Biomaterial Database

Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis. 2022

Umedjon Ibragimov, and Russell W Mansfield, and Courtney R Yarbrough, and Janet R Cummings, and Melvin D Livingston, and Regine Haardörfer, and Stephanie Beane, and Monica M Fadanelli, and Danielle F Haley, and Hannah L F Cooper

Behavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: umed.ibragimov@emory.edu.

Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment. This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an "on switch"-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM. The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant. We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify - and repair - breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.

UI	MeSH Term	Description	Entries
D008484	Medicaid	Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.	Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000083682	Opiate Overdose	Accidental or deliberate use of an OPIOID in excess of normal dosage. It includes overdose for prescription and illicit opioids.	Opioid Overdose,Opiate Overdoses,Opioid Overdoses,Overdose, Opiate,Overdose, Opioid
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults
D000701	Analgesics, Opioid	Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS.	Opioid,Opioid Analgesic,Opioid Analgesics,Opioids,Full Opioid Agonists,Opioid Full Agonists,Opioid Mixed Agonist-Antagonists,Opioid Partial Agonists,Partial Opioid Agonists,Agonist-Antagonists, Opioid Mixed,Agonists, Full Opioid,Agonists, Opioid Full,Agonists, Opioid Partial,Agonists, Partial Opioid,Analgesic, Opioid,Full Agonists, Opioid,Mixed Agonist-Antagonists, Opioid,Opioid Agonists, Full,Opioid Agonists, Partial,Opioid Mixed Agonist Antagonists,Partial Agonists, Opioid
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D058991	Patient Protection and Affordable Care Act	An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.	Affordable Care Act,Affordable Care Act (ACA),Health Care Reform Act,Obamacare,PL 111-148,PL111-148,Public Law 111-148,111-148, PL,Act, Affordable Care,Acts, Affordable Care,Acts, Affordable Care (ACA),Affordable Care Acts,Care Act, Affordable,Care Act, Affordable (ACA),Care Acts, Affordable,PL 111 148,PL111 148,Public Law 111 148
D035862	Vulnerable Populations	Groups of persons whose range of options is severely limited, who are frequently subjected to COERCION in their DECISION MAKING, or who may be compromised in their ability to give INFORMED CONSENT.	Disadvantaged Populations,Patients, Underserved,Populations, Underserved,Sensitive Population Groups,Sensitive Populations,Disadvantaged Population,Patient, Underserved,Population Group, Sensitive,Population, Disadvantaged,Population, Sensitive,Population, Underserved,Population, Vulnerable,Sensitive Population,Sensitive Population Group,Underserved Patient,Underserved Patients,Underserved Population,Underserved Populations,Vulnerable Population