Aging
State-level effect of Medicaid expansion on Alzheimer’s disease and related dementias mortality Jenna Rajczyk* Jeffrey Wing Jenna Rajczyk Julie Strominger Parvati Singh
Introduction: With the rapid aging of the US population, the prevalence of dementia is projected to double. The enactment of the Affordable Care Act’s Medicaid expansion may have created opportunities for dementia detection and classification. We examine whether and to what extent Medicaid expansion influenced potential reporting of dementia as the underlying cause of death.
Methods: State-level Alzheimer’s disease and related dementias (ADRD) mortality data for persons 65 years and older were downloaded from CDC WONDER for 2000-2019. ADRD was classified as ICD-10 codes: F01, F03, and G30. Staggered difference-in-difference analysis was used to estimate the ADRD mortality rate pre- and post-Medicaid expansion. An overall average treatment effect for the treated (ATT) was estimated along with dynamic event study analysis to gauge the temporal effect window post-Medicaid expansion. As a sensitivity analysis, results were compared to all-cause and cardiovascular disease (CVD) mortality.
Results: A total of 29 out of 50 states expanded Medicaid by 2019. Post expansion, ADRD mortality increased by 9.02 per 100,000 people (95% CI: 1.81, 16.23). The change in mortality was most pronounced two years post expansion, gradually increasing each year (two-years post ATT: 10.02; 95% CI: 3.51, 16.52; five-years post ATT: 13.58; 95% CI: 2.82, 24.34; Figure). This trend was not observed across the same period for CVD mortality (ATT: 0.80; 95% CI: -12.42, 14.02) and the post-expansion difference observed for all-cause mortality lacked precision compared to dementia mortality (ATT: 7.43; 95% CI: -23.12, 37.98).
Conclusions: ADRD mortality increased following state-level Medicaid expansion, but this increase was not observed similarly for CVD mortality nor all-cause mortality. The lag between expansion and the increase in mortality may arise from increased detection through Medicaid supported care and being listed or correctly identified as the underlying cause of death.
