Background

In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage, changes to the marketplace, and contraceptive coverage, but its impact on birth trends, particularly adolescent births, is currently unknown.

Objectives

We sought to determine whether ACA implementation was associated with changes in adolescent births and whether this differed by insurance type (Medicaid or private insurance).

Methods

We used revised 2009-2017 birth certificate data, restricted to resident women with a Medicaid or privately paid singleton birth (N = 27,748,028). Segmented regression analysis was used to examine births to adolescent mothers (12-19 years old) before and after the ACA.

Results

There were 27,748,028 singleton births (n = 2,013,521 adolescent births) among U.S. residents between 2009 and 2017 in this analytic sample. Adjusted models revealed that the ACA was associated with a 23% significant decrease in odds of an adolescent birth (OR = 0.78; 95% CI, 0.77-0.79) for Medicaid-funded births and a 19% decrease (OR = 0.81; 95% CI, 0.79-0.83) for privately insured births, with a further declining trend. Overall declines in adolescent births among the Medicaid population appear to be driven by states that chose to expand Medicaid.

Conclusion

Beyond the declining secular trend already observed in adolescent pregnancy over the last 10 years, the ACA appears to have had a substantial impact on adolescent births, likely due to Medicaid expansion and increased access to affordable contraception. From a population health perspective, efforts to undo the ACA could have important consequences for maternal, infant, and family health in the United States.

中文翻译：

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按保险类型划分的平价医疗法案 (ACA) 实施和青少年出生：美国 2009 年至 2017 年出生的中断时间序列分析

背景

2010 年，平价医疗法案 (ACA) 颁布，到 2014 年全部条款生效，包括扩大医疗补助覆盖范围、市场变化和避孕覆盖范围，但其对生育趋势，尤其是青少年生育的影响，目前尚不清楚。

目标

我们试图确定 ACA 的实施是否与青少年生育率的变化相关，以及这是否因保险类型（医疗补助或私人保险）而异。

方法

我们使用修订后的 2009-2017 年出生证明数据，仅限于享受医疗补助或私人支付的单胎生育的居民妇女 ( N  = 27,748,028)。分段回归分析用于检查 ACA 前后青春期母亲（12-19 岁）的分娩情况。

结果

 在这个分析样本中，2009 年至 2017 年间，美国居民中有 27,748,028 名单胎出生（n = 2,013,521 名青少年出生）。调整后的模型显示，ACA 与青少年生育几率显着降低 23%（OR = 0.78；95% CI，0.77-0.79）和 19%（OR = 0.81；95%）相关CI, 0.79-0.83) 私人保险生育，并有进一步下降的趋势。医疗补助人口中青少年生育率的总体下降似乎是由选择扩大医疗补助的州推动的。

结论

除了在过去 10 年中已经观察到青少年怀孕率下降的长期趋势外，ACA 似乎对青少年生育产生了重大影响，这可能是由于医疗补助计划的扩大和获得负担得起的避孕药具的增加。从人口健康的角度来看，取消 ACA 的努力可能会对美国的孕产妇、婴儿和家庭健康产生重要影响。