PMID- 34118120
OWN - NLM
STAT- MEDLINE
DCOM- 20220301
LR  - 20230509
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 27
IP  - 12
DP  - 2021 Dec
TI  - Medicaid Expansion Association With End-Stage Liver Disease Mortality Depends on 
      Leniency of Medicaid Hepatitis C Virus Coverage.
PG  - 1723-1732
LID - 10.1002/lt.26209 [doi]
AB  - The Affordable Care Act expanded Medicaid around the same time that direct-acting 
      antivirals became widely available for the treatment of hepatitis C virus (HCV). 
      However, there is significant variation in Medicaid HCV treatment eligibility 
      criteria between states. We explored the combined effects of Medicaid expansion 
      and leniency of HCV coverage under Medicaid on liver outcomes. We assessed 
      state-level end-stage liver disease (ESLD) mortality rates, listings for liver 
      transplantation (LT), and listing-to-death ratios (LDRs) for adults aged 25 to 
      64 years using data from United Network for Organ Sharing and Centers for Disease 
      Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. 
      States were divided into 4 nonoverlapping groups based on expansion status on 
      January 1, 2014 (expansion versus nonexpansion) and leniency of Medicaid HCV 
      coverage (lenient versus restrictive coverage). Joinpoint regression analysis 
      evaluated the significant changes in slope over time (joinpoints) during the 
      pre-expansion (2009-2013) and postexpansion (2014-2018) time periods. We found 
      significant changes in the annual percent change for population-adjusted ESLD 
      deaths between 2014 and 2015 in all cohorts except for the 
      nonexpansion/restrictive cohort, in which deaths increased at the same annual 
      percent change from 2009 to 2018 (annual percent change of +2.5%; 95% confidence 
      interval [CI], 1.8-3.3]). In the expansion/lenient coverage cohort, deaths 
      increased at an annual percent change of +2.6% (95% CI, 1.8-3.5) until 2014 and 
      then tended to decrease at an annual percent change of -0.4% (95% CI, -1.5 to 
      0.8). LT listings tended to decrease over time for all cohorts. For LDRs, only 
      the expansion/lenient and expansion/restrictive cohorts had statistically 
      significant joinpoints. Improvements in ESLD mortality and LDRs were associated 
      with both Medicaid expansion and leniency of HCV coverage under Medicaid. These 
      findings suggest the importance of implementing more lenient and widespread 
      public health insurance to improve liver disease outcomes, including mortality.
CI  - Copyright (c) 2021 by the American Association for the Study of Liver Diseases.
FAU - Wahid, Nabeel A
AU  - Wahid NA
AUID- ORCID: 0000-0002-6372-6904
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
FAU - Lee, Jihui
AU  - Lee J
AD  - Department of Population Health SciencesWeill Cornell MedicineNew YorkNY.
FAU - Kaplan, Alyson
AU  - Kaplan A
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
AD  - Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNY.
FAU - Fortune, Brett E
AU  - Fortune BE
AUID- ORCID: 0000-0002-0646-467
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
AD  - Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNY.
FAU - Safford, Monika M
AU  - Safford MM
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
AD  - Division of General Internal MedicineWeill Cornell MedicineNew YorkNY.
FAU - Brown, Robert S Jr
AU  - Brown RS Jr
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
AD  - Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNY.
FAU - Rosenblatt, Russell
AU  - Rosenblatt R
AUID- ORCID: 0000-0003-3981-7053
AD  - Department of MedicineWeill Cornell Medicine/NewYork-Presbyterian HospitalNew 
      YorkNY.
AD  - Division of Gastroenterology and HepatologyWeill Cornell MedicineNew YorkNY.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210720
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
RN  - 0 (Antiviral Agents)
SB  - IM
CIN - Liver Transpl. 2021 Dec;27(12):1704-1705. PMID: 34418271
MH  - Adult
MH  - Antiviral Agents
MH  - *End Stage Liver Disease/diagnosis/surgery
MH  - Hepacivirus
MH  - *Hepatitis C/drug therapy/epidemiology
MH  - *Hepatitis C, Chronic/drug therapy/epidemiology
MH  - Humans
MH  - Insurance Coverage
MH  - *Liver Transplantation
MH  - Medicaid
MH  - Middle Aged
MH  - Patient Protection and Affordable Care Act
MH  - United States/epidemiology
EDAT- 2021/06/13 06:00
MHDA- 2022/03/03 06:00
CRDT- 2021/06/12 12:16
PHST- 2021/05/20 00:00 [revised]
PHST- 2021/04/08 00:00 [received]
PHST- 2021/06/03 00:00 [accepted]
PHST- 2021/06/13 06:00 [pubmed]
PHST- 2022/03/03 06:00 [medline]
PHST- 2021/06/12 12:16 [entrez]
AID - 01445473-202112000-00009 [pii]
AID - 10.1002/lt.26209 [doi]
PST - ppublish
SO  - Liver Transpl. 2021 Dec;27(12):1723-1732. doi: 10.1002/lt.26209. Epub 2021 Jul 
      20.