title: An Early Look at the Association Between State Medicaid Expansion and Disparities in Cardiovascular Diseases: A Comprehensive Population Health Management Approach.
abstract: Cardiovascular disease (CVD) is one of the most prevalent chronic diseases nationally and disproportionately affects low-income individuals. There are substantial disparities on CVD outcomes that stem from the lack of health insurance among low-income populations. The Affordable Care Act expands Medicaid health insurance to low-income populations, and aims to increase the utilization of health, social, and economic preventive services to reduce health disparities and prevent chronic diseases. The authors analyzed data from the 2014 Behavioral Risk Factor Surveillance System to understand the potential impact of Medicaid expansion on disparities in CVD among low-income populations. Logistic regression models examined the association between CVD self-reported outcomes among low-income adults with incomes at or below 138% of the federal poverty level in states that have chosen to expand Medicaid and those states choosing not to expand, controlling for socioeconomic, demographic, behavioral, social, and health variables that affect CVD. Overall, the results show that adults in Medicaid expansion states have significantly lower odds of experiencing poor heart health compared to those in non-Medicaid expansion states (odds ratio = 0.767, 95% confidence interval 0.667-0.882). Additionally, significant findings were found between the association of CVD and demographic, socioeconomic, health, and health behavioral covariates. Policy makers should consider policies, systems, and interventions that increase access to a comprehensive set of preventive, population health, and socioeconomic services targeting the key determinants of CVD and other outcomes when expanding Medicaid and designing state plans and waivers.
authors.affiliation: Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University , South Orange, New Jersey.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Rogers
authors.affiliation: Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University , South Orange, New Jersey.
authors.forename: Ning Jackie
authors.initials: NJ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Medicaid; Medicaid expansion; cardiovascular disease; chronic disease prevention and management; social determinants of health