Evidence map›Paper›PMID 35259679›Full record

ArticleDrug and alcohol dependence2022

Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis.

Umedjon Ibragimov, Russell W Mansfield, Courtney R Yarbrough, Janet R Cummings, Melvin D Livingston, Regine Haardörfer, Stephanie Beane, Monica M Fadanelli, Danielle F Haley, Hannah L F Cooper

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Drug and alcohol dependence, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. The uneven impact of Medicaid expansion on rural and urban Black, Latino/a, and White mortality.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Umedjon IbragimovBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: umed.ibragimov@emory.edu.
Russell W MansfieldBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Courtney R YarbroughHealth Policy and Management Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Janet R CummingsHealth Policy and Management Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Melvin D LivingstonBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Regine HaardörferBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Stephanie BeaneBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Monica M FadanelliBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Danielle F HaleyDepartment of Community Health Sciences, School of Public Health, Boston University, USA.
Hannah L F CooperBehavioral, Social and Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Funding

Developing the evidence base for overdose policies: a multilevel analysis of NHBSR01DA046197 · NIDA · EMORY UNIVERSITY · PI COOPER, HANNAH LF · 2018 to 2022
$3.2M
Opioid Treatment Adoption in Primary Care Settings: Barriers and Facilitators to ImplementationK01DA051696 · NIDA · EMORY UNIVERSITY · PI YARBROUGH, COURTNEY R. · 2020 to 2024
$970k
Quantifying health policy impacts on substance use and treatment among women with and at risk for HIV: a longitudinal multilevel analysis using the Women's Interagency HIV StudyK01DA046307 · NIDA · NORTHEASTERN UNIVERSITY · PI HALEY, DANIELLE FRANCES · 2018 to 2022
$865k
NIDA NIH HHS K01 DA046307NIDA NIH HHS K01 DA051696NIDA NIH HHS R01 DA046197
6 · The paper itself

Abstract

backgroundOpioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment.

methodsThis quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an "on switch"-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM.

findingsThe adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant.

conclusionsWe found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify - and repair - breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.

Indexed as

MedicaidOpiate OverdoseAdultAnalgesics, OpioidHumansPatient Protection and Affordable Care ActUnited StatesVulnerable PopulationsAnalgesics, OpioidDifference-in-difference modelingMedicaid expansionOpioid epidemicOpioid overdose-related mortality rates

Identifiers

PMID35259679
PMCPMC8971012

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.