By HealthDay News
With the expansion of Medicaid under Obamacare, fewer Americans are uninsured and more are getting their blood pressure and blood sugar under control, a new study finds.
The gains are especially strong among Black and Hispanic patients, according to Boston University researchers.
"Our results suggest that over the longer-run, expanding Medicaid eligibility may improve key chronic disease health outcomes for low-income, marginalized populations, which is an important consideration for the 12 states that have not yet adopted Medicaid expansion," said researcher Megan Cole Brahim, an assistant professor of health law, policy and management.
Her team found that Medicaid expansion under the Affordable Care Act has resulted in better care and service capacity at federally qualified health centers.
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The centers serve one in five Medicaid patients and one in three whose income is below the federal poverty line.
In the 26 states that expanded Medicaid by January 2014, the federally qualified health centers saw a 9 percentage point drop in patients who were uninsured, compared with states that did not expand Medicaid, the study found.
Compared to nonexpansion states, there also was a 2 percentage point increase in blood pressure and blood sugar control in expansion states, the researchers said.
For the study, the research team analyzed data from more than 900 federally qualified health centers that served nearly 19 million patients per year.
In states that expanded Medicaid, the percentage of uninsured patients dropped from about 42% in 2012 to 21% in 2018. Meanwhile, the rate of uninsured patients in other states fell from 52% to 42%.
Over five years, Medicaid expansion states saw a 2 percentage point rise in high blood pressure control compared with other states. Among Black patients and Hispanic patients, the improvement was even greater -- 3 percentage points.
Improvement was also seen in blood sugar control -- 2 percentage points overall 4 percentage points among Black folks and nearly 3 percentage points among Hispanic patients, the researchers reported.
"Once a patient gains health insurance coverage, associated health outcomes likely don't improve overnight," Cole Brahim said in a university news release.
"It takes time for patients to become better connected to care and care management while gaining access to prescription medications," Brahim said.
She added that it also takes time for federally qualified health centers to invest new revenue into things that improve the quality of care.
Despite the improvements, however, the researchers noted that racial and ethnic disparities persist.
Co-author Timothy Levengood, a doctoral student in the health law, policy and management department, said, "We have a good sense that these disparities are reflective of the political, economic, and social systems we live in that do not currently provide equal opportunities for health on the basis of skin color."
"Whether you can afford to regularly see a doctor and keep these conditions in check contributes substantially to whether you will develop these chronic conditions or die from them. It's important to study relevant policy changes to these systems to combat these disparities and to craft a more equitable society for all Americans," Levengood said.
The findings were published online this month in JAMA Health Forum.More information
For information about the Affordable Care Act, visit HealthCare.gov.
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Study offers more evidence that stress can drive blood pressure higher
By HealthDay News
If you often feel stressed out, your blood pressure may rise over time alongside higher odds for other heart concerns, a new study indicates.
Researchers found adults with normal blood pressure but high levels of stress hormones were more likely to develop high blood pressure in six to seven years than those with lower stress hormone levels.
"The stress hormones norepinephrine, epinephrine, dopamine and cortisol can increase with stress from life events, work, relationships, finances and more. And we confirmed that stress is a key factor contributing to the risk of hypertension and cardiovascular events," said study author Dr. Kosuke Inoue, an assistant professor of social epidemiology at Kyoto University in Japan.
The study, published Monday in Hypertension, included more than 400 people, ages 48 to 87, who took part in a larger study of atherosclerosis -- clogged arteries that can lead to heart disease -- involving six U.S. communities.
They participated in a 12-hour overnight urine test between July 2004 and October 2006.
The researchers analyzed their levels of norepinephrine, epinephrine, dopamine and cortisol.
The first three are related to the autonomic nervous system, which regulates heart rate, blood pressure and breathing. Cortisol is a steroid hormone that is released during stress.
"Although all of these hormones are produced in the adrenal gland, they have different roles and mechanisms to influence the cardiovascular system, so it is important to study their relationship with hypertension and cardiovascular events, individually," Inoue said in a journal news release.
He is also affiliated with the Fielding School of Public Health at the University of California, Los Angeles.
Participants were followed through June 2018 to see if they developed high blood pressure, or hypertension, and cardiovascular events such as chest pain, needing an artery-opening procedure, or a heart attack or stroke.
A growing body of research refers to the mind-heart-body connection, which suggests a person's mind can positively or negatively affect risk for heart disease and strokes.
"Previous research focused on the relationship between stress hormone levels and hypertension or cardiovascular events in patients with existing hypertension. However, studies looking at adults without hypertension were lacking," Inoue said.
The research team found that over a roughly 6.5-year follow-up period, every doubling of the four stress hormone levels was associated with a 21% to 31% increase in the risk of developing high blood pressure.
And over a median of 11 years, each doubling of cortisol levels was associated with a 90% increased risk of heart events or stroke.
"It is important to examine the impact of stress on adults in the general population because it provides new information about whether routine measurement of stress hormones needs to be considered to prevent hypertension and CVD [cardiovascular disease] events," Inoue said.
The authors acknowledged some limitations to the study: It did not include people who already had high blood pressure and did not use other tests to measure stress hormones.More information
The American Psychological Association offers some healthy suggestions for reducing stress.
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