title: Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients.
abstract: BACKGROUND
  Disparities in trauma outcomes based on insurance and race are especially pronounced among young adults who have relatively high uninsured rates and incur a disproportionate share of trauma in the population. The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parent's health insurance plans until age 26 years, leading to >3 million young adults gaining insurance. We investigated the impact of the DCP on racial disparities in coverage expansion among trauma patients.
  
  
  METHODS
  Using the 2007-2012 National Trauma Data Bank, we compared changes in coverage among 529,844 19- to 25-year-olds with 484,974 controls aged 27 to 34 years not affected by the DCP. Subgroup analyses were conducted by race and ethnicity and by census region.
  
  
  RESULTS
  The pre-DCP uninsured rates among young adults were highest among black patients (48.1%) and Hispanic patients (44.3%), and significantly lower among non-Hispanic white patients (28.9%). However, non-Hispanic white young adults experienced a significantly greater absolute reduction in the uninsured rate (-4.9 percentage points) than black (-2.9; p = 0.01) and Hispanic (-1.7; p < 0.001) young adults. These absolute reductions correspond to a 17.0% relative reduction in the uninsured rate for white patients, 6.1% for black patients, and 3.7% for Hispanic patients. Racial disparities in the provision's impact on coverage among trauma patients were largest in the South and West census regions (p < 0.01).
  
  
  CONCLUSIONS
  Although the DCP increased insurance coverage for young adult trauma patients of all races, both absolute and relative racial disparities in insurance coverage widened. The extent of these racial disparities also differed by geographic region. Although this policy produced overall progress toward greater coverage among young adults, its heterogeneous impact by race has important implications for future disparities research in trauma.
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA. Electronic address: jwscott@partners.org.
authors.forename: John W
authors.initials: JW
authors.lastname: Scott
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA; Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham & Women's Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Department of Medicine, Brigham & Women's Hospital, Boston, MA; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tsai
authors.affiliation: Faculty of Arts and Sciences, Harvard University, Cambridge, MA.
authors.forename: Kirstin W
authors.initials: KW
authors.lastname: Scott
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act; D012189:Retrospective Studies; D014481:United States; D014947:Wounds and Injuries / Q000191:economics* / Q000208:ethnology; D055815:Young Adult