Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status

Tomi Akinyemiju, Megha Jha, Justin Xavier Moore, Maria Pisu

Research output: Contribution to journalArticle

Abstract

Introduction: About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. Methods: Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences. Results: Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states. Conclusion: States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.

Original languageEnglish (US)
Pages (from-to)196-202
Number of pages7
JournalPreventive Medicine
Volume88
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Fingerprint

Medicaid
Comorbidity
Behavioral Risk Factor Surveillance System
Chronic Disease
Patient Protection and Affordable Care Act
Centers for Medicare and Medicaid Services (U.S.)
Insurance Coverage
Health Insurance
Population Groups
Demography
Delivery of Health Care

Keywords

  • Affordable care act
  • Comorbidities
  • Disparities
  • Medicaid expansion

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status. / Akinyemiju, Tomi; Jha, Megha; Moore, Justin Xavier; Pisu, Maria.

In: Preventive Medicine, Vol. 88, 01.07.2016, p. 196-202.

Research output: Contribution to journalArticle

Akinyemiju, Tomi ; Jha, Megha ; Moore, Justin Xavier ; Pisu, Maria. / Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status. In: Preventive Medicine. 2016 ; Vol. 88. pp. 196-202.
@article{0ae0c1229f58406d853929b9598104d1,
title = "Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status",
abstract = "Introduction: About 92{\%} of US older adults have at least one chronic disease or medical condition and 77{\%} have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. Methods: Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences. Results: Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6{\%} vs. 35.5{\%}, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2{\%} vs. 20.3{\%}, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6{\%} vs. 26.9{\%}, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states. Conclusion: States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.",
keywords = "Affordable care act, Comorbidities, Disparities, Medicaid expansion",
author = "Tomi Akinyemiju and Megha Jha and Moore, {Justin Xavier} and Maria Pisu",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.ypmed.2016.04.009",
language = "English (US)",
volume = "88",
pages = "196--202",
journal = "Preventive Medicine",
issn = "0091-7435",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status

AU - Akinyemiju, Tomi

AU - Jha, Megha

AU - Moore, Justin Xavier

AU - Pisu, Maria

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Introduction: About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. Methods: Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences. Results: Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states. Conclusion: States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.

AB - Introduction: About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. Methods: Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed, and Medicaid expansion status was assessed from the Center for Medicare and Medicaid Services report on State Medicaid and CHIP Income Eligibility Standards. Next, age adjusted mean number of comorbidities between expanded and non-expanded states was compared, with adjustment for socio-demographic differences. Results: Expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6% vs. 35.5%, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2% vs. 20.3%, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6% vs. 26.9%, p < 001), and higher average number of comorbidities (1.62 vs. 1.52, p < 0.01) in non-expanded states compared to expanded states. Overall, the prevalence of comorbidities was higher among BRFSS participants in states that did not expand Medicaid compared with those in expanded states. Conclusion: States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.

KW - Affordable care act

KW - Comorbidities

KW - Disparities

KW - Medicaid expansion

UR - http://www.scopus.com/inward/record.url?scp=84964462278&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964462278&partnerID=8YFLogxK

U2 - 10.1016/j.ypmed.2016.04.009

DO - 10.1016/j.ypmed.2016.04.009

M3 - Article

C2 - 27095325

AN - SCOPUS:84964462278

VL - 88

SP - 196

EP - 202

JO - Preventive Medicine

JF - Preventive Medicine

SN - 0091-7435

ER -