PDF(Pubmed)
Abstract：
There is limited evidence on whether the Affordable Care Act Medicaid expansion beginning in 2014 improved access to elective procedures. Uninsured individuals are at higher risk of obesity and may have experienced improved uptake of bariatric surgery following Medicaid expansion.
To examine the association between Medicaid expansion and the receipt of inpatient elective bariatric surgery among Medicaid-covered and uninsured individuals aged 26 to 64 years.
This cohort study used difference-in-differences analysis of all-payer data (2010-2017) of 637 557 elective bariatric surgeries for patients aged 26 to 74 years from 11 Medicaid expansion states and 6 nonexpansion states. Nonexpansion states and individuals aged 65 to 74 years were control cohorts. Data analysis was performed from July 6, 2020, to July 23, 2021.
Living in a Medicaid expansion state.
The main outcomes were the (1) number of elective bariatric surgeries, (2) population count, and (3) rate of bariatric surgery (number of surgeries per 10 000 population) among Medicaid-covered and uninsured individuals.
Of the 600 798 elective bariatric surgeries in adults aged 26 to 64 years between 2010 and 2017 from the 17 study states, Medicaid-covered and uninsured individuals accounted for 18.3% of the total surgery volume in expansion states and 14.5% in nonexpansion states. A total of 296 798 patients (78.9%) in expansion states were women vs 177 386 (78.9%) in nonexpansion states. Among individuals aged 26 to 64 years, the median age was 44 (IQR, 37-52) years. Racial and ethnic distribution was non-Hispanic White, 60.2%; non-Hispanic Black, 17.7%; Hispanic, 16.6%; and other, 5.5%. Between 2013 and 2017, the volume of bariatric surgeries for Medicaid-covered and uninsured patients increased annually by 30.3% in expansion states and 16.5% in nonexpansion states. Medicaid expansion was associated with a 36.6% annual increase (95% CI, 8.2% to 72.5%) in surgery volume, a 9.0% annual increase (95% CI, 3.8% to 14.5%) in the population, and a 25.5% change (95% CI, -1.3% to 59.4%) in the rate of bariatric surgery. By race and ethnicity, Medicaid expansion was associated with an increase in the rate of bariatric surgery among non-Hispanic White individuals (31.6%; 95% CI, 6.1% to 63.0%) but no significant change among non-Hispanic Black (5.9%; 95% CI, -19.8% to 39.9%) and Hispanic (28.9%; 95% CI, -24.4% to 119.8%) individuals.
This cohort study found that Medicaid expansion was associated with increased rates of bariatric surgery among lower-income non-Hispanic White individuals, but not among Hispanic and non-Hispanic Black individuals.
To examine the association between Medicaid expansion and the receipt of inpatient elective bariatric surgery among Medicaid-covered and uninsured individuals aged 26 to 64 years.
This cohort study used difference-in-differences analysis of all-payer data (2010-2017) of 637 557 elective bariatric surgeries for patients aged 26 to 74 years from 11 Medicaid expansion states and 6 nonexpansion states. Nonexpansion states and individuals aged 65 to 74 years were control cohorts. Data analysis was performed from July 6, 2020, to July 23, 2021.
Living in a Medicaid expansion state.
The main outcomes were the (1) number of elective bariatric surgeries, (2) population count, and (3) rate of bariatric surgery (number of surgeries per 10 000 population) among Medicaid-covered and uninsured individuals.
Of the 600 798 elective bariatric surgeries in adults aged 26 to 64 years between 2010 and 2017 from the 17 study states, Medicaid-covered and uninsured individuals accounted for 18.3% of the total surgery volume in expansion states and 14.5% in nonexpansion states. A total of 296 798 patients (78.9%) in expansion states were women vs 177 386 (78.9%) in nonexpansion states. Among individuals aged 26 to 64 years, the median age was 44 (IQR, 37-52) years. Racial and ethnic distribution was non-Hispanic White, 60.2%; non-Hispanic Black, 17.7%; Hispanic, 16.6%; and other, 5.5%. Between 2013 and 2017, the volume of bariatric surgeries for Medicaid-covered and uninsured patients increased annually by 30.3% in expansion states and 16.5% in nonexpansion states. Medicaid expansion was associated with a 36.6% annual increase (95% CI, 8.2% to 72.5%) in surgery volume, a 9.0% annual increase (95% CI, 3.8% to 14.5%) in the population, and a 25.5% change (95% CI, -1.3% to 59.4%) in the rate of bariatric surgery. By race and ethnicity, Medicaid expansion was associated with an increase in the rate of bariatric surgery among non-Hispanic White individuals (31.6%; 95% CI, 6.1% to 63.0%) but no significant change among non-Hispanic Black (5.9%; 95% CI, -19.8% to 39.9%) and Hispanic (28.9%; 95% CI, -24.4% to 119.8%) individuals.
This cohort study found that Medicaid expansion was associated with increased rates of bariatric surgery among lower-income non-Hispanic White individuals, but not among Hispanic and non-Hispanic Black individuals.
摘要：
关于从2014年开始的《平价医疗法案》扩展是否改善了选择程序的机会的证据有限。没有保险的人患肥胖症的风险更高，并且在医疗补助扩大后可能经历了减肥手术的摄取。
在26至64岁的医疗补助保险和无保险人群中，研究扩大医疗补助与接受住院择期减肥手术之间的关联。
这项队列研究对来自11个医疗补助扩展状态和6个非扩展状态的26至74岁患者的637557例选择性减肥手术的所有付款人数据（2010-2017年）进行了差异分析。非扩张状态和65至74岁的个体是对照组。数据分析于2020年7月6日至2021年7月23日进行。
生活在医疗补助扩张状态。
主要结果是（1）选择性减肥手术的数量，(2)人口统计，和（3）在医疗补助覆盖和未投保的个人中，减肥手术率（每10000人的手术数量）。
在2010年至2017年期间，来自17项研究状态的26至64岁成年人的600798项选择性减肥手术中，在扩张州，医疗补助覆盖和无保险的个人占总手术量的18.3％，在非扩张州占14.5％。扩张状态下共有296798例患者（78.9％）为女性，非扩张状态下共有177386例（78.9％）。在26至64岁的个人中，平均年龄为44岁(IQR，37-52）年。种族和种族分布是非西班牙裔白人，60.2%；非西班牙裔黑人，17.7%；西班牙裔，16.6%；其他，5.5%。在2013年至2017年期间，扩展州和非扩展州的医疗补助覆盖和无保险患者的减肥手术量每年增加30.3％，非扩展州增加16.5％。医疗补助扩大与手术量每年增长36.6%（95%CI，8.2%至72.5%）相关，人口年增长率为9.0%(95%CI，3.8%至14.5%)，减重手术率变化25.5%(95%CI,-1.3%~59.4%)。按种族和民族划分，医疗补助扩大与非西班牙裔白人个体的减肥手术率增加相关(31.6%;95%CI,6.1%~63.0%),但非西班牙裔黑人个体(5.9%;95%CI,-19.8%~39.9%)和西班牙裔个体(28.9%;95%CI,-24.4%~119.8%)无显著变化。
这项队列研究发现，在低收入的非西班牙裔白人中，医疗补助扩大与减肥手术率增加有关。但在西班牙裔和非西班牙裔黑人中却没有。
在26至64岁的医疗补助保险和无保险人群中，研究扩大医疗补助与接受住院择期减肥手术之间的关联。
这项队列研究对来自11个医疗补助扩展状态和6个非扩展状态的26至74岁患者的637557例选择性减肥手术的所有付款人数据（2010-2017年）进行了差异分析。
生活在医疗补助扩张状态。
主要结果是（1）选择性减肥手术的数量，
在2010年至2017年期间，来自17项研究状态的26至64岁成年人的600798项选择性减肥手术中，
这项队列研究发现，在低收入的非西班牙裔白人中，医疗补助扩大与减肥手术率增加有关。
