《平价医疗法案对肯塔基州结直肠癌筛查、发病率和生存率的影响》。
Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky.
机构信息
Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY.
Department of Surgery, University of Kentucky Medical Center, Lexington, KY.
出版信息
J Am Coll Surg. 2019 Apr;228(4):342-353.e1. doi: 10.1016/j.jamcollsurg.2018.12.035. Epub 2019 Feb 22.
BACKGROUND
Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky.
STUDY DESIGN
The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation.
RESULTS
Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (-1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage.
CONCLUSIONS
Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.
背景
在癌症发病率和死亡率方面，肯塔基州位居美国第一。由于贫困水平高且未参保医疗保险的人数众多，阿巴拉契亚肯塔基州的癌症发病率更为严重。肯塔基州是首批通过《平价医疗法案》（ACA）扩大医疗补助计划的州之一，该州居民的保险覆盖范围显著增加。我们的研究目的是确定 Medicaid 扩大计划对肯塔基州结直肠癌（CRC）筛查、诊断和生存的影响。
研究设计
肯塔基州卫生与家庭服务部和肯塔基州癌症登记处查询了 2011 年 1 月 1 日至 2016 年 12 月 31 日期间接受 CRC 筛查（根据美国预防服务工作组）或诊断为原发性侵袭性 CRC 的个人（≥20 岁）的数据。比较了 ACA 实施前后（2011 年至 2013 年和 2014 年至 2016 年）的 CRC 筛查率、发病率和生存率。
结果
在 2011 年至 2016 年期间，有 930,176 人接受了 CRC 筛查，诊断出 11,441 例新的 CRC。在 ACA 实施后，接受 Medicaid 保险的患者接受 CRC 筛查的比例大幅增加（增加了 230%，p < 0.001），阿巴拉契亚地区（增加了 44%）的筛查增加幅度高于非阿巴拉契亚地区（增加了 22%，p < 0.01）。在有 Medicaid 保险的人群中，ACA 实施后 CRC 的发病率增加（增加了 6.7%，p < 0.001）。此外，阿巴拉契亚地区早期 CRC（I/II 期）的比例增加了 9.3%（p = 0.09），而非阿巴拉契亚地区的比例几乎没有变化（减少了 1.5%，p = 0.60）。ACA 实施后结直肠癌的生存率得到了提高（风险比 0.73，p < 0.01），尤其是在有 Medicaid 保险的阿巴拉契亚人群中。
结论
Medicaid 扩大计划的实施导致 Medicaid 患者的 CRC 筛查、CRC 诊断和总体生存率显著提高，在阿巴拉契亚人群中产生了更为深远的影响。
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