Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr;263(4):705-11.
doi: 10.1097/SLA.0000000000001310.

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights From Massachusetts

Andrew P Loehrer  1 , Alexander T Hawkins, Hugh G Auchincloss, Zirui Song, Matthew M Hutter, Virendra I Patel
Affiliations

Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights From Massachusetts

Andrew P Loehrer et al. Ann Surg. 2016 Apr.

Abstract

Objective: To evaluate the impact of health insurance expansion on racial disparities in severity of peripheral arterial disease.

Background: Lack of insurance and non-white race are associated with increased severity, increased amputation rates, and decreased revascularization rates in patients with peripheral artery disease (PAD). Little is known about how expanded insurance coverage affects disparities in presentation with and management of PAD. The 2006 Massachusetts health reform expanded coverage to 98% of residents and provided the framework for the Affordable Care Act.

Methods: We conducted a retrospective cohort study of nonelderly, white and non-white patients admitted with PAD in Massachusetts (MA) and 4 control states. Risk-adjusted difference-in-differences models were used to evaluate changes in probability of presenting with severe disease. Multivariable linear regression models were used to evaluate disparities in disease severity before and after the 2006 health insurance expansion.

Results: Before the 2006 MA insurance expansion, non-white patients in both MA and control states had a 12 to 13 percentage-point higher probability of presenting with severe disease (P < 0.001) than white patients. After the expansion, measured disparities in disease severity by patient race were no longer statistically significant in Massachusetts (+3.0 percentage-point difference, P = 0.385) whereas disparities persisted in control states (+10.0 percentage-point difference, P < 0.001). Overall, non-white patients in MA had an 11.2 percentage-point decreased probability of severe PAD (P = 0.042) relative to concurrent trends in control states.

Conclusions: The 2006 Massachusetts insurance expansion was associated with a decreased probability of patients presenting with severe PAD and resolution of measured racial disparities in severe PAD in MA.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Unadjusted trends in a) severe ischemia, b) revascularization procedures, and c) amputations for uninsured or government-subsidized non-white patients * 2006 Massachusetts insurance expansion
Figure 1
Figure 1
Unadjusted trends in a) severe ischemia, b) revascularization procedures, and c) amputations for uninsured or government-subsidized non-white patients * 2006 Massachusetts insurance expansion
Figure 1
Figure 1
Unadjusted trends in a) severe ischemia, b) revascularization procedures, and c) amputations for uninsured or government-subsidized non-white patients * 2006 Massachusetts insurance expansion
Figure 2
Figure 2
Impact of Massachusetts health reform on racial disparities in a) disease severity, b) revascularization, and c) amputation during hospitalization
Figure 2
Figure 2
Impact of Massachusetts health reform on racial disparities in a) disease severity, b) revascularization, and c) amputation during hospitalization
Figure 2
Figure 2
Impact of Massachusetts health reform on racial disparities in a) disease severity, b) revascularization, and c) amputation during hospitalization
See this image and copyright information in PMC

References

    1. Giacovelli JK, Egorova N, Nowygrod R, et al. Insurance status predicts access to care and outcomes of vascular disease. J Vasc Surg. 2008;48:905–911. - PMC - PubMed
    1. Morrissey NJ, Giacovelli J, Egorova N, et al. Disparities in the treatment and outcomes of vascular disease in Hispanic patients. J Vasc Surg. 2007;46:971–978. - PMC - PubMed
    1. Amaranto DJ, Abbas F, Krantz S, et al. An evaluation of gender and racial disparity in the decision to treat surgically arterial disease. J Vasc Surg. 2009;50:1340–1347. - PubMed
    1. Homan KH, Henke PK, Dimick JB, et al. Racial disparities in the use of revascularization before leg amputation in Medicare patients. J Vasc Surg. 2011;54:420–426. - PMC - PubMed
    1. Feinglass J, Rucker-Whitaker C, Lindquist L, et al. Racial differences in primary and repeat lower extremity amputation: results from a multihospital study. J Vasc Surg. 2005;41:823–829. - PubMed

Publication types

MeSH terms