{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:51:21Z","timestamp":1778622681743,"version":"3.51.4"},"reference-count":24,"publisher":"American Public Health Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p> Objectives. To examine the association of state Medicaid expansion status with mortality changes during the COVID-19 pandemic in the United States. <\/jats:p><jats:p> Methods. Deaths among individuals 20 to 64\u2009years of age in 3142 counties were identified from 2018 to 2022 mortality surveillance data. Age-adjusted mortality rates were calculated for each county and by cause of death. Changes in mortality rates before and after the onset of the COVID-19 pandemic (2018\u20132019 vs 2021\u20132022) in Medicaid expansion states relative to nonexpansion states were calculated after adjustment for county sociodemographic factors and state COVID-19 vaccination rates. <\/jats:p><jats:p> Results. All-cause mortality rates increased in 2020\u20132021 nationwide and decreased slightly in 2022. Overall, the increase was slower in Medicaid expansion states, leading to a net decrease of 31.8 (95% confidence interval [CI]\u2009=\u200920.9, 42.8) deaths per 100\u2009000 person-years associated with Medicaid expansion from 2018\u20132019 to 2021\u20132022. The decrease was largest for deaths from heart disease and liver disease and was observed across subpopulations stratified by sex, age, and race. <\/jats:p><jats:p> Conclusions. Increases in mortality rates were slower in Medicaid expansion states than in nonexpansion states during the COVID-19 public health emergency, suggesting a protective effect of Medicaid expansion on population health during the pandemic. ( Am J Public Health. 2025;115(6):890\u2013899. https:\/\/doi.org\/10.2105\/AJPH.2025.308045 ) <\/jats:p>","DOI":"10.2105\/ajph.2025.308045","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T22:12:28Z","timestamp":1743718348000},"page":"890-899","source":"Crossref","is-referenced-by-count":4,"title":["Medicaid Expansion and US Mortality Rates During the COVID-19 Pandemic, 2018\u20132022"],"prefix":"10.2105","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-7949","authenticated-orcid":false,"given":"Xuesong","family":"Han","sequence":"first","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kewei Sylvia","family":"Shi","sequence":"additional","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinjin","family":"Fan","sequence":"additional","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7072-0535","authenticated-orcid":false,"given":"Parichoy Pal","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Hu","sequence":"additional","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0644-5572","authenticated-orcid":false,"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Xuesong Han, Kewei Sylvia Shi, Qinjin Fan, Parichoy Pal Choudhury, and K. Robin Yabroff are with Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA. Kewei Sylvia Shi is also with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Xin Hu is with the Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"844","reference":[{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01436"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00252-8"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02796-3"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.7326\/M21-2134"},{"key":"bib7","first-page":"100264","volume":"12","author":"Campbell T","year":"2022","journal-title":"Lancet Reg Health Am."},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.1632"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.01469"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14044"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.2007"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306329"},{"key":"bib16","volume-title":"Changing the US Health Care System: Key Issues in Health Services Policy and Management.","author":"Andersen RM","year":"2011"},{"key":"bib20","doi-asserted-by":"publisher","DOI":"10.1177\/21501319231170164"},{"key":"bib21","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12672"},{"key":"bib22","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.adf9742"},{"key":"bib23","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.11.042"},{"key":"bib24","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15968"},{"issue":"9","key":"bib26","first-page":"3610","volume":"25","author":"Fedeli U","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"bib28","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.1373"},{"issue":"4","key":"bib29","first-page":"436","volume":"113","author":"Erhunmwunsee L","year":"2021","journal-title":"J Natl Med Assoc."},{"key":"bib30","doi-asserted-by":"publisher","DOI":"10.1080\/08964289.2021.1990007"},{"key":"bib31","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00522"},{"key":"bib32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.13100"},{"key":"bib33","volume-title":"Medicaid Expansion Is a Red and Blue State Issue.","author":"Tolbert J","year":"2024"},{"key":"bib34","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2301021"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.2025.308045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T20:08:25Z","timestamp":1747253305000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2025.308045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.2105\/AJPH.2025.308045"],"URL":"https:\/\/doi.org\/10.2105\/ajph.2025.308045","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}