Alvarez Elysia M, Keegan Theresa H, Johnston Emily E, Haile Robert, Sanders Lee, Wise Paul H, Saynina Olga, Chamberlain Lisa J
Division of Pediatric Hematology and Oncology, Stanford University School of Medicine, Palo Alto, California.
Division of Hematology and Oncology, University of California at Davis School of Medicine, Sacramento, California.
Cancer. 2018 Jan 1;124(1):110-117. doi: 10.1002/cncr.30978. Epub 2017 Sep 22.
BACKGROUND: Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. METHODS: The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. RESULTS: Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. CONCLUSIONS: The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society.
背景：私人医疗保险与癌症患者更好的治疗结果相关。然而，据作者所知，关于《患者保护与平价医疗法案》受抚养人保险范围扩大（ACA-DCE）对患有癌症的年轻成年人保险状况的影响知之甚少。ACA-DCE自2010年起将私人保险覆盖范围扩大至年轻成年人（至26岁）。 方法：本研究是一项基于人群的回顾性分析，研究对象为2006年至2014年期间加利福尼亚州住院的年轻成人肿瘤患者（年龄22 - 30岁，共11,062例患者）。多变量回归分析研究了与拥有私人保险相关的因素。结果以调整后的比值比和95%置信区间呈现。差异分析研究了ACA-DCE对不同种族/族裔和联邦贫困水平的保险覆盖情况的影响。 结果：多变量回归表明，与白人患者相比，黑人和西班牙裔种族/族裔的患者在ACA-DCE前后拥有私人保险的可能性较小。年龄较小（22 - 25岁）与ACA-DCE实施后拥有私人保险相关（比值比，1.20；95%置信区间，1.06 - 1.35）。在差异分析中，居住在中等收入（2006 - 2009年：64.6%对2011 - 2014年：69.1%；P = .003）和高收入（80.4%对82%；P = .043）邮政编码区域的22至25岁白人患者以及居住在高收入邮政编码区域的22至25岁亚洲人（73.2对85.7%；P = .022）的私人保险有所增加。在这两个时间段之间，所有22至25岁西班牙裔患者的私人保险减少。 结论：ACA-DCE条款增加了保险覆盖范围，但并非所有患者都受益。高收入社区的白人和亚洲患者的私人保险增加，这可能会扩大患有癌症的年轻成年人在私人保险覆盖方面的社会差距。《癌症》2018年；124：110 - 7。© 2017美国癌症协会。
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