Medicaid Expansion and Racial–Ethnic and Sex Disparities in Cardiovascular Diseases Over 6 Years: A Generalized Synthetic Control Approach

Abstract

Background: Studies have suggested Medicaid expansion enacted in 2014 has resulted in a reduction in overall cardiovascular disease (CVD) mortality in the United States. However, it is unknown whether Medicaid expansion has a similar effect across race–ethnicity and sex. We investigated the effect of Medicaid expansion on CVD mortality across race–ethnicity and sex. Methods: Data come from the behavioral risk factor surveillance system and the US Centers for Disease Control’s Wide-ranging Online Data for Epidemiologic Research, spanning the period 2000–2019. We used the generalized synthetic control method, a quasi-experimental approach, to estimate effects. Results: Medicaid expansion was associated with −5.36 (mean difference [MD], 95% confidence interval [CI] = −22.63, 11.91) CVD deaths per 100,000 persons per year among Blacks; −4.28 (MD, 95% CI = −30.08, 21.52) among Hispanics; −3.18 (MD, 95% CI = −8.30, 1.94) among Whites; −5.96 (MD, 95% CI = −15.42, 3.50) among men; and −3.34 (MD, 95% CI = −8.05, 1.37) among women. The difference in mean difference (DMD) between the effect of Medicaid expansion in Blacks compared with Whites was −2.18; (DMD, 95% CI = −20.20, 15.83); between that in Hispanics compared with Whites: −1.10; (DMD, 95% CI = −27.40, 25.20) and between that in women compared with men: 2.62; (DMD, 95% CI = −7.95, 13.19). Conclusions: Medicaid expansion was associated with a reduction in CVD mortality overall and in White, Black, Hispanic, male, and female subpopulations. Also, our study did not find any difference or disparity in the effect of Medicaid on CVD across race–ethnicity and sex–gender subpopulations, likely owing to imprecise estimates.