The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion
The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion
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DOI：
10.1177/1077558720919620
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发表时间：
2020-05-13
影响因子：
2.5
通讯作者：
Dudley, R. Adams
中科院分区：
文献类型：
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作者：
Yan, Brandon W.;Sloan, Frank A.;Dudley, R. Adams
尽管《平价医疗法案》的医疗补助扩张减少了不保险，但人们对其对死亡率的影响知之甚少，特别是在阿片类药物流行的背景下。我们使用疾病控制和预防中心的死亡率数据进行了一项差异中的差异研究，比较了2011年至2016年扩张和非扩张状态之间的死亡率趋势。我们分析了20至64岁成年人的全因死亡，医疗保健适用死亡，药物过量死亡和药物过量以外的死亡原因。医疗补助扩大与医疗保健适用死亡率降低2.7%（p = 0.020）和非药物过量死亡率降低1.9%（p = 0.042）相关。然而，扩展与全因死亡率的任何变化无关（降低0.2%，p = 0.84）。此外，药物过量死亡人数在扩张州比非扩张州上升得更快。在药物过量死亡被排除之前，全因死亡率没有降低，这表明阿片类药物流行对医疗补助扩大所挽救的任何潜在生命产生了缓解影响。
Although the Affordable Care Act's Medicaid expansion reduced uninsurance, less is known about its impact on mortality, especially in the context of the opioid epidemic. We conducted a difference-in-differences study comparing trends in mortality between expansion and nonexpansion states from 2011 to 2016 using the Centers for Disease Control and Prevention mortality data. We analyzed all-cause deaths, health care amenable deaths, drug overdose deaths, and deaths from causes other than drug overdose among adults aged 20 to 64 years. Medicaid expansion was associated with a 2.7% reduction (p = .020) in health care amenable mortality, and a 1.9% reduction (p = .042) in mortality not due to drug overdose. However, the expansion was not associated with any change in all-cause mortality (0.2% reduction, p = .84). In addition, drug overdose deaths rose more sharply in expansion versus nonexpansion states. The absence of all-cause mortality reduction until drug overdose deaths were excluded indicate that the opioid epidemic had a mitigating impact on any potential lives saved by Medicaid expansion.