Abstract：
The authors examined associations between Medicaid expansion and self-reported mental health by race-ethnicity, focusing on lagged associations.
This retrospective, cross-sectional study used 2011-2019 data from the Behavioral Risk Factor Surveillance System. The sample included low-income, childless adults ages 25-64 years. Difference-in-differences (DID) analysis was used to estimate associations between Medicaid expansion and self-reported mental health. Lagged associations were examined by separating the postexpansion period into proximal (2014-2016) and distal (2017-2019) periods.
In the overall sample (N=327,248), Medicaid expansion was associated with a reduction in the mean number of self-reported past-month poor mental health days (DID=-0.12, 95% CI=-0.21 to -0.03), after adjustment for covariates. The expansion was associated with significant reductions in past-month poor mental health days for the following groups: non-Hispanic White (DID=-0.18, 95% CI=-0.29 to -0.07), non-Hispanic Asian (DID=-1.15, 95% CI=-1.37 to -0.93), non-Hispanic other (DID=-0.62, 95% CI=-1.03 to -0.21), and Hispanic (DID=-0.48, 95% CI=-0.73 to -0.23). The non-Hispanic Black group had a significant increase in past-month poor mental health days (DID=0.27, 95% CI=0.06 to 0.49), and no significant change was noted for the American Indian or Alaska Native (AIAN) group. Improvements in mental health observed at the beginning of the policy implementation (proximal period) were not sustained over time for some racial-ethnic minority groups.
Although Medicaid expansion improved mental health for the overall sample, some racial-ethnic disparities were detected. The negative and insignificant associations for the non-Hispanic Black and AIAN groups, respectively, highlight the need to better understand why the Medicaid expansion affected racial-ethnic groups differently.
This retrospective, cross-sectional study used 2011-2019 data from the Behavioral Risk Factor Surveillance System. The sample included low-income, childless adults ages 25-64 years. Difference-in-differences (DID) analysis was used to estimate associations between Medicaid expansion and self-reported mental health. Lagged associations were examined by separating the postexpansion period into proximal (2014-2016) and distal (2017-2019) periods.
In the overall sample (N=327,248), Medicaid expansion was associated with a reduction in the mean number of self-reported past-month poor mental health days (DID=-0.12, 95% CI=-0.21 to -0.03), after adjustment for covariates. The expansion was associated with significant reductions in past-month poor mental health days for the following groups: non-Hispanic White (DID=-0.18, 95% CI=-0.29 to -0.07), non-Hispanic Asian (DID=-1.15, 95% CI=-1.37 to -0.93), non-Hispanic other (DID=-0.62, 95% CI=-1.03 to -0.21), and Hispanic (DID=-0.48, 95% CI=-0.73 to -0.23). The non-Hispanic Black group had a significant increase in past-month poor mental health days (DID=0.27, 95% CI=0.06 to 0.49), and no significant change was noted for the American Indian or Alaska Native (AIAN) group. Improvements in mental health observed at the beginning of the policy implementation (proximal period) were not sustained over time for some racial-ethnic minority groups.
Although Medicaid expansion improved mental health for the overall sample, some racial-ethnic disparities were detected. The negative and insignificant associations for the non-Hispanic Black and AIAN groups, respectively, highlight the need to better understand why the Medicaid expansion affected racial-ethnic groups differently.
摘要：
■作者研究了按种族种族划分的医疗补助扩展与自我报告的心理健康之间的关联，专注于滞后的协会。
■这次回顾展，横断面研究使用2011-2019年行为危险因素监测系统的数据。样本包括低收入人群，无子女的成年人年龄25-64岁。差异差异（DID）分析用于估计医疗补助扩大与自我报告的心理健康之间的关联。通过将扩张后时期分为近端（2014-2016年）和远端（2017-2019年）来检查滞后的关联。
■在整个样本中（N=327,248），医疗补助扩大与自我报告的上月心理健康不良天数的平均减少有关（DID=-0.12，95％CI=-0.21至-0.03），在调整协变量后。扩张与以下人群过去一个月心理健康不良天数的显着减少有关：非西班牙裔白人（DID=-0.18，95％CI=-0.29至-0.07），非西班牙裔亚洲人（DID=-1.15，95%CI=-1.37至-0.93），非西班牙裔其他（DID=-0.62，95%CI=-1.03至-0.21），和西班牙裔（DID=-0.48，95%CI=-0.73至-0.23）。非西班牙裔黑人群体在过去一个月的心理健康不良天数（DID=0.27，95％CI=0.06至0.49）显着增加，美洲印第安人或阿拉斯加原住民（AIAN）组无明显变化。对于某些种族少数群体，在政策实施开始时（近端）观察到的心理健康改善并未随着时间的推移而持续。
■虽然医疗补助扩大改善了总体样本的心理健康，发现了一些种族差异。非西班牙裔黑人和AIAN群体的负面和微不足道的关联，分别,强调需要更好地理解为什么医疗补助扩张对种族族裔群体的影响不同。
■这次回顾展，横断面研究使用2011-2019年行为危险因素监测系统的数据。样本包括低收入人群，无子女的成年人年龄25-64岁。差异差异（DID）分析用于估计医疗补助扩大与自我报告的心理健康之间的关联。通过将扩张后时期分为近端（2014-2016年）和远端（2017-2019年）来检查滞后的关联。
■在整个样本中（N=327,248），医疗补助扩大与自我报告的上月心理健康不良天数的平均减少有关（DID=-0.12，95％CI=-0.21至-0.03），在调整协变量后。扩张与以下人群过去一个月心理健康不良天数的显着减少有关：非西班牙裔白人（DID=-0.18，95％CI=-0.29至-0.07），非西班牙裔亚洲人（DID=-1.15，95%CI=-1.37至-0.93），非西班牙裔其他（DID=-0.62，95%CI=-1.03至-0.21），和西班牙裔（DID=-0.48，95%CI=-0.73至-0.23）。非西班牙裔黑人群体在过去一个月的心理健康不良天数（DID=0.27，95％CI=0.06至0.49）显着增加，美洲印第安人或阿拉斯加原住民（AIAN）组无明显变化。对于某些种族少数群体，在政策实施开始时（近端）观察到的心理健康改善并未随着时间的推移而持续。
■虽然医疗补助扩大改善了总体样本的心理健康，发现了一些种族差异。非西班牙裔黑人和AIAN群体的负面和微不足道的关联，分别,强调需要更好地理解为什么医疗补助扩张对种族族裔群体的影响不同。
