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Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act
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June 2020
Source: Med Care. 58(Suppl 6 1):S31-S39
Details:
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Alternative Title:Med Care
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Personal Author:
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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.
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Source:
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Pubmed ID:32412951
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Pubmed Central ID:PMC7365657
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