Mortality rose in non-expansion states but stayed flat where rolls grew
States generally stabilized their cardiovascular mortality rates after opting for Medicaid expansion under the Affordable Care Act (ACA), a study showed.
Data from a CDC mortality database indicated that cardiovascular mortality among middle-age adults (ages 45-64) stayed about the same in expansion states (146.5 to 146.4 deaths per 100,000 residents per year before and after expansion), whereas it increased in non-expansion states (176.3 to 180.9 deaths per 100,000 residents per year; P=0.001).
Additionally, Medicaid expansion was associated with 4.0 fewer deaths per 100,000 residents (95% CI 2.1-6.0) annually from cardiovascular causes after adjustment for demographic and economic characteristics, according to Sameed Khatana, MD, of Perelman School of Medicine at the University of Pennsylvania in Philadelphia, who presented the study Friday at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions.
"Our findings suggest that Medicaid expansion was associated with a beneficial effect on cardiovascular mortality and may be an important consideration for states debating expansion of Medicaid eligibility," the investigators concluded.
"There have been prior studies showing that Medicaid expansion is associated with better access to care, more use of preventive care, and less chance of financial hardship, but studies showing a link between expansion and outcomes have taken longer – probably because it takes time for access to health care to impact actual health outcomes," Karen Joynt Maddox, MD, MPH, of Washington University School of Medicine in St. Louis, told MedPage Today.
"I think this is a great addition to the literature. As cardiovascular clinicians, we should advocate for our patients to have access to the care they need, and this study gives us more data with which to do that," she added.
Eric Stecker, MD, MPH, of Oregon Health & Science University in Portland, called this an "important study" and commented that it's "critical that we better understand the potential health benefits from insurance expansion, given its large societal expense."
"Potential mechanisms remain unknown, but preliminary evidence raises the possibility that we are seeing the early effects of insurance-facilitated improvements in cardiovascular preventive care," he told MedPage Today.
The study was based on age-adjusted mortality rates from 2010 to 2016 in 1,960 counties across the nation. As of 2016, 19 states had not expanded Medicaid eligibility. Massachusetts and Wisconsin were excluded from the study because their Medicaid expansion was not related to the ACA.
The researchers noted that Medicaid expansion made the biggest difference in cardiovascular deaths in non-metropolitan counties and at areas with the most residents living in poverty, though this interaction was not statistically significant, Khatana told MedPage Today.
Among the limitations of the study were its observational design and its inability to assess different disease states. It is also possible that the trends have changed since 2016, Khatana added.
"We are now trying to identify particularly high risk cardiovascular populations who may be particularly sensitive to the provision of health insurance, such as through Medicaid, and assess whether these populations had any changes in outcomes associated with Medicaid expansion," he said.
Khatana disclosed no conflicts of interest.
AHA Quality of Care and Outcomes Research
Source Reference: Khatana SAM, et al "Association of Medicaid expansion with cardiovascular mortality -- a quasi-experimental analysis" AHA QCOR 2019.
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