Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion.
Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion.
复制标题
DOI：
10.1001/jamahealthforum.2021.3083
复制
发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Lewis KH
中科院分区：
文献类型：
--
作者：
Hanchate AD;Qi D;Paasche-Orlow MK;Lasser KE;Liu Z;Lin M;Lewis KH
平价医疗法案医疗补助的扩大与选择性减肥手术的增加有关吗？在这项队列研究中，对2010年至2017年来自11个扩大医疗补助计划的州和6个未扩大医疗补助计划的州的637557例减肥手术进行了差异中差异分析，医疗补助计划的扩大与2014-2017年医疗补助覆盖和未保险的26至64岁非西班牙裔白人成年人的减肥手术率每年增加31.6%有关。在非西班牙裔黑人和西班牙裔成年人中没有观察到增加。这项研究表明，额外的政策变化和临床项目可能是必要的，以解决种族和少数民族人群所面临的不成比例的障碍，以确保更公平地获得基于证据的肥胖治疗。关于2014年开始的《平价医疗法案》（Affordable Care Act）医疗补助扩张是否改善了选择性手术的可及性，证据有限。没有保险的人肥胖的风险更高，并且在医疗补助扩大后可能经历了减肥手术的改善。在26 - 64岁的医疗补助覆盖人群和未参保人群中，研究医疗补助扩大与住院选择性减肥手术的接受之间的关系。该队列研究对来自11个医疗补助扩展州和6个非医疗补助扩展州的26至74岁患者的637557例选择性减肥手术的所有付款人数据（2010-2017）进行了差异中差异分析。非扩张州和65至74岁的个体为对照组。数据分析时间为2020年7月6日至2021年7月23日。生活在医疗补助扩张的州。主要结果是(1)选择性减肥手术的数量，(2)人口数量，(3)在医疗补助覆盖和未投保的个体中减肥手术的比率（每10000人的手术数量）。在2010年至2017年期间，来自17个研究州的600 798例26至64岁成年人的选择性减肥手术中，医疗补助覆盖和未保险的个体占扩展州手术总量的18.3%，占非扩展州手术总量的14.5%。扩张状态共有296798例（78.9%）为女性，非扩张状态为177386例（78.9%）。在26 ~ 64岁的个体中，年龄中位数为44岁（IQR, 37 ~ 52）岁。种族和民族分布为非西班牙裔白人，占60.2%；非西班牙裔黑人，17.7%；西班牙裔,16.6%;其他的5.5%。2013年至2017年期间，医疗补助覆盖和未参保患者的减肥手术数量在扩大的州每年增长30.3%，在未扩大的州每年增长16.5%。医疗补助扩大与手术数量年增长36.6% (95% CI， 8.2%至72.5%)，人口年增长9.0% (95% CI， 3.8%至14.5%)，减肥手术率年增长25.5% （95% CI, -1.3%至59.4%）相关。按种族和民族划分，医疗补助扩大与非西班牙裔白人中减肥手术率的增加有关（31.6%;95% CI， 6.1%至63.0%），但在非西班牙裔黑人（5.9%;95% CI, -19.8%至39.9%）和西班牙裔（28.9%,95% CI, -24.4%至119.8%）中没有显著变化。这项队列研究发现，在低收入的非西班牙裔白人中，医疗补助计划的扩大与减肥手术率的增加有关，但在西班牙裔和非西班牙裔黑人中则没有关系。这项队列研究比较了在实施《平价医疗法案》后，有和没有医疗补助扩大的州选择性减肥手术的比率。
Was Affordable Care Act Medicaid expansion associated with increased uptake of elective bariatric surgery? In this cohort study using a difference-in-differences analysis of 637 557 bariatric surgeries from 2010 to 2017 from 11 states that expanded Medicaid and 6 states that did not, Medicaid expansion was associated with a 31.6% annual increase in the rate of bariatric surgery during 2014-2017 among Medicaid-covered and uninsured non-Hispanic White adults aged 26 to 64 years. No increase was observed among non-Hispanic Black and Hispanic adults. This study suggests that additional policy changes and clinical programs may be necessary to address barriers disproportionately faced by racial and ethnic minority populations to ensure more equitable access to evidence-based treatment of obesity. There is limited evidence on whether the Affordable Care Act Medicaid expansion beginning in 2014 improved access to elective procedures. Uninsured individuals are at higher risk of obesity and may have experienced improved uptake of bariatric surgery following Medicaid expansion. To examine the association between Medicaid expansion and the receipt of inpatient elective bariatric surgery among Medicaid-covered and uninsured individuals aged 26 to 64 years. This cohort study used difference-in-differences analysis of all-payer data (2010-2017) of 637 557 elective bariatric surgeries for patients aged 26 to 74 years from 11 Medicaid expansion states and 6 nonexpansion states. Nonexpansion states and individuals aged 65 to 74 years were control cohorts. Data analysis was performed from July 6, 2020, to July 23, 2021. Living in a Medicaid expansion state. The main outcomes were the (1) number of elective bariatric surgeries, (2) population count, and (3) rate of bariatric surgery (number of surgeries per 10 000 population) among Medicaid-covered and uninsured individuals. Of the 600 798 elective bariatric surgeries in adults aged 26 to 64 years between 2010 and 2017 from the 17 study states, Medicaid-covered and uninsured individuals accounted for 18.3% of the total surgery volume in expansion states and 14.5% in nonexpansion states. A total of 296 798 patients (78.9%) in expansion states were women vs 177 386 (78.9%) in nonexpansion states. Among individuals aged 26 to 64 years, the median age was 44 (IQR, 37-52) years. Racial and ethnic distribution was non-Hispanic White, 60.2%; non-Hispanic Black, 17.7%; Hispanic, 16.6%; and other, 5.5%. Between 2013 and 2017, the volume of bariatric surgeries for Medicaid-covered and uninsured patients increased annually by 30.3% in expansion states and 16.5% in nonexpansion states. Medicaid expansion was associated with a 36.6% annual increase (95% CI, 8.2% to 72.5%) in surgery volume, a 9.0% annual increase (95% CI, 3.8% to 14.5%) in the population, and a 25.5% change (95% CI, –1.3% to 59.4%) in the rate of bariatric surgery. By race and ethnicity, Medicaid expansion was associated with an increase in the rate of bariatric surgery among non-Hispanic White individuals (31.6%; 95% CI, 6.1% to 63.0%) but no significant change among non-Hispanic Black (5.9%; 95% CI, –19.8% to 39.9%) and Hispanic (28.9%; 95% CI, –24.4% to 119.8%) individuals. This cohort study found that Medicaid expansion was associated with increased rates of bariatric surgery among lower-income non-Hispanic White individuals, but not among Hispanic and non-Hispanic Black individuals. This cohort study compares the rate of elective bariatric surgery in states with vs without Medicaid expansion after implementation of the Affordable Care Act.
登录
查看更多内容
影响因子：
2.9
作者：
Gebran, Selim G.;Knighton, Brooks;Rasko, Yvonne M.
通讯作者：
Rasko, Yvonne M.
影响因子：
120.7
作者：
Jakobsen, Gunn Signe;Smastuen, Milada Cvancarova;Hjelmesaeth, Joran
通讯作者：
Hjelmesaeth, Joran
影响因子：
3.8
作者：
Gould, Kelsie M.;Zeymo, Alexander;Al-Refaie, Waddah B.
通讯作者：
Al-Refaie, Waddah B.
影响因子：
3.4
作者：
Andrews, Roxanne M.
通讯作者：
Andrews, Roxanne M.
影响因子：
16.9
作者：
Courcoulas, Anita P.;King, Wendy C.;Yanovski, Susan Z.
通讯作者：
Yanovski, Susan Z.