2026-05-11 ブラウン大学
＜関連情報＞
- https://www.brown.edu/news/2026-05-11/medicaid-dialysis-mortality
- https://jamanetwork.com/journals/jamapediatrics/article-abstract/2848765
メディケイド拡大と透析を開始した若年成人の1年死亡率 Medicaid Expansion and 1-Year Mortality Among Young Adults Initiating Dialysis
Shailender Swaminathan, PhD; Daeho Kim, PhD; Benjamin D. Sommers, MD, PhD;et al
JAMA Pediatrics Published:May 11, 2026
DOI:10.1001/jamapediatrics.2026.1530
Key Points
Question Was Medicaid expansion under the Affordable Care Act associated with lower 1-year mortality among young adults with kidney failure initiating dialysis?
Finding In this cohort study involving 7139 individuals comparing young adults affected by Medicaid expansion (ages 19-23 years) with adolescents whose eligibility was unchanged (ages 14-18 years), 1-year mortality among 19- to 23-year-olds initiating dialysis declined by a statistically significant 1.8 percentage points after expansion. Medicaid coverage increased and uninsurance decreased significantly among young adults, coinciding with improvements in predialysis care, length of hemodialysis sessions, and use of peritoneal dialysis.
Meaning Medicaid expansion was associated with reductions in mortality among young adults with kidney failure, suggesting that expanded health insurance coverage may improve survival and care quality in this high-risk population.
Abstract
Importance The Affordable Care Act (ACA) provided continued Medicaid coverage to US children transitioning into young adulthood, but whether expansion averted deaths among younger adults with kidney failure remains unclear.
Objective To examine the association of Medicaid expansion with 1-year mortality among young adults with kidney failure initiating dialysis.
Design, Setting, and Participants This cohort study using a quasi-experimental difference-in-differences design compared changes in outcomes before and after Medicaid expansion between patients aged 19 to 23 years (affected by expansion) and patients aged 14 to 18 years (comparison group with unchanged eligibility). The study period extended from January 1, 2010, to December 31, 2019. Data analysis was performed from January 2023 to February 2025.
Exposure Medicaid expansion under the ACA.
Main Outcomes and Measures The primary outcome was 1-year mortality from the date of dialysis initiation. Secondary outcomes were Medicaid coverage, uninsurance, predialysis nephrology care, prescribed hemodialysis duration, modality of dialysis, and catheter use at hemodialysis initiation.
Results Among 7139 patients in expansion states, 2348 were 14 to 18 years old (1280 male [54.5%]; 1068 female [45.5%]), and 4791 were 19 to 23 years old (2717 male [56.7%]; 2074 female [43.3%]. One-year mortality for 19- to 23-year-olds declined from 3.6% (95% CI, 2.4% to 4.9%) in the pre-expansion period to 2.1% (95% CI, 1.2% to 3.0%) after expansion (change, −1.5 percentage points; 95% CI, −2.5 to −0.6), while for 14- to 18-year-olds, the concurrent mortality rate was 0.7% (95% CI, 0.3% to 1.0%) pre-expansion and 1.1% (95% CI, 0.5% to 1.7%) postexpansion (change, 0.4 percentage points; 95% CI, −0.3 to 1.1). The adjusted difference-in-difference estimate was −1.8 percentage points (95% CI, −2.9 to −0.7). Medicaid coverage for 19- to 23-year-olds increased from 37.1% to 48.5% and uninsurance rates declined from 19.4% to 7.8%. After accounting for concurrent changes among 14- to 18-year-olds, the adjusted difference-in-difference estimates were 8.4 percentage points (95% CI, 4.8 to 12.0) for Medicaid and −9.1 percentage points (95% CI, −12.4 to −5.8) for uninsurance. Medicaid expansion was associated with higher rates of predialysis nephrology care, prescribed hemodialysis sessions of 4 or more hours, and use of peritoneal dialysis, but not associated with use of catheters for hemodialysis or kidney transplant rates.
Conclusions and Relevance This study found that Medicaid expansion was associated with reductions in 1-year mortality among young adults with kidney failure initiating dialysis. Policy changes to health insurance programs may affect survival for young adults with this highly morbid condition.
