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New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion.
Fam Med Community Health. 2020 12; 8(4)FM

Abstract

OBJECTIVE

To assess the Affordable Care Act (ACA) Medicaid expansion's impact on new hypertension and diabetes diagnoses in community health centres (CHCs).

DESIGN

Rates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in-difference (DID) pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did not.

SETTING

We used electronic health record data (pre-ACA: 1 January 2012-31 December 2013-post-ACA: 1 January 2014-31 December 2016) from the Accelerating Data Value Across a National Community Health Center Network clinical data network. We included clinics with ≥50 patients contributing to person-time-at risk in each study year.

PARTICIPANTS

Patients aged 19-64 with ≥1 ambulatory visit in the study period were included. We then excluded patients who were pregnant during the study period (N=127 530). For the hypertension outcome, we excluded individuals with a diagnosis of hypertension prior to the start of the study period, those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit, and those who had a diagnosis more than 3 years after their last visit (pre-ACA non-expansion N=130 973; expansion N=193 198; post-ACA non-expansion N=186 341; expansion N=251 015). For the diabetes analysis, we excluded patients with a diabetes diagnosis prior to study start, on their first visit or first visit after inactive patient status, and diagnosis while not an active patient (pre-ACA non-expansion N=145 435; expansion N=198 558; post-ACA non-expansion N=215 039; expansion N=264 644).

RESULTS

In non-expansion states, adjusted hypertension diagnosis rates saw a relative decrease of 6%, while in expansion states, the adjusted rates saw a relative increase of 7% (DID 1.14, 95% CI 1.11 to 1.18). For diabetes diagnosis, adjusted rates in non-expansion states experienced a significant relative increase of 28% and in expansion states the relative increase was 25%; yet these differences were not significant pre-ACA to post-ACA comparing expansion and non-expansion states (DID 0.98, 95% CI 0.91 to 1.05).

CONCLUSION

There was a differential impact of Medicaid expansion for hypertension and diabetes diagnoses. Moderate increases were found in diabetes diagnosis rates among all patients served by CHCs post-ACA (both in expansion and non-expansion states). These increases suggest that ACA-related opportunities to gain health insurance (such as marketplaces and the Medicaid expansion) may have facilitated access to diagnostic tests for this population. The study found a small change in hypertension diagnosis rates from pre-ACA to post-ACA (a decrease in non-expansion and an increase in expansion states). Despite the significant difference between expansion and non-expansion states, the small change from pre-ACA to post-ACA suggests that the diagnosis of hypertension is likely documented for patients, regardless of health insurance availability. Future studies are needed to understand the impact of the ACA on hypertension and diabetes treatment and control.

Authors+Show Affiliations

Family Medicine, Oregon Health & Science University, Portland, Oregon, USA angierh@ohsu.edu.Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.Family Medicine, Oregon Health & Science University, Portland, Oregon, USA. Biostatistics Group, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon, USA.Research, OCHIN, Portland, Oregon, USA.Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33334850

Citation

Angier, Heather, et al. "New Hypertension and Diabetes Diagnoses Following the Affordable Care Act Medicaid Expansion." Family Medicine and Community Health, vol. 8, no. 4, 2020.
Angier H, Huguet N, Ezekiel-Herrera D, et al. New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. Fam Med Community Health. 2020;8(4).
Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. Family Medicine and Community Health, 8(4). https://doi.org/10.1136/fmch-2020-000607
Angier H, et al. New Hypertension and Diabetes Diagnoses Following the Affordable Care Act Medicaid Expansion. Fam Med Community Health. 2020;8(4) PubMed PMID: 33334850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. AU - Angier,Heather, AU - Huguet,Nathalie, AU - Ezekiel-Herrera,David, AU - Marino,Miguel, AU - Schmidt,Teresa, AU - Green,Beverly B, AU - DeVoe,Jennifer E, PY - 2020/12/18/entrez PY - 2020/12/19/pubmed PY - 2020/12/19/medline KW - access KW - and evaluation KW - diabetes mellitus KW - health care quality KW - health policy KW - health services KW - hypertension JF - Family medicine and community health JO - Fam Med Community Health VL - 8 IS - 4 N2 - OBJECTIVE: To assess the Affordable Care Act (ACA) Medicaid expansion's impact on new hypertension and diabetes diagnoses in community health centres (CHCs). DESIGN: Rates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in-difference (DID) pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did not. SETTING: We used electronic health record data (pre-ACA: 1 January 2012-31 December 2013-post-ACA: 1 January 2014-31 December 2016) from the Accelerating Data Value Across a National Community Health Center Network clinical data network. We included clinics with ≥50 patients contributing to person-time-at risk in each study year. PARTICIPANTS: Patients aged 19-64 with ≥1 ambulatory visit in the study period were included. We then excluded patients who were pregnant during the study period (N=127 530). For the hypertension outcome, we excluded individuals with a diagnosis of hypertension prior to the start of the study period, those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit, and those who had a diagnosis more than 3 years after their last visit (pre-ACA non-expansion N=130 973; expansion N=193 198; post-ACA non-expansion N=186 341; expansion N=251 015). For the diabetes analysis, we excluded patients with a diabetes diagnosis prior to study start, on their first visit or first visit after inactive patient status, and diagnosis while not an active patient (pre-ACA non-expansion N=145 435; expansion N=198 558; post-ACA non-expansion N=215 039; expansion N=264 644). RESULTS: In non-expansion states, adjusted hypertension diagnosis rates saw a relative decrease of 6%, while in expansion states, the adjusted rates saw a relative increase of 7% (DID 1.14, 95% CI 1.11 to 1.18). For diabetes diagnosis, adjusted rates in non-expansion states experienced a significant relative increase of 28% and in expansion states the relative increase was 25%; yet these differences were not significant pre-ACA to post-ACA comparing expansion and non-expansion states (DID 0.98, 95% CI 0.91 to 1.05). CONCLUSION: There was a differential impact of Medicaid expansion for hypertension and diabetes diagnoses. Moderate increases were found in diabetes diagnosis rates among all patients served by CHCs post-ACA (both in expansion and non-expansion states). These increases suggest that ACA-related opportunities to gain health insurance (such as marketplaces and the Medicaid expansion) may have facilitated access to diagnostic tests for this population. The study found a small change in hypertension diagnosis rates from pre-ACA to post-ACA (a decrease in non-expansion and an increase in expansion states). Despite the significant difference between expansion and non-expansion states, the small change from pre-ACA to post-ACA suggests that the diagnosis of hypertension is likely documented for patients, regardless of health insurance availability. Future studies are needed to understand the impact of the ACA on hypertension and diabetes treatment and control. SN - 2009-8774 UR - https://www.unboundmedicine.com/medline/citation/33334850/New_hypertension_and_diabetes_diagnoses_following_the_Affordable_Care_Act_Medicaid_expansion_ L2 - https://fmch.bmj.com/lookup/pmidlookup?view=long&pmid=33334850 DB - PRIME DP - Unbound Medicine ER -