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This article is the authors’ final published version in Frontiers in Public Health, Volume 9, November 2021, Article number 707907.

The published version is available at Copyright © Ayubcha et al.


Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings.

Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999-2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018).

Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = -1.37 [95% CI -2.73, -0.42]) and all-cause (Population-Adjusted Average Treatment Effect = -2.57 [95%CI -8.46, -0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = -5.40 monthly deaths per 100,000 individuals [95% CI -12.50, -3.34], -18.84% [95% CI -43.64%, -11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = -1.95 monthly deaths per 100,000 individuals [95% CI -3.04, -0.98], -21.88% [95% CI -34.10%, -10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities.

Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

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