Assessing the Impact of the Affordable Care Act’s Medicaid Expansion on SIDS Rates, 2011-2021 Open Access

Abstract

Background: Despite longstanding declines, sudden infant death syndrome (SIDS) rates

have increased in recent years. There have been persistent inequities in infant mortality,

with the highest rates occurring among non-Hispanic American Indigenous and non-

Hispanic Black infants. The Patient Protection and Affordable Care Act of 2010

(PPACA) led to a reduction of uninsured women of reproductive age, including women

with children. With inadequate access to prenatal/postnatal care being a known risk

factor for SIDS, it is possible that expansion of Medicaid eligibility could have had

trickle down effects on infant health outcomes, including SIDS.

Objective: To evaluate whether SIDS rates changed after states expanded their

Medicaid eligibility, both overall and by maternal race.

Methods: A difference-in-differences regression was used to compare SIDS rates

(overall and stratified by maternal race: non-Hispanic Black and non-Hispanic White)

between states that expanded their Medicaid eligibility and those that did not between

2011 and 2021. The analyses controlled for state-level poverty, unemployment, and

governor’s political party.

Results: Overall, there was no association in both crude and adjusted models between

Medicaid expansion and SIDS rates between 2011 to 2021 (Diff-in-Diff Coef. = 0.0018,

95% CI: -0.13, 0.16; Diff-in-Diff Coef. = 0.011, 95% CI: -0.12, 0.14). These findings did not

differ for babies born to non-Hispanic Black or non-Hispanic White mothers.

Conclusion: SIDS rates were not associated with Medicaid expansion from 2011-2021.

Notably, infant mortality increased during the latter part of the study period (beginning

just before the onset of the COVID-19 pandemic). Pandemic-related disruptions may

have offset any potential benefits that could have been realized due to Medicaid

eligibility expansion.

Table of Contents

Introduction....................................................................................................................................................2

Methods..........................................................................................................................................................4

Results............................................................................................................................................................6

Discussion.......................................................................................................................................................8

Public Health Implications................................................................................................................................9

References…...................................................................................................................................................11

Tables & Figures.............................................................................................................................................13

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Infant Mortality SIDS Healthcare Medicaid
Committee Chair / Thesis Advisor	Lauren Christiansen-Lindquist, Emory University

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