Browsing by Author "Mosesso, Kelly"

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    Association of State Medicaid Expansion With Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States
    (JAMA, 2020-10-08) Nephew, Lauren D.; Mosesso, Kelly; Desai, Archita; Ghabril, Marwan; Orman, Eric S.; Patidar, Kavish R.; Kubal, Chandrashekhar; Noureddin, Mazen; Chalasani, Naga; Medicine, School of Medicine
    Importance Millions of Americans gained insurance through the state expansion of Medicaid, but several states with large populations of racial/ethnic minorities did not expand their programs. Objective To investigate the implications of Medicaid expansion for liver transplant (LT) wait-listing trends for racial/ethnic minorities. Design, Setting, and Participants A cohort study was performed of adults wait-listed for LT using the United Network of Organ Sharing database between January 1, 2010, and December 31, 2017. Poisson regression and a controlled, interrupted time series analysis were used to model trends in wait-listing rates by race/ethnicity. The setting was LT centers in the United States. Main Outcomes and Measures (1) Wait-listing rates by race/ethnicity in states that expanded Medicaid (expansion states) compared with those that did not (nonexpansion states) and (2) actual vs predicted rates of LT wait-listing by race/ethnicity after Medicaid expansion. Results There were 75 748 patients (median age, 57.0 [interquartile range, 50.0-62.0] years; 48 566 [64.1%] male) wait-listed for LT during the study period. The cohort was 8.9% Black and 16.4% Hispanic. Black patients and Hispanic patients were statistically significantly more likely to be wait-listed in expansion states than in nonexpansion states (incidence rate ratio [IRR], 1.54 [95% CI, 1.44-1.64] for Black patients and 1.21 [95% CI, 1.15-1.28] for Hispanic patients). After Medicaid expansion, there was a decrease in the wait-listing rate of Black patients in expansion states (annual percentage change [APC], −4.4%; 95% CI, −8.2% to −0.6%) but not in nonexpansion states (APC, 0.5%; 95% CI, −4.0% to 5.2%). This decrease was not seen when Black patients with hepatitis C virus (HCV) were excluded from the analysis (APC, 3.1%; 95% CI, −2.4% to 8.9%), suggesting that they may be responsible for this expansion state trend. Hispanic Medicaid patients without HCV were statistically significantly more likely to be wait-listed in the post–Medicaid expansion era than would have been predicted without Medicaid expansion (APC, 13.2%; 95% CI, 4.0%-23.2%). Conclusions and Relevance This cohort study found that LT wait-listing rates have decreased for Black patients with HCV in states that expanded Medicaid. Conversely, wait-listing rates have increased for Hispanic patients without HCV. Black patients and Hispanic patients may have benefited differently from Medicaid expansion.
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    Examining the Relationships Between Resilience, Cardiovascular Health, and Race Among US Adults
    (Oxford University Press, 2024-12-31) Sprague, Briana; Mosesso, Kelly; Medicine, School of Medicine
    Modifiable risk and resilience factors explain up to 90% of cardiovascular disease risk. These may contribute to racial cardiovascular health (CVH) disparities, but there has been limited examination of the role of resilience on CVH and disparities. Our goal was to examine (1) which risk and resilience measures were associated with CVH and (2) whether there were differences in these measures by race among a sample of US adults. Aim 1’s sample included adults aged 34-84 from the MIDUS biomarker substudy (N = 1255). Aim 2’s sample comprised of adults aged 28-84 from the MIDUS parent study (N = 4702). The primary outcome of interest was CVH, operationalized as the AHA’s Life’s Essential 8 total score, behavior, and health subscores. The hypothesized resilience measures were psychological well-being (“PWB”; assessed with Ryff and Multidimensional Personality Scale), purpose in life, mindfulness, gratitude, and optimism (MPS subscales). Of those, greater PWB (Ryff), purpose in life, and optimism correlated with better Essential 8 total score and behavioral subscore (ps <.01). Higher PWB (MPS), as well as higher gratitude, were associated with better Essential 8 behavioral scores (p <.05). Of these, PWB (MPS), gratitude, and optimism were significantly differences by race, where Black adults had significantly greater values on all measures (p <.001). Implications for future research and practice will be discussed.