《平价医疗法案》预防性服务条款对乳腺癌分期的潜在影响：初步评估
Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment.
作者信息
Silva Abigail, Molina Yamile, Hunt Bijou, Markossian Talar, Saiyed Nazia
机构信息
Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL, United States.
Division of Community Health Sciences, University of Illinois School of Public Health, Chicago, IL, United States.
出版信息
Cancer Epidemiol. 2017 Aug;49:108-111. doi: 10.1016/j.canep.2017.05.015. Epub 2017 Jun 9.
INTRODUCTION
The Affordable Care Act's (ACA) preventive services provision (PSP) removes copayments for preventive services such as cancer screening. We examined: 1) whether a shift in breast cancer stage occurred, and 2) the impact of the provision on racial/ethnic disparities in stage.
MATERIALS AND METHODS
Data from the National Cancer Database were used. The pre- and post-PSP periods were identified as 2007-2009 and 2011-2013, respectively. Proportion differences (PDs) and 95% confidence Intervals (CIs) were calculated.
RESULTS
All three racial/ethnic groups experienced a statistically significant shift toward Stage I breast cancer. Pre-PSP, the black:white disparity in Stage I cancer was -9.5 (95% CI: -8.9, -10.4) and the Latina:white disparity was -5.2 (95% CI: -4.0, -6.1). Post-PSP, the disparities improved slightly.
DISCUSSION
Preliminary data suggest that the ACA's PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities.
引言
《平价医疗法案》（ACA）的预防性服务条款（PSP）取消了诸如癌症筛查等预防性服务的自付费用。我们研究了：1）乳腺癌分期是否发生了变化，以及2）该条款对分期方面种族/民族差异的影响。
材料与方法
使用了来自国家癌症数据库的数据。PSP实施前和实施后的时间段分别确定为2007 - 2009年和2011 - 2013年。计算了比例差异（PDs）和95%置信区间（CIs）。
结果
所有三个种族/民族群体在I期乳腺癌方面均出现了具有统计学意义的转变。在PSP实施前，I期癌症的黑人与白人差异为 -9.5（95%置信区间：-8.9，-10.4），拉丁裔与白人差异为 -5.2（95%置信区间：-4.0，-6.1）。在PSP实施后，差异略有改善。
讨论
初步数据表明，ACA的PSP可能对总体癌症分期以及按种族/民族划分的癌症分期产生有意义的影响。然而，可能需要更多时间才能看到差异的减少。
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