The Association Between Medicaid Expansion and Disparities in Vestibular Schwannoma Incidence
Corresponding Author
Alexander S. Homer AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Send correspondence to Alexander S. Homer, Brown University, Alpert Medical School, 222 Richmond Street, Providence, RI 02903. Email: [email protected]
Kathryn Y. Noonan, Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111. Email: [email protected]
Search for more papers by this authorViknesh S. Kasthuri AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorBenjamin J. Homer ScB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorRishubh Jain AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorEmily K. Gall MD
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
Search for more papers by this authorCorresponding Author
Kathryn Y. Noonan MD
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
Send correspondence to Alexander S. Homer, Brown University, Alpert Medical School, 222 Richmond Street, Providence, RI 02903. Email: [email protected]
Kathryn Y. Noonan, Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111. Email: [email protected]
Search for more papers by this authorCorresponding Author
Alexander S. Homer AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Send correspondence to Alexander S. Homer, Brown University, Alpert Medical School, 222 Richmond Street, Providence, RI 02903. Email: [email protected]
Kathryn Y. Noonan, Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111. Email: [email protected]
Search for more papers by this authorViknesh S. Kasthuri AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorBenjamin J. Homer ScB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorRishubh Jain AB
The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A.
Search for more papers by this authorEmily K. Gall MD
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
Search for more papers by this authorCorresponding Author
Kathryn Y. Noonan MD
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
Send correspondence to Alexander S. Homer, Brown University, Alpert Medical School, 222 Richmond Street, Providence, RI 02903. Email: [email protected]
Kathryn Y. Noonan, Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111. Email: [email protected]
Search for more papers by this authorNo sources of funding were utilized for this work. The authors have no conflicts of interest to disclose.
Abstract
Objectives
The effect of Medicaid expansion as a part of the Affordable Care Act on vestibular schwannoma (VS) incidence overall and in marginalized populations has not yet been elucidated. The goal of this study was to determine if Medicaid expansion was associated with increases in VS incidence overall, as well as in patients of non-white race or in counties of low socioeconomic status (SES).
Methods
We performed a difference-in-difference (DiD) analysis from January 1st 2010–December 31st 2017 utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Our DiD method compared the change in VS rate between counties that did and did not expand Medicaid among patients of white and non-white race, in low and high SES counties, before and after expansion.
Results
The study included 17,312 cases across 1020 counties. Medicaid expansion was associated with a 15% increase (incidence rate ratio 95% CI: [11%, 19]) in VS incidence. White populations saw a 10% increase (CI: [1.06, 1.19]), Black populations saw a 20% increase (CI: [1.10, 1.29]), and patients of other races saw a 44% increase in incidence associated with expansion (CI: [1.21, 1.70]). Low SES counties saw an increase in incidence 1.12 times higher than that of high SES counties (CI:[1.04, 1.20]).
Conclusion
Medicaid expansion was associated with increases in VS incidence across populations. Furthermore, this increase was more evident in disadvantaged populations, such as patients of non-white race and those from low SES counties. These findings emphasize the impact of Medicaid expansion on healthcare utilization for VS diagnosis.
Level of Evidence
3—Retrospective Cohort Study Laryngoscope, 134:4383–4388, 2024
Supporting Information
| Filename | Description |
|---|---|
| lary31517-sup-0001-AppendixA.docxWord 2007 document , 14.9 KB | Appendix A. States Excluded and Included in Analysis. |
| lary31517-sup-0002-AppendixB.tiffTIFF image, 4 MB | Appendix B. Event Plot for Vestibular Schwannoma Incidence. Event analysis depicting the relative difference in vestibular schwannoma rate between expansion and non-expansion counties in each year, adjusted for the year before expansion. The red line represents the null hypothesis that the difference in incidence between treatment groups is consistent over time. Vertical blue bars represent 95% confidence intervals. Red dots represent the point estimate for the adjusted difference between counties. The results of the analysis show that pre-expansion trends were not significantly difference between expansion and non-expansion counties before expansion. |
| lary31517-sup-0003-AppendixC.docxWord 2007 document , 15.1 KB | Appendix C. Difference-in-Difference Regressions Overall and by Race. |
| lary31517-sup-0004-AppendixD.docxWord 2007 document , 15.9 KB | Appendix D. Triple Differences-in-Differences Analysis. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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