TY  - JOUR
PY  - 2022//
TI  - Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: a difference in differences analysis
JO  - Drug and alcohol dependence
A1  - Ibragimov, Umedjon
A1  - Mansfield, Russell W.
A1  - Yarbrough, Courtney R.
A1  - Cummings, Janet R.
A1  - Livingston, Melvin D. 3rd
A1  - Haardörfer, Regine
A1  - Beane, Stephanie
A1  - Fadanelli, Monica M.
A1  - Haley, Danielle F.
A1  - Cooper, Hannah L. F.
SP  - e109381
EP  - e109381
VL  - 233
IS  - 
N2  - BACKGROUND: Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment. <br><br>METHODS: This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an "on switch"-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM. <br><br>FINDINGS: The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant. <br><br>CONCLUSIONS: We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify - and repair - breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.<p />  <p>Language: en</p>
LA  - en
SN  - 0376-8716
UR  - http://dx.doi.org/10.1016/j.drugalcdep.2022.109381
ID  - ref1
ER  -