Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion
Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion
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DOI：
10.1001/jamanetworkopen.2019.5529
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发表时间：
2019-06-01
影响因子：
13.8
通讯作者：
Rowhani-Rahbar, Ali
中科院分区：
文献类型：
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作者：
Brown, Emily C. B.;Garrison, Michelle M.;Rowhani-Rahbar, Ali
在美国，身体虐待和忽视影响着相当多的儿童。2014年医疗补助计划的扩大，其中几个州选择扩大他们的医疗补助计划，与父母的财务稳定性和获得精神卫生保健。目的为了确定医疗补助计划的扩大是否与身体虐待和忽视率的变化有关。设计，设置和参与者这项生态研究使用了国家级的全国儿童虐待和虐待数据系统（NCANDS）的数据，从1月1日，2010年，通过2016年12月31日，比较选择扩大医疗补助与那些没有的州的身体虐待和忽视率的变化。在研究期间，所有身体虐待和忽视6岁以下儿童的案件都被提交给州一级的儿童保护服务机构，并在达到虐待风险阈值后进行进一步干预。仅记录性虐待或情感虐待的案件被排除在外。从2018年4月12日至3月26日进行了差异中的差异分析，2019年.揭露国家一级医疗补助扩展状态.主要结果和措施筛查的发病率-结果分析了31个州和哥伦比亚特区的数据，这些州和特区扩大了医疗补助计划，在研究期间没有这样做的州，基线忽视计数分别为646463和388265。在医疗补助扩大后，每年每10万名6岁以下儿童中的忽视病例减少422例（95%CI，-753至-91），这是在调整混杂因素后报告的，以比较扩大后和扩大前的比率，扩大医疗补助的州与非扩大州在此期间的变化。从2013年到2016年，有受抚养子女的成年人的医疗补助覆盖率在没有扩大医疗补助的州增加了1.9%（四分位数范围，0.4%至4.3%），在扩大医疗补助的州增加了4.2%（四分位数范围，0.9%至6.0%）。没有发现医疗补助覆盖范围或医疗补助资格标准和身体虐待或忽视rate.CONCLUSIONS和相关性之间的关联医疗补助扩张与减少报告的儿童忽视率，但不是身体虐待率。这些发现表明，扩大医疗补助可能有助于防止儿童忽视。
wIMPORTANCE Physical abuse and neglect affect a significant number of children in the United States. The 2014 Medicaid expansion, in which several states opted to expand their Medicaid programs, is associated with parental financial stability and access to mental health care.OBJECTIVE To determine whether Medicaid expansion is associated with changes in physical abuse and neglect rates.DESIGN, SETTING, AND PARTICIPANTS This ecological study used state-level National Child Abuse and Neglect Data Systems (NCANDS) data from January 1, 2010, through December 31, 2016, to compare the change in physical abuse and neglect rates in states that chose to expand Medicaid vs those that did not. All cases of physical abuse and neglect of children younger than 6 years during the study period that were referred to state-level Child Protective Services and screened in for further intervention after having met a maltreatment risk threshold were included. Cases with only documented sexual or emotional abuse were excluded. A difference-in-difference analysis was conducted from April 12, 2018, through March 26, 2019.EXPOSURES State-level Medicaid expansion status.MAIN OUTCOMES AND MEASURES Incidence rate of screened-in referrals for physical abuse or neglect per 100 000 children younger than 6 years per year by state.RESULTS Data were analyzed for 31 states and the District of Columbia that expanded Medicaid and 19 states that did not during the study period, with baseline neglect counts of 646 463 and 388 265, respectively. After Medicaid expansion, 422 fewer cases of neglect per 100 000 children younger than 6 years (95% CI, -753 to -91) were reported each year after adjusting for confounders for comparison of postexpansion and preexpansion rates in states that expanded Medicaid contrasting with the change during that time in nonexpansion states. From 2013 to 2016, Medicaid coverage for adults with dependent children increased a median 1.9% (interquartile range, 0.4% to 4.3%) in the states that did not expand Medicaid and 4.2% (interquartile range, 0.9% to 6.0%) in the states that did. No associations were found between Medicaid coverage or Medicaid eligibility criteria and physical abuse or neglect rates.CONCLUSIONS AND RELEVANCE Medicaid expansion was associated with a reduction in the reported child neglect rate, but not the physical abuse rate. These findings suggest that expanding Medicaid may help prevent child neglect.