Impact of Medicaid Expansion on Liver-Related Mortality.

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The Affordable Care Act provided the opportunity for states to expand Medicaid for low-income individuals. Not all states adopted Medicaid expansion, and the timing of adoption among expansion states varied. Prior studies demonstrated that Medicaid expansion improved mortality for several chronic conditions. Although there are data on the association between Medicaid expansion on insurance type among patients waitlisted for a liver transplant, there are no data on its impact on liver disease-related mortality in the broader population. We therefore sought to evaluate the association between Medicaid expansion and state-level liver disease-related mortality using a quasi-experimental study design.We evaluated age-adjusted state-level liver disease-related mortality rates using CDC data. We fit multivariable linear regression models that accounted for socio-demographic, clinical, and access-to-care variables at the state level, and a difference-in-difference estimator to evaluate the association between Medicaid expansion and liver disease-related mortality.In multivariable linear regression models, there was a significant association between Medicaid expansion and liver disease-related mortality (p=0.02). Medicaid expansion was associated with 8.3 (95% CI: 1.6-15.1) fewer deaths from liver disease per 1,000,000 adult residents per year after Medicaid expansion compared to what would have been expected to occur if those states followed the same trajectory as non-expansion states. The impact of Medicaid expansion translated to 870 fewer liver-related deaths per year in expansion states (4,350 in the post-expansion study period from 2014-2018).These data support the contention that Medicaid expansion has been associated with significantly decreased liver disease-related mortality. Universal Medicaid expansion could further decrease liver disease-related mortality in the US.

View the full article @ Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

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