Why the study?
Black and Hispanic patients are less likely to receive CRT than White patients, and it is unknown whether Affordable Care Act Medicaid expansion was associated with increased receipt of CRT by race and ethnicity.
Does Medicaid expansion improve the receipt of cardiac resynchronization therapy across different racial and ethnic groups?
Does Medicaid expansion improve the receipt of cardiac resynchronization therapy across different racial and ethnic groups?
Medicaid expansion increased CRT utilization among White patients but did not improve access for Black or Hispanic patients, indicating persistent racial disparities in advanced cardiac care.
Disparities in CRT access persist after Medicaid expansion; leaves open whether equity-focused policies can improve device therapy receipt in underrepresented groups.
Background Black and Hispanic patients are less likely to receive cardiac resynchronization therapy (CRT) than White patients. Medicaid expansion has been associated with increased access to cardiovascular care among racial and ethnic groups with higher prevalence of underinsurance. It is unknown whether the Medicaid expansion was associated with increased receipt of CRT by race and ethnicity. Methods and Results Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington, DC, we analyzed 1061 patients from early‐adopter states (Medicaid expansion by January 2014) and 745 patients from nonadopter states (no implementation 2013–2014). Estimates of change in census‐adjusted rates of CRT with or without defibrillator by race and ethnicity and Medicaid adopter status 1 year before and after January 2014 were conducted using a quasi‐Poisson regression model. Following the Medicaid expansion, the rate of CRT did not significantly change among Black individuals from early‐adopter states (1.07 [95% CI, 0.78–1.48]) or nonadopter states (0.79 [95% CI, 0.57–1.09]). There were no significant changes in rates of CRT among Hispanic individuals from early‐adopter states (0.99 [95% CI, 0.70–1.38]) or nonadopter states (1.01 [95% CI, 0.65–1.57]). There was a 34% increase in CRT rates among White individuals from early‐adopter states (1.34 [95% CI, 1.05–1.70]), and no significant change among White individuals from nonadopter states (0.77 [95% CI, 0.59–1.02]). The change in CRT rates among White individuals was associated with the timing of the Medicaid implementation ( P =0.003). Conclusions Among states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, implementation of Medicaid expansion was associated with increase in CRT rates among White individuals residing in states that adopted the Medicaid expansion policy. Further work is needed to address disparities in CRT among Black and Hispanic patients.
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Mwansa et al. (2022) studied this question.
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