Bariatric surgery among vulnerable populations: The effect of the Affordable Care Act's Medicaid expansion
Bariatric surgery among vulnerable populations: The effect of the Affordable Care Act's Medicaid expansion
复制标题
DOI：
10.1016/j.surg.2019.05.005
复制
发表时间：
2019-11-01
期刊：
影响因子：
3.8
通讯作者：
Al-Refaie, Waddah B.
中科院分区：
文献类型：
--
作者：
Gould, Kelsie M.;Zeymo, Alexander;Al-Refaie, Waddah B.
背景：肥胖对弱势群体的影响不成比例。减肥手术是治疗肥胖相关并发症的一种有效的长期治疗方法：然而，少数民族和低收入及公共保险患者的减肥手术率较低。《平价医疗法案》的医疗补助扩大改善了获得医疗保险的机会，但其对减肥手术差异的影响尚未得到评估。我们试图确定平价医疗法案的医疗补助扩张对减肥手术不同利用率的影响。方法：一共47个，974例非老年成人减肥手术患者（年龄18-64岁）在2个医疗补助扩展州中确定（肯塔基州和马里兰州）与2个非扩张对照州（佛罗里达和北卡罗来纳州）之间的2012年和2015年使用医疗保健成本和利用项目的国家住院病人数据库。采用泊松中断时间序列，通过保险（医疗补助/无保险与私人保险）、收入（高收入与低收入）和种族（非裔美国人与白色人）确定调整后的减肥手术发生率。然后计算减肥手术计数的差异，以衡量减肥手术率的差距。结果：调整后的发生率的减肥手术之间的医疗补助或无保险和低收入患者增加了15.8%和5.1%，每季度，分别后，平价医疗法案在扩张状态（P < .001）。在扩张州的私人保险和高收入患者中没有看到边际变化。调整后的发病率增加，非洲裔美国人和白色患者，但这些利率并没有显着改变之前和之后的平价医疗法案在expansion states.Conclusion：差距在减肥手术率的保险和收入减少后，平价医疗法案的医疗补助扩张，但种族差异持续存在。未来的研究应该跟踪这些趋势，并确定减少减肥手术种族差异的因素。(C)2019由Elsevier Inc.出版
Background: Obesity disproportionately affects vulnerable populations. Bariatric surgery is an effective long-term treatment for obesity-related complications: however, bariatric surgical rates are lower among racial minorities and low-income and publicly insured patients. The Affordable Care Act's Medicaid expansion improved access to health insurance, but its impact on bariatric surgical disparities has not been evaluated. We sought to determine the impact of the Affordable Care Act's Medicaid expansion on disparate utilization rates of bariatric surgery.Methods: A total of 47,974 nonelderly adult bariatric surgical patients (ages 18-64 years) were identified in 2 Medicaid-expansion states (Kentucky and Maryland) versus 2 nonexpansion control states (Florida and North Carolina) between 2012 and 2015 using the Healthcare Cost and Utilization Project's State Inpatient Database. Poisson interrupted time series were conducted to determine the adjusted incidence rates of bariatric surgery by insurance (Medicaid/uninsured versus privately insured), income (high income versus low income), and race (African American versus white). The difference in the counts of bariatric surgery were then calculated to measure the gap in bariatric surgery rates.Results: The adjusted incidence rate of bariatric surgery among Medicaid or uninsured and low-income patients increased by 15.8% and 5.1% per quarter, respectively, after the Affordable Care Act in expansion states (P < .001). No marginal change was seen in privately insured and high-income patients in expansion states. The adjusted incidence rates increased among African American and white patients, but these rates did not change significantly before and after the Affordable Care Act in expansion states.Conclusion: The gap in bariatric surgery rates by insurance and income was reduced after the Affordable Care Act's Medicaid expansion, but racial disparities persisted. Future research should track these trends and identify factors to reduce racial disparity in bariatric surgery. (C) 2019 Published by Elsevier Inc.