effect" may underlie a number of other disparities in health care. [23][24][25][26][27][28][29][30] This study represents, to our knowledge, the first to elucidate differences in cancer outcomes by comparing uninsured patients younger than 65 years of age with insured patients older than 65 years of age. Our analysis demonstrated a decreased 5-year CSM which may be mediated by the higher likelihood of receiving cancerspecific surgery for insured patients with head and neck cancer.…”

Section: Discussionmentioning

confidence: 99%

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The “Medicare effect” on head and neck cancer diagnosis and survival

et al. 2023

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Background Uninsured individuals age 55–64 experience disproportionately poor outcomes compared to their insured counterparts. Adequate coverage may prevent these delays. This study investigates a “Medicare‐effect” on head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for persons ages 60–70 years in the United States from 2000 to 2016 with HNSCC. A “Medicare effect” was defined as an increase in incidence, reduction in advanced stage presentation, and/or decrease in cancer‐specific mortality (CSM). Results Compared to their Medicaid or uninsured counterparts, patients age 65 have an increased incidence of HNSCC diagnosis, reduction in advanced stage presentation, decrease in cancer‐specific mortality, and higher likelihood of receiving cancer‐specific surgery. Conclusions Patients age 65 with Medicare have decreased incidence of HNSCC, less hazard of late‐stage diagnosis, and lower cancer‐specific mortality than their Medicaid or uninsured counterparts, supporting the idea of a “Medicare effect” in HNSCC.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The “Medicare effect” on head and neck cancer diagnosis and survival

et al. 2023

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“…30 For example, Medicaid expansion under the Patient Protection and Affordable Care Act was recently found to be associated with decreased suicide rates among both the general population and individuals diagnosed with cancer. 31,32 Second, Hispanic and American Indian, Alaska Native, Asian, and Pacific Islander individuals with cancer were at substantially higher suicide risks than their peers without cancer, which points to potential barriers to health care resources, structural racism, and difficulties navigating health care systems among these populations. 33,34 This finding underscores the importance of increasing diversity, language, and cultural competence among health care professionals, improving health insurance coverage, and tailoring psychosocial support for Hispanic and American Indian, Alaska Native, Asian, and Pacific…”

Section: Discussionmentioning

confidence: 99%

“…The political, social, cultural, and economic environment may also contribute to the suicide risk in an area and merit further research . For example, Medicaid expansion under the Patient Protection and Affordable Care Act was recently found to be associated with decreased suicide rates among both the general population and individuals diagnosed with cancer . Second, Hispanic and American Indian, Alaska Native, Asian, and Pacific Islander individuals with cancer were at substantially higher suicide risks than their peers without cancer, which points to potential barriers to health care resources, structural racism, and difficulties navigating health care systems among these populations .…”

Section: Discussionmentioning

confidence: 99%

Suicide Risk Among Individuals Diagnosed With Cancer in the US, 2000-2016

Jemal

et al. 2023

JAMA Netw Open

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ImportanceIndividuals diagnosed with cancer have elevated suicide risks compared with the general population. National estimates of suicide risks among individuals with cancer are lacking in the US, and knowledge about risk factors is limited.ObjectiveTo provide contemporary estimates of suicide risks associated with cancer and to identify sociodemographic and clinical factors associated with suicide risks among individuals diagnosed with cancer.Design, Setting, and ParticipantsA population-based cohort of individuals diagnosed with cancer from January 1, 2000, to December 31, 2016, from 43 states in the US were followed up through December 31, 2016. Standardized mortality ratios (SMRs) were calculated adjusting for attained age at death, sex, and race and ethnicity groups to compare suicide risks in the cancer cohort vs the general US population. Cox proportional hazards regression models were fitted to identify cancer-specific risk factors of suicide among the cancer cohort. Analyses were conducted from October 27, 2020, to May 13, 2022.Main Outcomes and MeasuresThe main outcomes were risk of suicide death compared with the general population, measured by the standardized mortality ratio; and risk of suicide death associated with sociodemographic and clinical factors among individuals with cancer.ExposureDiagnosis of cancer.ResultsAmong a total of 16 771 397 individuals with cancer, 8 536 814 (50.9%) were 65 years or older at cancer diagnosis, 8 645 631 (51.5%) were male, 13 149 273 (78.4%) were non-Hispanic White, and 20 792 (0.1%) died from suicide. The overall SMR for suicide was 1.26 (95% CI, 1.24-1.28), with a decreasing trend (from an SMR of 1.67 [95% CI, 1.47-1.88] in 2000 to 1.16 [95% CI, 1.11-1.21] in 2016). Compared with the general population, elevated suicide risks were observed in the cancer cohort across all sociodemographic groups, with particularly high SMRs among Hispanic individuals (SMR, 1.48; 95% CI, 1.38-1.58), Medicaid-insured individuals (SMR, 1.72; 95% CI, 1.61-1.84), Medicare-insured individuals 64 years or younger (SMR, 1.94; 95% CI, 1.80-2.07), or uninsured individuals (SMR, 1.66; 95% CI, 1.53-1.80). Moreover, the highest SMR was observed in the first 6 months after the cancer diagnosis (SMR, 7.19; 95% CI, 6.97-7.41). Among individuals diagnosed with cancer, relatively higher suicide risks (ie, hazard ratios) were observed for cancer types with a poor prognosis and high symptom burden in the first 2 years after diagnosis, including cancers of oral cavity and pharynx, esophagus, stomach, brain and other nervous system, pancreas, and lung. After 2 years, individuals with cancers subject to long-term quality-of-life impairments, such as oral cavity and pharynx, leukemia, female breast, uterine, and bladder, had higher suicide risks.Conclusions and RelevanceIn this cohort study of individuals with cancer, elevated suicide risks remained despite a decreasing trend during the past 2 decades. Suicide risks varied by sociodemographic and clinical factors. Timely symptom management and targeted psychosocial interventions are warranted for suicide prevention in individuals diagnosed with cancer.

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“…This suggests that continued expansion of state Medicaid health insurance plans can have secondary benefits in mental health care and suicide morbidity and mortality. 14,15 Overall, there is still a lot of work needed to improve insurance access and mental health treatment to reduce rates of completed suicide attempts among vulnerable patient populations.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Completed Suicides Among Emergency Department Visits for Attempted Suicides

Weldeslase

Akinyemi

Silvestre

et al. 2023

The American Surgeon™

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Background The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides. Methods We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse. Results From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the unsuccessful suicide attempt group had a median age of 30 years (IQR, 24) and were 42.7% male. The most common mechanisms of suicide attempt were poisoning (58.8%) and cut injury (25.6%). Gunshot was the most lethal mechanism accounting 40.3% of the completed suicides despite representing 1.3% of the attempts who came to ED. After controlling for common risk factors for attempted suicide, significant predictors of completed suicide include higher income status, uninsured status, male sex, and higher age. Discussion Among US patients presenting to the ED following attempted suicide, factors associated with suicide completion include increasing age, male sex, higher income, gunshot injuries, and uninsured status.

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Association of State Medicaid Expansion Status With Rates of Suicide Among US Adults

Cited by 12 publications

References 42 publications

The “Medicare effect” on head and neck cancer diagnosis and survival

The “Medicare effect” on head and neck cancer diagnosis and survival

Suicide Risk Among Individuals Diagnosed With Cancer in the US, 2000-2016

Predictors of Completed Suicides Among Emergency Department Visits for Attempted Suicides

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