Diabetes mortality rates among African Americans: A descriptive analysis pre and post Medicaid expansion

Abstract

Background: Compared with other racial and ethnic groups, African Americans are disproportionately burdened by high rates of deaths due to diabetes. Insurance coverage and access to primary care are critical for prevention and chronic disease management. Purpose: To examine the difference in age-adjusted diabetes mortality rates in African Americans before and after Medicaid expansion. Methods: Using ICD-10 Cause List E10–E14, age-adjusted diabetes mortality rates among African Americans were extracted from the Centers for Disease Control and Prevention's Compressed Mortality File. Sufficient and reliable data were available for 36 states and the District of Columbia. With a 95% confidence interval, two periods were analyzed: pre-Medicaid expansion - years 2008, 2009, 2010 and post-Medicaid expansion - years 2014, 2015, 2016. Three-year means for both periods were calculated for each state. Differences for each state are presented and contextualized as a state that opted in or out of expanding Medicaid coverage. Results: There was a slight reduction in diabetes mortality in African Americans (41.14/100,000 pre-expansion and 38.94/100,000 post-expansion). We found variability across states – regardless of expansion status. Differences in rates ranged from a decrease of 15.43/100,000 to an increase of 9.53/100,000. Out of all states that met our criteria, 24 states expanded coverage; age-adjusted diabetes death rates declined in 16 of those states. There were also reductions in eight states that did not expand coverage. Conclusion: Future research is needed to explore if Medicaid expansion is associated with reductions in diabetes mortality in the African American community. Keywords: Diabetes, ACA, African Americans, Medicaid, Health reform, Mortality