Departments of Environmental and Occupational Health.
Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
Med Care. 2018 Nov;56(11):944-949. doi: 10.1097/MLR.0000000000000984.
We tested whether Medicaid expansion under the Affordable care Act was associated with increased screening for cervical, breast, and colorectal cancer among low-income adults.
We analyzed Behavioral Risk Factor Surveillance System data, identifying 2012 as preexpansion and 2016 as postexpansion (2014 was treated as a wash-out, and 2013 and 2015 had missing screening data from most states). States (including District of Columbia) either expanded Medicaid in 2014 (n=28) or not (n=18); five states that expanded after 2014 were excluded. Participants included low-income adults aged 18-64 without dependent children. A difference-in-difference approach tested whether expansion was significantly associated with screening, controlling for time, state effects, age, sex, race/ethnicity, education, and urban/rural population. For comparison, we also conducted analyses among the low-income Medicare (aged 65 and above) population, and a higher income population.
There was a significant expansion effect for women aged 18-64 for cervical cancer screening (N=29,059; odds ratio, 1.04; 95% confidence interval, 1.01-1.08), and for adults 50-64 for colorectal cancer screening (N=32,290; odds ratio, 1.12; 95% confidence interval, 1.03-1.22). Effects for mammography for women aged 40-64, or aged 50-64, were not significant. As expected, there were no significant improvements associated with expansion among the Medicare population, or among a population ineligible due to higher income.
Medicaid expansion under the Affordable Care Act was associated with increased screening for cervical and colorectal cancer for low-income adults. It will be important to monitor possible adverse cancer outcomes in nonexpansion states among vulnerable populations over time.
我们测试了平价医疗法案下的医疗补助扩展是否与低收入成年人中宫颈癌、乳腺癌和结直肠癌筛查的增加有关。
我们分析了行为风险因素监测系统的数据，将 2012 年定为扩围前，2016 年定为扩围后（2014 年被视为冲洗期，2013 年和 2015 年大多数州都缺少筛查数据）。州（包括哥伦比亚特区）要么在 2014 年扩大了医疗补助（n=28），要么没有（n=18）；五个在 2014 年后扩大的州被排除在外。参与者包括无子女的 18-64 岁低收入成年人。差异-差异方法检验了扩围是否与筛查显著相关，同时控制了时间、州效、年龄、性别、种族/族裔、教育程度和城乡人口。为了比较，我们还在低收入医疗保险（65 岁及以上）人群和高收入人群中进行了分析。
对于 18-64 岁的女性宫颈癌筛查（N=29059；优势比，1.04；95%置信区间，1.01-1.08）和 50-64 岁的成年人结直肠癌筛查（N=32290；优势比，1.12；95%置信区间，1.03-1.22），扩围的效果显著。对于 40-64 岁或 50-64 岁的女性乳房 X 光检查，效果不显著。正如预期的那样，在医疗保险人群或由于收入较高而不符合条件的人群中，扩围并没有带来显著的改善。
平价医疗法案下的医疗补助扩围与低收入成年人的宫颈癌和结直肠癌筛查增加有关。随着时间的推移，监测在无扩围州中弱势群体可能出现的不利癌症结果将非常重要。
