医疗补助的扩张和以前被监禁的人的死亡率
Pasangi S Perera1,2, Vanessa E Miller2,3, Kate Vinita Fitch1,2
1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill.
JAMA network open
|September 17, 2024
概括
罗德岛州的医疗补助扩张减少了以前被监禁的人的死亡率,特别是过量使用药物和杀人死亡. 然而,这些好处集中在白人身上,种族少数群体的收益有限.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
背景情况:
- 自2014年以来,医疗补助计划的扩张改善了美国弱势群体的医疗保健机会.
- 与普通人口相比,以前被监禁的人面临着不成比例的高死亡率.
- 了解医疗补助扩展对这一高风险群体的影响,对于公共卫生政策至关重要.
研究的目的:
- 评估医疗补助扩张和以前被监禁者释放后死亡率之间的人口层面的关联.
- 为了比较罗德岛 (扩大医疗补助) 与北卡罗来纳州 (没有扩大) 的死亡率结果 (所有原因,药物过量,自杀,谋杀).
主要方法:
- 一项队列研究利用监禁释放数据 (2009-2018) 与死亡记录 (2009-2019) 相关,用于罗德岛和北卡罗来纳州释放的个人.
- 纳入了18岁以上的参与者;排除了研究期间临时关押,监禁死亡或未释放的情况.
- 2014年1月1日生效的罗德岛州的全额医疗补助扩张是暴露的原因.
主要成果:
- 与北卡罗来纳州相比,罗德岛在医疗补助后的扩张中,所有原因死亡率 (每10万人/年为-72) 持续下降.
- 在药物过量死亡 (每10万人年172人) 和杀人死亡 (每10万人年23人) 中也观察到显著的减少.
- 对于非西班牙裔白人个人来说,全因死亡率的降低明显更大,对于非西班牙裔黑人和其他种族少数群体来说,收益很小. 自杀死亡率没有显著变化.
结论:
- 罗德岛州的医疗补助扩张与以前被监禁的人群中所有原因,过量服用和杀人死亡率的减少有关.
- 医疗补助扩张的好处没有得到公平的分配,白人比种族少数群体的死亡率下降更大.
- 需要进一步的研究来解决差异,并确保以前被监禁的人群在Medicaid扩张后获得公平的健康结果.
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