Journal Article

The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction

Valdovinos, Erica M., Niedzwiecki, Matthew J., Guo, Joanna, Hsia, Renee Y.

2020

Overview

After having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act's expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI. Quasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010-2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18-64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality. A total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality. The Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / African Americans / Biology and Life Sciences / California / Care and treatment / Codes / Datasets / Demographic aspects / Emergency medical care / Ethnicity / Expansion / Female / Florida / Government programs / Growth / Health aspects / Health care access / Health care disparities / Heart attack / Heart attacks / Hispanic Americans / Hospital Mortality / Hospitalization / Hospitals / Humans / Inequality / Institutional racism / Insurance coverage / Male / Medicaid / Medicine / Medicine and Health Sciences / Middle Aged / Minority & ethnic groups / Mortality / Myocardial infarction / Myocardial Infarction - therapy / Patient outcomes / Patient Protection and Affordable Care Act / Patients / People and places / Percutaneous Coronary Intervention / Race / Race factors / Regression analysis / Regression models / Social Sciences / Uninsured people / United States / Young Adult