Medicaid Expansion and Health Care Use Among Adults With Asthma and Low Incomes: The Adult Asthma Call-Back Survey.

IF 3 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Public Health Reports Pub Date : 2024-07-01 Epub Date: 2024-02-15 DOI:10.1177/00333549241228501

Xiaoting Qin, Maria C Mirabelli, W Dana Flanders, Joy Hsu

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Abstract

Objectives: Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics.

Methods: We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used t tests to compare weighted percentages and 95% CIs, then performed adjusted difference-in-differences analyses. Secondary analyses stratified data by race, ethnicity, and sex.

Results: Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; P = .13). Use of asthma controller medication increased significantly among non-Hispanic Other participants in the nonexpansion group (2011-2013: 16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01). Asthma-related hospitalizations decreased significantly among women in the expansion group: 2011-2013 (7.8%; 95% CI, 5.3%-11.3%) and 2015-2019 (3.5%; 95% CI, 2.5%-4.9%) (P = .009).

Conclusions: Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.

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医疗补助扩展与患有哮喘且收入较低的成年人使用医疗服务的情况：成人哮喘回访调查》。

目标：哮喘对黑人和低收入人群的影响尤为严重，但有关这些人群的医疗补助扩展（以下简称扩展）数据却很有限。我们调查了成人哮喘患者在扩容前后使用医疗服务的情况，并研究了扩容后与哮喘相关的医疗服务使用情况是否因人口特征而异：我们分析了 2011-2013 年和 2015-2019 年行为风险因素监测系统成人哮喘回访调查的数据，调查对象是美国 23 个州 18-64 岁、目前患有哮喘且收入较低的参与者。我们评估了扩展组和未扩展组的 5 项哮喘相关结果，包括就诊（常规和急诊）和用药情况。我们使用 t 检验来比较加权百分比和 95% CI，然后进行调整后的差异分析。二次分析按种族、民族和性别对数据进行了分层：主要分析（N = 10 796）发现，扩增与任何结果之间均无显著关联。按种族和民族进行分层分析后发现没有明显变化（例如，2011-2013 年扩大组非西班牙裔黑人参与者的哮喘控制药物使用率为 24.1% [95% CI，14.4%-37.5%]，2015-2019 年为 35.5% [95% CI，27.0%-45.1%]；P = .13）。在非扩大组的非西班牙裔其他参与者中，哮喘控制药物的使用率显著增加（2011-2013 年：16.0% [95% CI]; 2015-2019 年：35.5% [95% CI]; P = .13）：16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01）。在扩展组中，哮喘相关住院治疗在女性中明显减少：2011-2013 年（7.8%；95% CI，5.3%-11.3%）和 2015-2019 年（3.5%；95% CI，2.5%-4.9%）（P = .009）：调查影响哮喘相关医疗保健使用的医疗保险以外的因素（如健康的社会决定因素），可以促进对促进哮喘和低收入成人健康公平的潜在策略的了解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Public Health Reports 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.00

自引率

6.10%

发文量

164

审稿时长

6-12 weeks

期刊介绍： Public Health Reports is the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service and has been published since 1878. It is published bimonthly, plus supplement issues, through an official agreement with the Association of Schools and Programs of Public Health. The journal is peer-reviewed and publishes original research and commentaries in the areas of public health practice and methodology, original research, public health law, and public health schools and teaching. Issues contain regular commentaries by the U.S. Surgeon General and executives of the U.S. Department of Health and Human Services and the Office of the Assistant Secretary of Health. The journal focuses upon such topics as tobacco control, teenage violence, occupational disease and injury, immunization, drug policy, lead screening, health disparities, and many other key and emerging public health issues. In addition to the six regular issues, PHR produces supplemental issues approximately 2-5 times per year which focus on specific topics that are of particular interest to our readership. The journal''s contributors are on the front line of public health and they present their work in a readable and accessible format.