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Member Research & Reports

Member Research & Reports

UAB Researchers Examine Disparities in Comorbidities Based on Medicaid Expansion Status

Approximately 92 percent of older adults living in the United States have been diagnosed with at least one chronic disease or condition — 77 percent having at least two — with higher instances of simultaneous diseases or conditions occurring within the population of uninsured, low-income adults. The Affordable Care Act Medicaid Expansion was implemented to provide greater access to healthcare for this particular group of disadvantaged adults and their families; however, as of May 1, only 25 U.S. states in addition to the District of Columbia have opted for expansion.

[Photo: Dr. Tomi Akinyemiju]

Using data from the 2013 Behavioral Risk Factor Surveillance System (the country’s “premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services”), Dr. Tomi Akinyemiju, assistant professor in the department of epidemiology at the University of Alabama at Birmingham — in collaboration with UAB alumna Ms. Megha Jha; pre-doctoral fellow Mr. Justin X. Moore, in UAB’s department of epidemiology; and Dr. Maria Pisu, associate professor in UAB’s division of preventive medicine — sought to ascertain the percentage of uninsured, low-income adults living within expanded states as contrasted with non-expanded states, as well as to evaluate the incidence of disease within both groups after adjusting for socio-demographic differences.

Study results indicated that “expanded states had a higher proportion of adults with income of at least $50,000 per year (39.6 percent versus 35.5 percent, p < 0.01) and a lower proportion of individuals with no health insurance coverage (15.2 percent versus 20.3 percent, p < 0.01) compared with non-expanded states. Among the uninsured, there was a higher proportion of obese (31.6 percent versus 26.9 percent, p < 001), and higher average number of comorbidities (1.62 versus 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.”

The researchers concluded that states without Medicaid expansion have a higher percentage of poor and uninsured adults who experience a higher percentage of chronic diseases and conditions.

“Disparities in the Prevalence of Comorbidities among US Adults by State Medicaid Expansion Status” was published online in April in the journal Preventive Medicine.

Journal article: