Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis.
Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis.
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DOI：
10.1016/j.drugalcdep.2022.109381
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发表时间：
2022-04-01
影响因子：
4.2
通讯作者：
Cooper HLF
中科院分区：
文献类型：
--
作者：
Ibragimov U;Mansfield RW;Yarbrough CR;Cummings JR;Livingston MD 3rd;Haardörfer R;Beane S;Fadanelli MM;Haley DF;Cooper HLF
阿片类药物过量是美国死亡的主要原因。医疗补助扩张被认为可以降低阿片类药物过量相关的死亡率（OORM），并可能对社会经济地位较低的人群产生特别强烈的影响。本研究评估了州医疗补助扩张与受教育程度低的个人的县级OORM率之间的关系。这项准实验研究使用滞后的多层次差异模型来检验国家医疗补助扩张与高中文凭或以下人群的县级OORM率之间的关系。纵向（2008-2018）OORM数据来自美国国家卫生统计中心，涉及48个州和哥伦比亚特区的2978个县。州一级的暴露是一个时变的二进制编码变量，捕捉了《平价医疗法案》下医疗补助扩张前后的情况（一个“开关”型变量）。研究的主要结果是低教育程度成年人的年度OORM率，对可能漏报的OORM进行了调整。调整后的县级研究人口每10万人OORM率从2008年的10.26 （SD=13.56）平均上升到2018年的14.51 （SD=18.20）。在控制政策和社会人口协变量的1年滞后多变量模型中，州医疗补助扩张与县级OORM率之间的关联在统计上不显著。我们没有发现证据表明扩大医疗补助资格会降低受教育程度较低的成年人的OORM率。未来的工作应该寻求证实我们的发现，并确定和修复机制中的故障，这些故障应该将医疗补助扩张与减少过量用药联系起来。
Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment. This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008–2018) OORM data on 2,978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an “on switch”-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM. The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD=13.56) in 2008 to 14.51 (SD=18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant. We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify – and repair – breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.
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影响因子：
9.7
作者：
Olfson, Mark;Wall, Melanie;Mojtabai, Ramin
通讯作者：
Mojtabai, Ramin
DOI：
10.1377/hlthaff.2019.01428
发表时间：
2020-03
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Saloner B;Maclean JC
通讯作者：
Maclean JC
影响因子：
3.5
作者：
Meinhofer, Angelica;Witman, Allison E.
通讯作者：
Witman, Allison E.
影响因子：
2.1
作者：
Averett, Susan L.;Smith, Julie K.;Wang, Yang
通讯作者：
Wang, Yang
影响因子：
2.5
作者：
Yan, Brandon W.;Sloan, Frank A.;Dudley, R. Adams
通讯作者：
Dudley, R. Adams