Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act

Details

• Alternative Title:
  Med Care
• Personal Author:
  Marino, Miguel ; Angier, Heather ; Fankhauser, Katie ; Valenzuela, Steele ; Hoopes, Megan ; Heintzman, John ; DeVoe, Jennifer ; Moreno, Laura ; Huguet, Nathalie
• Description:
  Background
  
  Racial and ethnic minorities are disproportionately affected by diabetes and at greater risk of experiencing poor diabetes-related outcomes compared with non-Hispanic whites. The Affordable Care Act (ACA) was implemented to increase health insurance coverage and reduce health disparities.
  
  Objective
  
  Assess changes in diabetes-associated biomarkers [hemoglobin Alc (HbAlc) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group.
  
  Research Design
  
  Retrospective cohort study of community health center (CHC) patients.
  
  Subjects
  
  Patients aged 19–64 with diabetes living in 1 of 10 Medicaid expansion states with ≥ 1 CHC visit and ≥ 1 HbAlc measurement in both the pre-ACA and the post-ACA time periods (N = 13,342).
  
  Methods
  
  Linear mixed effects and Cox regression modeled outcome measures.
  
  Results
  
  Overall, 33.5% of patients were non-Hispanic white, 51.2% Hispanic, and 15.3% non-Hispanic black. Newly insured Hispanics and non-Hispanic whites post-ACA exhibited modest reductions in HbAlc levels, similar benefit was not observed among non-Hispanic black patients. The largest reduction was among newly insured Hispanics versus newly insured non-Hispanic whites (P < 0.05). For the subset of patients who had uncontrolled HbAlc (HbAlc ≥ 9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbAlc (hazard ratio = 2.21: 95% confidence interval, 1.10—4.66) relative to the continuously insured group.
  
  Conclusions
  
  The impact of the ACA Medicaid expansion on health disparities is multifaceted and may differ across racial/ethnic groups. This study highlights the importance of CHCs for the health of minority populations.
  
  
• Subjects:
  Adolescent Adult Biomarkers Black Or African American Child Diabetes Mellitus Female Glycated Hemoglobin Health Status Disparities Hispanic Or Latino Humans Lipoproteins, LDL Male Middle Aged Patient Protection And Affordable Care Act Retrospective Studies United States White People Young Adult

  More +
• Keywords:
  Affordable Care Act Diabetes Health Insurance Health Outcomes Health Policy Medicaid Natural Experiment
• Source:
  Med Care. 58(Suppl 6 1):S31-S39
• Pubmed ID:
  32412951
• Pubmed Central ID:
  PMC7365657
• Document Type:
  Journal Article
• Funding:
  R01 HL136575/HL/NHLBI NIH HHSUnited States/ ; U18 DP006116/DP/NCCDPHP CDC HHSUnited States/ ; U18DP006116/ACL/ACL HHSUnited States/
• Volume:
  58
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a5b1e33d8284b33af14a490f17667cad2a2c6ae1f5b93a0ac7f50a5c305d9c1ce6ef0f4f73a9f607083b65e12503a70a88007fee9d6769e75fe7155cafecd485
• Download URL:
  https://stacks.cdc.gov/view/cdc/90704/cdc_90704_DS1.pdf
• File Type:
  [PDF - 651.27 KB ]