Medicaid expansion and infant mortality: the (questionable) impact of the Affordable Care Act

Cook, Amanda; Stype, Amanda

doi:10.1136/jech-2019-213666

Cited by 4 publications

(3 citation statements)

References 12 publications

(18 reference statements)

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“…Medicaid expansion was associated with improvements in birth outcomes overall. However, in contrast with most of the studies examining the effect of Medicaid expansion on racial disparities [ 25 – 27 ] and in line with Cook and Stype [ 28 ], we find that Medicaid expansion is associated with better outcomes for White newborns but fail to find a significant relationship between Medicaid expansion and birth outcomes for Black newborns in Texarkana.…”

Section: Discussioncontrasting

confidence: 78%

“…Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among Black infants (in states and Washington, DC) [ 27 ]. However, another study found that infant mortality decreased for babies born to White mothers as a result of Medicaid expansion, but not for babies born to Black mothers [ 28 ]. Therefore, the results seem to be sensitive to sample selection, which makes the external validity of the findings questionable.…”

Section: Introductionmentioning

confidence: 99%

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Association of Medicaid expansion with birth outcomes: evidence from a natural experiment in Texas

Saygili,

Bayindir

2024

BMC Public Health

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Background Empirical evidence on the effects of Medicaid expansion is mixed and highly state-dependent. The objective of this study is to examine the association of Medicaid expansion with preterm birth and low birth weight, which are linked to a higher risk of infant mortality and chronic health conditions throughout life, providing evidence from a non-expansion state, overall and by race/ethnicity. Methods We used the newborn patient records obtained from Texas Public Use Data Files from 2010 to 2019 for hospitals in Texarkana, which is located on the border of Texas and Arkansas, with all of the hospitals serving pregnancy and childbirth patients on the Texas side of the border. We employed difference-in-differences models to estimate the effect of Medicaid expansion on birth outcomes (preterm birth and low birth weight) overall and by race/ethnicity. Newborns from Arkansas (expanded Medicaid in 2014) constituted the treatment group, while those from Texas (did not adopt the expansion) were the control group. We utilized a difference-in-differences event study framework to examine the gradual impact of the Medicaid expansion on birth outcomes. Results Medicaid expansion was associated with a 1.38-percentage-point decrease (95% confidence interval (CI), 0.09–2.67) in preterm birth overall. Event study results suggest that preterm births decreased gradually over time. Medicaid expansion was associated with a 2.04-percentage-point decrease (95% CI, 0.24–3.85) in preterm birth and a 1.75-percentage-point decrease (95% CI, 0.42–3.08) in low birth weight for White infants. However, Medicaid expansion was not associated with significant changes in birth outcomes for other race/ethnicity groups. Conclusions Our findings suggest that Medicaid expansion in Texas can potentially improve birth outcomes. However, bridging racial disparities in birth outcomes might require further efforts such as promoting preconception and prenatal care, especially among the Black population.

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Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Association of Medicaid expansion with birth outcomes: evidence from a natural experiment in Texas

Saygili,

Bayindir

2024

BMC Public Health

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“…The fact mothers without insurance consistently had the highest mortality rates may reflect their underlying SES. Ensuring all mothers have appropriate insurance is important; however, previous studies have debated the effect of the expansion of Medicaid on infant mortality …”

Section: Discussionmentioning

confidence: 99%

National Trends in Preterm Infant Mortality in the United States by Race and Socioeconomic Status, 1995-2020

Venkatesan,

Rees,

Gardiner

et al. 2023

JAMA Pediatr

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ImportanceInequalities in preterm infant mortality exist between population subgroups within the United States.ObjectiveTo characterize trends in preterm infant mortality by maternal race and socioeconomic status to assess how inequalities in preterm mortality rates have changed over time.Design, Setting, and ParticipantsThis was a retrospective longitudinal descriptive study using the US National Center for Health Statistics birth infant/death data set for 12 256 303 preterm infant births over 26 years, between 1995 and 2020. Data were analyzed from December 2022 to March 2023.ExposuresMaternal characteristics including race, smoking status, educational attainment, antenatal care, and insurance status were used as reported on an infant’s US birth certificate.Main Outcomes and MeasuresPreterm infant mortality rate was calculated for each year from 1995 to 2020 for all subgroups, with a trend regression coefficient calculated to describe the rate of change in preterm mortality.ResultsThe average US preterm infant mortality rate (IMR) decreased from 33.71 (95% CI, 33.71 to 34.04) per 1000 preterm births per year between 1995-1997, to 23.32 (95% CI, 23.05 to 23.58) between 2018-2020. Black non-Hispanic infants were more likely to die following preterm births than White non-Hispanic infants (IMR, 31.09; 95% CI, 30.44 to 31.74, vs 21.81; 95% CI, 21.43 to 22.18, in 2018-2020); however, once born, extremely prematurely Black and Hispanic infants had a narrow survival advantage (IMR rate ratio, 0.87; 95% CI, 0.84 to 0.91, in 2018-2020). The rate of decrease in preterm IMR was higher in Black infants (−0.015) than in White (−0.013) and Hispanic infants (−0.010); however, the relative risk of preterm IMR among Black infants compared with White infants remained the same between 1995-1997 vs 2018-2020 (relative risk, 1.40; 95% CI, 1.38 to 1.44, vs 1.43; 95% CI, 1.39 to 1.46). The rate of decrease in preterm IMR was higher in nonsmokers compared with smokers (−0.015 vs −0.010, respectively), in those with high levels of education compared with those with intermediate or low (−0.016 vs – 0.010 or −0.011, respectively), and in those who had received adequate antenatal care compared with those who did not (−0.014 vs −0.012 for intermediate and −0.013 for inadequate antenatal care). Over time, the relative risk of preterm mortality widened within each of these subgroups.Conclusions and RelevanceThis study found that between 1995 and 2020, US preterm infant mortality improved among all categories of prematurity. Inequalities in preterm infant mortality based on maternal race and ethnicity have remained constant while socioeconomic disparities have widened over time.

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Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity

Constantin

Wehby

2023

American Journal of Preventive Medicine

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Medicaid expansion and infant mortality: the (questionable) impact of the Affordable Care Act

Cited by 4 publications

References 12 publications

Association of Medicaid expansion with birth outcomes: evidence from a natural experiment in Texas

Association of Medicaid expansion with birth outcomes: evidence from a natural experiment in Texas

National Trends in Preterm Infant Mortality in the United States by Race and Socioeconomic Status, 1995-2020

Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity

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