Importance The 2016 presidential campaign was marked by intensified rhetoric around the deportation of undocumented immigrants. The association of such rhetoric with primary, emergency, and inpatient care among undocumented immigrants is unclear.

Objective To examine the association of increased anti-immigrant rhetoric during the 2016 presidential campaign with health care use among a group of Medicaid-ineligible patients largely composed of undocumented immigrants.

Design, Setting, and Participants Using a difference-in-differences (DID) approach, this cohort study analyzed health care use between January 1, 2014, and May 31, 2018, in a retrospective cohort of Medicaid and Medicaid-ineligible (>90% undocumented) adult and pediatric patients. The inflection point of interest was June 16, 2015, the date of Donald Trump’s announcement of candidacy, which represented a documented increase in anti-immigration rhetoric during the presidential campaign. Analyses were controlled for age, self-reported sex, and baseline comorbidities. Data analysis was conducted from August 28, 2018, to September 1, 2020.

Main Outcomes and Measures The DID of the number of completed primary care encounters before and after June 16, 2015, in Medicaid compared with Medicaid-ineligible patients. Secondary outcomes included the DID of emergency department (ED) visits and inpatient discharges over the same period.

Results There were 20 211 patients included in the analysis: 1501 (7.4%) in the sample of predominantly undocumented Medicaid-ineligible patients (861 [57.4%] female) and 18 710 (92.6%) in the Medicaid control group (10 443 [55.8%] female). The mean (SD) age as of 2018 in the Medicaid-ineligible group was 38.2 (15.4) years compared with 22.2 (16.5) years in the control group. There was a differential decrease in completed visits among Medicaid-ineligible children compared with Medicaid children (DID estimate, 0.8; 95% CI, 0.7-0.9) and Medicaid-ineligible adults (DID estimate, 0.8; 95% CI, 0.8-0.9). There was also a significant differential increase in ED visits among Medicaid-ineligible children (DID estimate, 2.3; 95% CI, 1.1-5.0). In addition, there was a differential decrease in inpatient discharges among Medicaid-ineligible adults (DID estimate, 0.5; 95% CI, 0.4-0.7), with no significant change in ED visits or ED admission rates in this group.

Conclusions and Relevance In this cohort study, there was a significant decrease in primary care use among undocumented patients during a period of increased anti-immigrant rhetoric associated with the 2016 presidential campaign, coincident with an increase in ED visits among children and a decrease in inpatient discharges among adults, with the latter possibly attributed to a decrease in elective admissions during this period.

重要性 2016年总统大选的特点是围绕无证移民被驱逐出境的言论愈演愈烈。在没有证件的移民中，这种言论与初级，急诊和住院护理之间的关系尚不清楚。

目的 在一组主要由无证移民组成的不符合Medicaid资格的患者中，研究2016年总统竞选期间反移民言论增加与医疗保健的相关性。

设计，设置和参与者本研究 采用差异差异（DID）方法，对2014年1月1日至2018年5月31日之间的医疗补助和不符合医疗补助资格的回顾性队列（> 90）进行了分析。未记录的百分比）成年和小儿患者。拐点的关注点是2015年6月16日，即唐纳德·特朗普宣布参选之日，这表明在总统竞选期间反移民言论的增加。对年龄，自我报告的性别和基线合并症进行了分析。数据分析于2018年8月28日至2020年9月1日进行。

主要结果和措施 与不符合Medicaid资格的患者相比，Medicaid于2015年6月16日之前和之后完成的初级保健遭遇的DID。次要结果包括同期急诊就诊的DID和住院病人出院的情况。

结果 分析中包括20 211例患者：在主要未记录的不符合Medicaid资格的患者样本中为1501例（7.4％）（女性为861 [57.4％]），在Medicaid对照组中为18 710例（92.6％）（10 443 [55.8] ％] 女性）。截至2018年，符合医疗补助资格的组的平均（SD）年龄为38.2（15.4）岁，而对照组为22.2（16.5）岁。与Medicaid儿童（DID估计为0.8； 95％CI为0.7-0.9）和不符合Medicaid的成年人（DID估计值为0.8； 95％CI为0.8-0.9）相比，不符合Medicaid的儿童的完成就诊的差异有所减少。 。符合Medicaid资格的儿童中ED访视也显着增加（DID估计值为2.3； 95％CI为1.1-5.0）。此外，不符合医疗补助资格的成年人的住院出院率也有所下降（DID估计值为0.5；而DID估计值为0.5）。

结论与相关性 在这项队列研究中，在与2016年总统大选有关的反移民言论增加期间，无证件患者的初级保健使用显着减少，同时儿童急诊就诊次数增加，住院患者减少成人之间的出院率高，后者可能是由于在此期间选拔入学人数减少所致。