Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Unaffordable housing and cancer: novel insights into a complex question

“…Quasi-experimental study designs employ the approximate randomness of factors related to exposure (eg, the timing of a policy implementation) to evaluate the effect of a policy, accounting for time-fixed confounders by design ( 17-19 ). With the appropriate data, including pre-expansion and postexpansion data on cancer mortality and time-varying confounders, these methods can and have been used to successfully evaluate the effect of Medicaid expansion on mortality from cancer ( 20 ) and cardiovascular disease ( 21 ). Rigorous quasi-experimental methods can also be used to evaluate the health-related effects of housing policies.…”

Erratum: Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

“…Regarding the paper by Nianogo et al in the March issue of EPIDEMIOLOGY, 1 the authors have identified some typographical errors in the reporting of Table 1 in the results section under baseline characteristics on Page 267 and in the reporting of the confidence interval pertaining to the effect of Medicaid among men on Page 268. The correct paragraphs (with bolded text) should be as follows:…”