Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis
Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis
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DOI：
10.1200/go.20.00068
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发表时间：
2020-06-01
影响因子：
4.5
通讯作者：
Olopade, Olufunmilayo
中科院分区：
文献类型：
--
作者：
Semprini, Jason;Olopade, Olufunmilayo
医疗补助计划的扩大旨在增加医疗保健的可及性。证据好坏参半，但理论和经验数据表明，通过增加获得保险的机会来降低医疗费用，增加了医疗保健的利用，并可能改善穷人和病人的健康。然而，这一重大卫生政策对健康差距的影响尚未得到彻底调查。目前这项研究的动机是当今最明显的不平等之一：黑人和白人妇女之间乳腺癌死亡率的差异。方法采用差异中差异固定效应回归模型评估医疗补助扩大对黑人和白人乳腺癌死亡率差异的影响。州级乳腺癌死亡率数据来自疾病控制和预防中心。每个州的医疗补助扩张状况由凯撒家庭基金会白皮书提供。他们进行了两项测试，一项是将所有扩张州与所有未扩张州进行比较，另一项是将所有扩张州与投票决定扩张但在2014年之前没有扩张的未扩张州进行比较。差分回归模型将2014年视为洗脱期，并将2012年和2013年（预处理）与2015年和2016年（后处理）进行比较。结果：扩大医疗补助并没有降低乳腺癌死亡率的差异。与预期相反，在将医疗补助扩大到所有符合医疗补助条件的年龄组的州，黑人/白人死亡率增加，对较年轻的年龄组有显著影响（P = 0.01至0.15）。结论：这些结果表明，各州不能仅仅依靠获得保险来缓解癌症或其他慢性疾病的差异。有必要进一步探讨低质量卫生系统的影响。(c)美国临床肿瘤学会2020年
PURPOSE Medicaid expansion was designed to increase access to health care. Evidence is mixed, but theory and empirical data suggest that lower cost of care through greater access to insurance increases health care utilization and possibly improves the health of poor and sick populations. However, this major health policy has yet to be thoroughly investigated for its effect on health disparities. The current study is motivated by one of today's most stark inequalities: the disparity in breast cancer mortality rates between Black and White women.METHODS This analysis used a difference-in-difference fixed effects regression model to evaluate the impact of Medicaid expansion on the disparity between Black and White breast cancer mortality rates. State-level breast cancer mortality data were obtained from the Centers for Disease Control and Prevention. Each state's Medicaid expansion status was provided by a Kaiser Family Foundation white paper. Two tests were conducted, one compared all expanding states with all nonexpanding states, and the second compared all expanding states with nonexpanding states that voted to expand-but did not by 2014. The difference-in-difference regression models considered the year 2014 a washout period and compared 2012 and 2013 (pretreatment) with 2015 and 2016 (posttreatment).RESULTS Medicaid expansion did not lower the disparity in breast cancer mortality. In contrast to expectations, the Black/White mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups, with significant effects in younger age groups (P = .01 to .15).CONCLUSIONThese results suggest that states cannot solely rely on access to insurance to alleviate disparities in cancer or other chronic conditions. More exploration of the impacts of low-quality health systems is warranted. (c) 2020 by American Society of Clinical Oncology