Loehrer Andrew P, Murthy Shilpa S, Song Zirui, Lubitz Carrie C, James Benjamin C
Department of Surgery, Massachusetts General Hospital, Boston.
Department of Surgery, Indiana University School of Medicine, Indianapolis.
JAMA Surg. 2017 Aug 1;152(8):734-740. doi: 10.1001/jamasurg.2017.0461.
To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer.
We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment.
DESIGN, SETTING, AND PARTICIPANTS: We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends.
Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated.
The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states.
The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level.
据我们所知，甲状腺癌发病率的增长速度比其他任何癌症类型都要快，目前是女性中第五大常见癌症。虽然这种增长可能是多因素导致的，但很少有人考虑保险状况对甲状腺癌治疗的影响。
我们利用2006年马萨诸塞州的医疗改革这一独特的自然实验，评估保险覆盖范围扩大与甲状腺癌治疗之间的关联。
设计、背景和参与者：我们使用医疗保健研究与质量局的州住院数据库，确定2001年至2011年期间在马萨诸塞州（n = 8534）和3个对照州（n = 48047）因甲状腺癌住院并接受甲状腺切除术的政府补贴保险、自费保险或私人保险患者。采用差异-in-差异模型评估2006年马萨诸塞州医疗改革与甲状腺癌治疗之间的关联，并对参与者的年龄、性别、合并症和长期趋势进行控制。
评估甲状腺癌治疗中甲状腺切除术率的变化是主要结局。
马萨诸塞州队列包括6443名女性（75.5%）和2091名男性（24.5%），其中6388名（79.6%）为白人，391名（4.9%）为黑人，527名（6.6%）为西班牙裔，424名（5.3%）为亚裔/太平洋岛民，63名（0.8%）为美洲原住民，228名（2.8%）为其他种族。对照州的参与者包括36818名女性（76.6%）和11229名男性（23.4%），其中30432名（65.5%）为白人，3818名（8.2%）为黑人，6462名（13.9%）为西班牙裔，2
