title: Will the Affordable Care Act (ACA) Improve Racial/Ethnic Disparity of Eye Examination Among US Working-Age Population with Diabetes?
abstract: This study aimed to examine the racial/ethnic disparity of eye examination rates among US adults with diabetes before and after the ACA. Working-age adults (18-64 years) with diabetes for years 2014-2017 were simulated by bootstrapping from the working-age diabetes patient sample of Medical Expenditure Panel Survey (MEPS) Household Component 2011. Insurance coverage rates were separately predicted for each racial/ethnic group based on the Congressional Budgeting Office (CBO) report in 2014 and the proportions of Medicaid eligibility. Eye examination rates were weighted to national estimates and compared between racial/ethnic groups. Confidence intervals were estimated using the bootstrap percentile method. Health insurance coverage after the ACA is projected to increase from 90.23 % in 2011 to 98.33 % in 2014 among non-Hispanic Whites (NHW), reaching 98.96 % in 2017. Minorities are forecasted to have about 15 % expansion of insurance coverage from 2011 (80.65 %) to 2014 (96.00 %), reaching 97.25 % in 2017. In 2011, 63.01 % of NHW had eye examinations with forecasted increase to 65.83 % in 2014 and 66.05 % in 2017, while the eye examination rate in the minorities will increase from 55.75 % in 2011 to 59.23 % in 2014 and remain at 59.48 % in 2017. Therefore, racial disparity in eye examination rates is forecasted to persist (ranging from 6.57 % in 2017 to 6.69 % in 2016). The ACA is projected to improve the eye examination rate along with the expansion in insurance coverage. Although predicted racial/ethnic disparities will improve, some differences will persist. Comprehensive strategies need to be developed to eliminate the disparity.
authors.affiliation: Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Section of Endocrinology, Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
authors.affiliation: Department of Medicine, School of Medicine and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Krousel-Wood
authors.affiliation: Division of Clinical and Administrative Science, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA.
authors.forename: Yingnan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Nellans
authors.affiliation: Department of Mathematics, Tulane University, New Orleans, LA, USA.
authors.forename: Qingyang
authors.initials: Q
authors.lastname: Luo
authors.affiliation: Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA. lshi1@tulane.edu.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
mesh_terms: D003920:Diabetes Mellitus; D005006:Ethnicity / Q000706:statistics & numerical data; D005123:Eye; D006801:Humans; D019458:Insurance Coverage; D009799:Ocular Physiological Phenomena; D058991:Patient Protection and Affordable Care Act; D014481:United States
keywords: Affordable Care Act; Diabetes; Eye examination; Racial disparity