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Kidney Week

Abstract: FR-OR060

Effect of Medicaid Expansion on the Incidence of ESRD Among Nonelderly Adults

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Thorsness, Rebecca, Brown University School of Public Health, Providence, Rhode Island, United States
  • Swaminathan, Shailender, Brown University, Providence, Rhode Island, United States
  • Lee, Yoojin, Brown University, Providence, Rhode Island, United States
  • Sommers, Benjamin, Harvard University, Boston, Massachusetts, United States
  • Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States
  • Nguyen, Kevin, Brown University School of Public Health, Providence, Rhode Island, United States
  • Kim, Daeho, Brown University, Providence, Rhode Island, United States
  • Trivedi, Amal, Brown University, Providence, Rhode Island, United States
Background

End stage renal disease (ESRD) can be prevented or delayed with effective management of chronic disease, particularly diabetes and hypertension. However, the uninsured have limited ability to finance health services and may forego preventive and chronic disease care. We examined the impact of Medicaid expansion on the incidence of ESRD in the non-elderly adult population.

Methods

A quasi-experimental differences-in-differences study of the incidence rate of ESRD in the non-elderly adult population in the US (annual average of 194,793,035 persons aged 19-64 years). We calculated quarterly incidence rates by geolocating incident patients (347,288 persons over the study period) within Public Use Microdata Areas (PUMAs), which are contiguous geographic areas of at least 100,000 persons nested within states. We estimated linear models comparing pre- vs post-expansion changes in the incidence rate in PUMAs in expansion vs non-expansion states. Models were adjusted for age group, sex, race/ethnicity, time-varying PUMA-level economic characteristics with fixed effects for year-quarter, season, and PUMA. We confirmed parallel pre-policy trends between expansion and non-expansion PUMAs.

Results

The mean quarterly ESRD incidence rate for the 19-64 population in 2012 and 2013 was 67.8 cases per million in expansion states and 78.5 cases per million in non-expansion states. While incidence increased in both expansion and non-expansion states over the study period, Medicaid expansion was associated with 1.7 fewer incident ESRD cases per million (95% CI: -3.28 to -0.17), relative to concurrent trends in non-expansion states. This observed effect represents a 2.5% relative reduction in incidence. These findings were robust to exclusion of early- and late-expanding states, and time-varying covariates.

Conclusion

The ACA’s Medicaid expansions were associated with a small but meaningful reduction in incidence of ESRD in the non-elderly adult population. The findings also demonstrate the potential for expansions of Medicaid coverage to generate offsetting reductions in spending in the Medicare program, the primary payer for the ESRD population in the US.

Funding

  • NIDDK Support