Racial and Ethnic Disparities in Access to Care during the Early Years of Affordable Care Act Implementation in California

Charles, Shana Alex; McEligot, Archana Jaiswal

doi:10.32398/cjhp.v16i1.2122

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Social factors may also limit our understanding of some of our outcomes (e.g., foregone care due to cost), which makes it more challenging to assess disparities in these measures (e.g., some vulnerable populations are less likely to report foregone care). For example, in a study using the 2015 CHIS, white Californians were more likely to report both having a usual source of care and foregoing needed care than their POC counterparts (Charles and McEligot 2018). Reporting cost as a barrier to healthcare implies that the respondent perceived an unmet need for such services, and this may be less likely for people with the greatest barriers to care.…”

Section: Discussionmentioning

confidence: 99%

“…In California, despite coverage gains, disparities in access by race/ethnicity have persisted since the implementation of the ACA. A study using the 2015 California Health Interview Survey (CHIS) found that Latino adults reported low rates of having a usual source of care, and Asian-American adults reported low rates of clinic visits (Charles and McEligot 2018). For Asian American subgroups, a study using the 2003-2017 CHIS reported increased coverage post-ACA but ongoing disparities relative to white Califorians in coverage and several measures of access and utilization (Park et al 2019).…”

Section: Background On the Aca Medicaid Expansionmentioning

confidence: 99%

See 1 more Smart Citation

Impacts of the Affordable Care Act Medicaid Expansion in California

Arthur¹,

Alarcón²,

Hartman³

2021

CJPP

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Section: Discussionmentioning

confidence: 99%

Section: Background On the Aca Medicaid Expansionmentioning

confidence: 99%

Impacts of the Affordable Care Act Medicaid Expansion in California

Arthur¹,

Alarcón²,

Hartman³

2021

CJPP

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Enduring inequalities: Revascularization before and after the ACA

Gusmano,

Weisz,

Palghat

et al. 2024

World Med & Health Policy

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The use of revascularization (coronary artery bypass surgery [CABG] and percutaneous coronary intervention [PCI]) in the United States is declining, but they remain important procedures for the treatment of patients with coronary artery disease. There are large and long‐standing disparities in the use of revascularization among patients hospitalized with heart disease. In this article, we investigate whether the implementation of the Patient Protection and Affordable Care Act (ACA) is associated with a reduction in disparities in the use of revascularization. We use data from the Agency for Healthcare Research and Quality (AHRQ)'s National Inpatient Sample (NIP) of the Healthcare Cost and Utilization Project (HCUP) project to compare the use of revascularization among patients 45 years and older in the United States in 2012 and 2018. For both years, we conducted multiple logistic regression analysis to assess the factors associated with coronary revascularization among patients hospitalized with heart disease. Hospitalizations for heart disease and the use of revascularization both fell between 2012 and 2018 at a rate that was greater than the reduction in heart disease deaths in the country. These findings are consistent with the clinical literature on the growth of medical management of heart disease. Disparities in the use of revascularization, by gender, insurance status, neighborhood, and race/ethnicity, were just as large after the implementation of the ACA in 2014. The expansion of insurance by the ACA, alone, was insufficient to reduce disparities in the use of revascularization in patients with diagnosed coronary heart disease in the United States.

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Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure

Savitz

Leong

Sung

et al. 2021

JAHA

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Background Variation in outcomes by race/ethnicity in adults with heart failure (HF) has been previously observed. Identifying factors contributing to these variations could help target interventions. We evaluated the association of race/ethnicity with HF outcomes and potentially contributing factors within a contemporary HF cohort. Methods and Results We identified members of Kaiser Permanente Northern California, a large integrated healthcare delivery system, who were diagnosed with HF between 2012 and 2016 and had at least 1 year of prior continuous membership and left ventricular ejection fraction data. We used Cox regression with time‐dependent covariates to evaluate the association of self‐identified race/ethnicity with HF or all‐cause hospitalization and all‐cause death, with backward selection for potential explanatory variables. Among 34 621 patients with HF, compared with White patients, Black patients had a higher rate of HF hospitalization (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18–1.38) but a lower rate of death (adjusted HR, 0.78; 95% CI, 0.72–0.85). In contrast, Asian/Pacific Islander patients had similar rates of HF hospitalization, but lower rates of all‐cause hospitalization (adjusted HR, 0.89; 95% CI, 0.85–0.93) and death (adjusted HR, 0.75; 95% CI, 0.69–0.80). Hispanic patients also had a lower rate of death (adjusted HR, 0.85; 95% CI, 0.80–0.91). Sensitivity analyses showed that effect sizes for Black patients were larger among patients with reduced ejection fraction. Conclusions In a contemporary and diverse population with HF, Black patients experienced a higher rate of HF hospitalization and a lower rate of death compared with White patients. In contrast, selected outcomes for Asian/Pacific Islander and Hispanic patients were more favorable compared with White patients. The observed differences were not explained by measured potentially modifiable factors, including pharmacological treatment. Future research is needed to identify explanatory mechanisms underlying ongoing racial/ethnic variation to target potential interventions.

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Racial and Ethnic Disparities in Access to Care during the Early Years of Affordable Care Act Implementation in California

Cited by 3 publications

References 15 publications

Impacts of the Affordable Care Act Medicaid Expansion in California

Impacts of the Affordable Care Act Medicaid Expansion in California

Enduring inequalities: Revascularization before and after the ACA

Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure

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