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Abstract: SA-PO131

Policy Impact on Diabetes Detection in Vulnerable Populations

Session Information

Category: Diabetes

  • 503 Diabetes Mellitus and Obesity: Translational


  • Cartwright, Kate, University of New Mexico, Albuquerque, New Mexico, United States
  • van der Goes, David N., University of New Mexico, Albuquerque, New Mexico, United States

Earlier detection of type 2 diabetes is associated with improved management of diabetes. Populations with barriers to care are more likely to have type 2 diabetes and are more likely to be diagnosed at an advanced stage of the disease. US residing Hispanics are not only more likely to be diagnosed with diabetes than their non-Hispanic counterparts, but they are also more likely to die of a diabetes-related cause. Before the ACA, Hispanics were the most likely to be uninsured or underinsured in all states. After the ACA, in states which expanded Medicaid, the uninsured rate for Latinos was reduced to 9% compared to 7% for non-Hispanic whites. However, in states which did not adopt Medicaid expansion, 24% of Latinos are uninsured compared to 10% of non-Hispanic whites. California went further by expanding coverage to non-citizens, which increased the number of non-citizens covered by about 31%. In this project, we analyze the change in self-reported diabetes among non-citizen Hispanic women in expansion and non-expansion states.


In a multivariate regression framework, we use the 2011-2015 NHIS to analyze the change in self-reported diagnosis of diabetes among Hispanic non-citizen women before and after the ACA Medicaid expansion. Less than 5% of Hispanic women in the South lived in states that expanded Medicaid, while approximately 97% of Hispanic women in the West lived in states that expanded Medicaid under the ACA. We use a difference-in-difference model with our second difference comparing the Southern US to the Western US.


Non-citizen Hispanic women living in Medicaid expansion states saw an 80% (1.81 OR; CI 1.11-2.93) relative increase in self-reported diabetes (compared to non-citizen Hispanic women in non-expansion states). Comparing the same group’s changes in self-assessed health and BMI showed no change. This indicates the change in self-reported diabetes in unlikely due to changes in health status, but instead due to improved detection of diabetes.


This investigation supports the argument that expanding health coverage is associated with improved health knowledge. One of the most vulnerable groups in the US, non-citizen Hispanic women, seems to have benefited from Medicaid coverage expansion. Improved detection of diabetes in this population creates an opportunity to better manage this condition and improve health outcomes, survival odds, and heatlh equity.