The impact of the Affordable Health Care Act (ACA) on Cardiovascular Death (CVD) rates in King County, Washington.

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death and disability worldwide, with a significant burden in the United States. Despite interventions such as the Affordable Care Act (ACA) aimed at reducing healthcare disparities and improving health outcomes, the direct impact of the ACA on CVD mortality among working-aged adults remains unclear. Objective: This study aims to evaluate the association between the implementation of the ACA and CVD death rates among working-aged adults (18-64 years) in King County, Washington, from 2009 to 2019. Methods: A Poisson regression analysis was conducted using quarterly age-sex-race-adjusted CVD death rates. Data were obtained from the Washington State Department of Health and the Office of Financial Management of the State of Washington. The primary exposure was the implementation of the ACA on January 1, 2014. The model adjusted for sex, age, race/ethnicity, and included an interaction term between the ACA and time (in quarters). Results: Post-ACA implementation, the risk of CVD death among working-aged adults in King County increased by 58% (IRR: 1.58; 95% CI: 1.41 - 1.76). Each additional quarter was associated with a 3% decrease in CVD death risk (IRR: 0.97; 95% CI: 0.96 - 0.98). The interaction between ACA and time was not statistically significant (IRR: 1.01; 95% CI: 0.99 - 1.03; p = 0.14). Significant predictors of increased CVD mortality included age (IRR: 1.13 per year; 95% CI: 1.12 - 1.13; p < 0.001) and male sex (IRR: 3.00; 95% CI: 2.71 - 3.25; p < 0.001). Racial disparities were observed, with Black individuals having the highest risk (IRR: 4.50; 95% CI: 3.90 - 5.20; p < 0.001). Conclusion: Contrary to the hypothesis, the study found an increased risk of CVD death among working-aged adults in King County following the ACA implementation. These findings highlight the complexity of healthcare reforms and the need for further research to understand the multifaceted determinants of CVD mortality.