Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion

Angier, Heather; Ezekiel-Herrera, David; Hoopes, Megan; Jacobs, Elizabeth A.; DeVoe, Jennifer E.; Huguet, Nathalie

doi:10.1353/hpu.2019.0011

Cited by 27 publications

(24 citation statements)

References 19 publications

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“…In nonexpansion states, by contrast, we saw only a small decline in uninsured rates along with a slight increase in privately insured cancer survivors, which was not statistically significant. These findings follow previous studies of the overall CHC population 9,35 and patients with diabetes, 39,40 which showed reductions in uninsured rates and Figure 1. Adjusted likelihood of being uninsured, insured/uninsured, insured with Medicaid, or insured with some private insurance during each 2-year period (2012-2013, 2014-2015, and 2016-2017) by expansion status.…”

Section: Discussionsupporting

confidence: 90%

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

Angier

Springer

Schmidt

et al. 2020

Cancer

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BACKGROUND: This study assessed the impact of Affordable Care Act (ACA) Medicaid expansion on health insurance rates and receipt of cardiovascular-related preventive screenings (body mass index, glycated hemoglobin [HbA1c], low-density lipoproteins, and blood pressure) for cancer survivors seen in community health centers (CHCs). METHODS: This study identified cancer survivors aged 19 to 64 years with at least 3 CHC visits in 13 states from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). Via inverse probability of treatment weighting multilevel multinomial modeling, insurance rates before and after the ACA were estimated by whether a patient lived in a state that expanded Medicaid, and changes between a pre-ACA time period and 2 post-ACA time periods were assessed. RESULTS: The weighted estimated sample size included 409 cancer survivors in nonexpansion states and 2650 in expansion states. In expansion states, the proportion of uninsured cancer survivors decreased significantly from 20.3% in 2012-2013 to 4.5%in 2016-2017, and the proportion of those with Medicaid coverage increased significantly from 38.8% to 55.6%. In nonexpansion states, there was a small decrease in uninsurance rates (from 33.6% in 2012-2013 to 22.5% in 2016-2017). Cardiovascularrelated preventive screening rates increased over time in both expansion and nonexpansion states: HbA1c rates nearly doubled from the pre-ACA period (2012-2013) to the post-ACA period (2016-2017) in expansion states (from 7.2% to 12.8%) and nonexpansion states (from 9.3% to 16.8%). CONCLUSIONS: This study found a substantial decline in uninsured visits among cancer survivors in Medicaid expansion states. Yet, 1 in 5 cancer survivors living in a state that did not expand Medicaid remained uninsured. Several ACA provisions likely worked together to increase cardiovascular-related preventive screening rates for cancer survivors seen in CHCs.

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Section: Discussionsupporting

confidence: 90%

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

Angier

Springer

Schmidt

et al. 2020

Cancer

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“…Angier et al show that by race/ethnicity, White patients who enrolled in Medicaid within expansion states were older and had more comorbidities compared with both Hispanic and Black patients. [ 33 ] Our model adjusted for age, the number of chronic comorbidities, and the Elixhauser mortality score. Therefore, differential rates of comorbidity between newly enrolled White and non-White Medicaid patients, particularly Hispanic patients, may explain this LOS discrepancy as an artifact of risk-adjustment.…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic and socioeconomic variations in hospital length of stay

2021

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Disparities by race/ethnicity and socioeconomic status (SES) exist in rehospitalization rates and inpatient mortality rates. Few studies have examined how length of stay (LOS, a measure of hospital efficiency/quality) differs by race/ethnicity and SES. This study's objective was to determine whether differences in risk-adjusted LOS exist by race/ethnicity and SES Using a retrospective cohort of 1,432,683 medical and surgical discharges, we compared risk-adjusted LOS, in days, by race/ ethnicity and SES (median household income by patient ZIP code in quartiles), using generalized linear models controlling for demographic and clinical factors, and differences between hospitals and between diagnoses. White patients were on average older than both Black and Hispanic patients, had more chronic conditions, and had a higher inpatient mortality risk. In adjusted analyses, Black patients had a significantly longer LOS than White patients (0.25-day difference when discharged to home and 0.23-day difference when discharged to non-home destinations, both P<.001); there was no difference between Hispanic and White patients. Wealthier patients had a shorter LOS than poorer patients (0.16-day difference when discharged to home and 0.06-day difference when discharged to nonhome destinations, both P<.001). These differences by race/ethnicity reversed for Medicaid patients. Disparities in LOS exist based on a patient's race/ethnicity and SES. Black and poorer patients, but not Hispanic patients, have longer LOS compared to White and wealthier patients. In aggregate, these differences may be related to trust and implicit bias and have implications for use of LOS as a quality metric. Future research should examine the drivers of these disparities.

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“…adherence to routine preventative eye care). The Hispanic population is more than twice as likely to be uninsured than the non-Hispanic white population, placing a great strain on access to needed early interventions [18]. Compared to non-Hispanic whites, Hispanics had lower levels of glycated hemoglobin (HbA1c) testing, eye exams, and other preventative health screenings [19].…”

Section: Discussionmentioning

confidence: 99%

Disparities in Ocular and Periocular Cancer Outcomes: Assessing Survival in Patients of Hispanic Origin

Loya

Abdullah

Zaheer

et al. 2020

Cureus

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A nationwide cancer database was used to perform a retrospective cohort study to compare the overall survival and cause-specific survival in patients with ocular and periocular cancer from varying Hispanic origins. A total of 19,831 cases from the Surveillance, Epidemiology, and End Results (SEER) registries between 1973 and 2015 were obtained for analysis. All-cause and cause-specific mortality risk, with adjustment for age group, sex, race, tumor site, tumor histology, grade, summary stage, laterality, surgery status, radiotherapy status, and chemotherapy status, was examined using Cox proportional hazard models. Of the patients included 19,194 patients were non-Spanish-Hispanic-Latino, and 637 patients were Spanish-Hispanic Latino. The Spanish-Hispanic-Latino population was further subdivided as 398 of Mexican origin, 44 of Puerto Rican origin, 135 of South or Central American (excluding Brazil) origin, and 60 of other Spanish/Hispanic origin (including Europe origin). The mean (+/-SD) follow-up period was 98.57 (+/-93.23) months. In adjusted Cox regression, patients of Spanish-Hispanic-Latino origin demonstrated increased all-cause (HR, 1.173; 95% CI 1.022-1.347; P = 0.023) and cancer-specific mortality (HR, 1.328; 95% CI 1.099-1.604; P = 0.003) as compared to their non-Spanish-Hispanic-Latino counterparts. Upon subclassification by Hispanic origin, patients of Mexican origin had significantly increased all-cause (HR, 1.229; 95% CI 1.032-1.464; P = 0.021) and cancer-specific mortality (HR, 1.516; 95% CI 1.204-1.909; P < .001) and patients with other Hispanic/Spanish origin, including Europe, had significantly increased all-cause (HR, 1.627; 95% CI 1.16-2.28; P =0.005), but not cancer-specific (HR, 1.243; 95% CI 0.734-2.104; P = 0.418) mortality. Patients of Puerto Rican origin and South or Central American (excluding Brazil) origin had no significant difference in all-cause or cancer-specific mortality compared to those of non-Spanish-Hispanic-Latino origin. Mortality risk from ocular and periocular cancers varies extensively by specific Hispanic origin. A greater understanding of these disparities is essential to identify vulnerable populations and provide adequate treatment to optimize long-term outcomes.

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Racial/Ethnic Disparities in Health Insurance and Differences in Visit Type for a Population of Patients with Diabetes after Medicaid Expansion

Cited by 27 publications

References 19 publications

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

Racial/ethnic and socioeconomic variations in hospital length of stay

Disparities in Ocular and Periocular Cancer Outcomes: Assessing Survival in Patients of Hispanic Origin

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