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137 Medicaid expansion and suicide deaths among nonelderly adults: evidence from the national violent death reporting system
  1. Anna Austin,
  2. Rebecca Naumann,
  3. Nicole Short
  1. University of North Carolina at Chapel Hill, University of North Carolina at Chapel Hill, USA


Rates of suicide death among nonelderly adults in the United States have steadily increased over the last two decades, with rates increasing from 13.2 to 18.2 deaths per 100,000 adults ages 18–64 years between 1999 and 2019. There is a critical need for rigorous research examining the impact of state and federal programs and policies, strategies which have the potential to reach large numbers of individuals, in preventing suicide in this population. Beginning in 2014, under the Patient Protection and Affordable Care Act, states had the option to expand Medicaid coverage to nonelderly residents with incomes up to 138% of the federal poverty level, representing one of the largest gains in health insurance coverage for nonelderly U.S. adults. Medicaid expansion has the potential to reduce suicide rates among nonelderly adults by increasing access to mental health care and decreasing the burden of healthcare-related expenses. We used 2005–2017 National Violent Death Reporting System data for eight Medicaid expansion and seven non-expansion states to examine the association of Medicaid expansion with rates of suicide death among nonelderly adults per 100,000 population using a difference-in-differences approach. Adjusting for state-level confounders, Medicaid expansion states had 1.2 (95% CI -2.5, 0.1) fewer suicide deaths per 100,000 population per year in the post-expansion period than would have been expected if they had followed the same trend in suicide rates as non-expansion states. Medicaid expansion was associated with reductions in suicide rates among women, men, white, non-Hispanic individuals, and those without a college degree. Medicaid expansion was not associated with a change in suicide rates among, and non-white or Hispanic individuals. While overall Medicaid expansion was associated with reductions in rates of suicide death among nonelderly adults, further research on underlying drivers of inequities in Medicaid expansion benefits by race/ethnicity is needed.

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