A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast

Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings.Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urba...

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Autores principales:	Cyrus Ayubcha, Pedram Pouladvand, Soussan Ayubcha
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	Medicaid expansion Medicaid cities mortality urban Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/2536ca9bdfc544cca4fdfd0a98430f41
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spelling	oai:doaj.org-article:2536ca9bdfc544cca4fdfd0a98430f412021-11-17T04:38:21ZA Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast2296-256510.3389/fpubh.2021.707907https://doaj.org/article/2536ca9bdfc544cca4fdfd0a98430f412021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpubh.2021.707907/fullhttps://doaj.org/toc/2296-2565Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings.Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999–2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018).Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = −1.37 [95% CI −2.73, −0.42]) and all-cause (Population-Adjusted Average Treatment Effect = −2.57 [95%CI −8.46, −0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = −5.40 monthly deaths per 100,000 individuals [95% CI −12.50, −3.34], −18.84% [95% CI −43.64%, −11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = −1.95 monthly deaths per 100,000 individuals [95% CI −3.04, −0.98], −21.88% [95% CI −34.10%, −10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities.Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.Cyrus AyubchaPedram PouladvandSoussan AyubchaFrontiers Media S.A.articleMedicaid expansionMedicaidcitiesmortalityurbanPublic aspects of medicineRA1-1270ENFrontiers in Public Health, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicaid expansion Medicaid cities mortality urban Public aspects of medicine RA1-1270
spellingShingle	Medicaid expansion Medicaid cities mortality urban Public aspects of medicine RA1-1270 Cyrus Ayubcha Pedram Pouladvand Soussan Ayubcha A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
description	Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings.Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999–2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018).Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = −1.37 [95% CI −2.73, −0.42]) and all-cause (Population-Adjusted Average Treatment Effect = −2.57 [95%CI −8.46, −0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = −5.40 monthly deaths per 100,000 individuals [95% CI −12.50, −3.34], −18.84% [95% CI −43.64%, −11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = −1.95 monthly deaths per 100,000 individuals [95% CI −3.04, −0.98], −21.88% [95% CI −34.10%, −10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities.Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.
format	article
author	Cyrus Ayubcha Pedram Pouladvand Soussan Ayubcha
author_facet	Cyrus Ayubcha Pedram Pouladvand Soussan Ayubcha
author_sort	Cyrus Ayubcha
title	A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
title_short	A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
title_full	A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
title_fullStr	A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
title_full_unstemmed	A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast
title_sort	quasi-experimental study of medicaid expansion and urban mortality in the american northeast
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/2536ca9bdfc544cca4fdfd0a98430f41
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A Quasi-Experimental Study of Medicaid Expansion and Urban Mortality in the American Northeast

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