Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act

BACKGROUND: Racial and ethnic minorities are disproportionately affected by diabetes and at greater risk of experiencing poor diabetes-related outcomes compared with non-Hispanic whites. The Affordable Care Act (ACA) was implemented to increase health insurance coverage and reduce health disparities. OBJECTIVE: Assess changes in diabetes-associated biomarkers [hemoglobin A1c (HbA1c) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group. RESEARCH DESIGN: Retrospective cohort study of community health center (CHC) patients. SUBJECTS: Patients aged 19-64 with diabetes living in 1 of 10 Medicaid expansion states with ≥1 CHC visit and ≥1 HbA1c measurement in both the pre-ACA and the post-ACA time periods (N=13,342). METHODS: Linear mixed effects and Cox regression modeled outcome measures. RESULTS: Overall, 33.5% of patients were non-Hispanic white, 51.2% Hispanic, and 15.3% non-Hispanic black. Newly insured Hispanics and non-Hispanic whites post-ACA exhibited modest reductions in HbA1c levels, similar benefit was not observed among non-Hispanic black patients. The largest reduction was among newly insured Hispanics versus newly insured non-Hispanic whites (P<0.05). For the subset of patients who had uncontrolled HbA1c (HbA1c≥9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbA1c (hazard ratio=2.27; 95% confidence interval, 1.10-4.66) relative to the continuously insured group. CONCLUSIONS: The impact of the ACA Medicaid expansion on health disparities is multifaceted and may differ across racial/ethnic groups. This study highlights the importance of CHCs for the health of minority populations

Cohort · Cohort study · Confidence interval · Diabetes mellitus · Environmental health · Ethnic group · Hazard ratio · Health care · Health equity · Medicaid · Patient Protection and Affordable Care Act · Proportional hazards model · Public health · Retrospective cohort study · Chronic Disease Management Strategies · Demography · Diabetes Management and Education · Internal Medicine · Medicine · Primary Care and Health Outcomes · Gerontology

• Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language

  Open Access•Rachel Springer, Jeremy Erroba et al.•SSM - Population Health•2024

  Añadir item

• Medicaid Eligibility Expansion Regardless of Immigration Status and Insurance Coverage Among Latinos Seen in Community Health Centers, 2018‒2023

  Nathalie Huguet, Jorge Kaufmann et al.•American Journal of Public Health•2025

  Añadir item

• Filling the Public Health Science Gaps for Diabetes With Natural Experiments

  Edward W Gregg, O Kenrik Duru et al.•Medical Care•2020

  Añadir item

• The Advance Clinical Research Network Past, Present, and Future

  Open Access•Wyatt P Bensken, Erika K Cottrell et al.•Medical Care•2026

  Añadir item

• The Oregon Experiment — Effects of Medicaid on Clinical Outcomes

  Katherine Baicker, Sarah Taubman et al.•New England Journal of Medicine•2013

  Añadir item

• Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35)

  Open Access•Irene Stratton, I M Stratton•BMJ•2000

  Añadir item

• Racial/Ethnic and social class differences in preventive care practices among persons with diabetes

  Open Access•Carol R Oladele, Carol R Williams Oladele et al.•BMC Public Health•2006

  Añadir item

• Insurance Status and Quality of Diabetes Care in Community Health Centers

  James Zhang, James X Zhang et al.•American Journal of Public Health•2009

  Añadir item

• Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage

  Thomas C Buchmueller, Zachary M Levinson et al.•American Journal of Public Health•2016

  Añadir item

• Health Care Disparities in the Post–Affordable Care Act Era

  Omolola E Adepoju, Michael A Preston et al.•American Journal of Public Health•2015

  Añadir item

• Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon

  Brigit A Hatch, Brigit Hatch et al.•American Journal of Public Health•2016

  Añadir item

• Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

  Open Access•Jie Chen, Arturo Vargas Bustamante et al.•Medical Care•2016

  Añadir item

• Insurance Continuity and Receipt of Diabetes Preventive Care in a Network of Federally Qualified Health Centers

  Rachel Gold, Jennifer Devoe et al.•Medical Care•2009

  Añadir item