Abstract 12928: The Impact of Medicaid Expansion on Black - White Disparities in Cardiovascular Disease Mortality

Abstract

Introduction: Cardiovascular disease (CVD) is a leading cause of mortality among US adults, especially low-income and uninsured adults. Non-Hispanic Black adults, who are overrepresented in these at-risk populations, are disproportionately burdened by poor cardiovascular health and CVD-related premature mortality. Medicaid expansion is associated with reduced CVD mortality overall, however research suggests that Medicaid expansion has had fewer impacts on health outcomes among non-Hispanic Black adults relative to non-Hispanic White adults. Therefore, it is unclear whether Medicaid expansion has lessened the disparate burden of CVD on this population. This study investigated the relationship between Medicaid expansion and Black-White disparities in CVD mortality. Methods: We estimated a difference-in-differences model using mortality data (2011 – 2019) from the Wide-Ranging Online Data for Epidemiologic Research (WONDER) system to compare changes in Black-White CVD mortality ratios between counties in expansion and non-expansion states. The age-adjusted mortality ratio (AAMR) was calculated by dividing the county-year age-adjusted mortality rate for non-Hispanic Black adults (ages 45 – 64) by the county-year age-adjusted mortality rate for non-Hispanic White adults. The final sample consisted of 1,720 county-year observations. Results: From 2011 – 2019, the AAMR was significantly higher among counties in expansion states ( p <0.001). Controlling for county-level factors, Medicaid expansion was associated with a 2.01% decrease in the AAMR in CVD, but this relationship was not statistically significant (Figure 1). County-level rate of cardiologists per 100,000 and median household income were associated with a significant increase in the AAMR. Conclusion: Medicaid expansion may be associated with reduced CVD mortality overall; however, it is insufficient to counteract social and economic drivers of racial disparities in CVD mortality.