Table 4. Changes in preventative health services for low-income non-elderly adults in pre-expansion, immediate post-expansion, and late post-expansion periods.
Difference‐in‐differences estimate for expansion states.∬
| Preventative Health Service (Unweighted N) | Baseline 2012–2013 (Mean % in expansion states*) | Immediate Post-expansion 2014–2015 Difference-in-Differences Estimate^ (%, 95% CI) | p-value | Late Post-expansion 2016–2017 Difference-in-Differences Estimate^ (%, 95% CI) | p-value |
|---|---|---|---|---|---|
| Cancer Screening | |||||
| Breast cancer screening (N = 54,094) | 66.6 | −0.3 (−4.0 to 3.5) | 0.89 | 0.6 (−3.4 to 4.5) | 0.78 |
| Cervical cancer screening (N = 142,917) | 74.0 | −0.5 (−2.7 to 1.6) | 0.63 | 0.4 (−1.9 to 2.7) | 0.75 |
| Colorectal cancer screening (N = 99,170) | 47.4 | −1.2 (−4.2 to 1.7) | 0.42 | 0.2 (−3.0 to 3.4) | 0.91 |
| Cardiovascular Risk Reduction | |||||
| Serum cholesterol screening (N = 272,004) | 72.8 | 1.4 (−0.9 to 3.8) | 0.24 | 0.6 (−1.7 to 2.8) | 0.63 |
| Serum cholesterol monitoring (N = 133,609) | 80.6 | 1.3 (−1.0 to 3.5) | 0.27 | 2.0 (−0.1 to 4.1) | 0.064 |
| Aspirin use (N = 171,900) | 5.5 | 8.7* (7.1 to 10.4) | <0.001 | 8.8* (7.2 to 10.5) | <0.001 |
| Diabetes Care | |||||
| Serum cholesterol monitoring (N = 58,150) | 91.0 | −3.6* (−7.3 to 0) | 0.048 | −3.1 (−6.5 to 0.3) | 0.071 |
| HbA1c monitoring (N = 27,623) | 76.8 | −1.2 (−5.4 to 3.0) | 0.57 | −3.6 (−7.7 to 0.6) | 0.095 |
| Foot examination (N = 27,424) | 67.8 | 1.8 (−2.9 to 6.5) | 0.44 | −0.2 (−5.3 to 5.0) | 0.95 |
| Eye examination (N = 27,622) | 54.2 | 0.4 (−4.5 to 5.3) | 0.88 | 0.6 (−4.7 to 5.8) | 0.84 |
| Influenza vaccination (N = 58,150) | 40.7 | 1.0 (−2.9 to 4.9) | 0.61 | 0.7 (−3.3 to 4.7) | 0.73 |
| Pneumonia vaccination (N = 58,150) | 38.0 | 2.1 (−1.7 to 5.9) | 0.29 | 1.6 (−2.3 to 5.5) | 0.41 |
| Other Primary Care | |||||
| Influenza vaccination (N = 463,262) | 26.0 | −0.1 (−1.3 to 1.0) | 0.86 | 1.4* (0.3 to 2.6) | 0.016 |
| Alcohol use screening (N = 22,871) | 77.1 | -- | -- | 1.1 (−1.7 to 3.8) | 0.45 |
| HIV screening (N = 461,088) | 43.6 | 0.5 (−0.8 to 1.8) | 0.46 | 1.9* (0.6 to 3.3) | 0.004 |
Difference-in-differences estimates compared immediate period to baseline, and late period to baseline. All estimates are adjusted for patient age and sex.
Breast cancer screening and cervical cancer screening were adjusted for age only.
Aspirin use was additionally adjusted for race/ethnicity, smoking status, hypertension, hyperlipidemia, diabetes, coronary heart disease or angina, stroke, and myocardial infarction.
Expansion states (n = 24) were Arizona, Arkansas, California, Colorado, Connecticut, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Washington, West Virginia
Non-expansion states (n = 19) were Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
Alaska, Louisiana, and Montana were included as non-expansion states for the immediate 2014–2015 time period, and expansion states for the late 2016–2017 time period.
Delaware, District of Columbia, Massachusetts, New York, and Vermont were excluded.
Significant at the level p<0.05.