Department of Gynecology and Obstetrics, and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Obstet Gynecol. 2020 Feb;135(2):257-265. doi: 10.1097/AOG.0000000000003630.
To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer.
We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21-64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004-2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center.
A total of 39,999 ovarian cancer cases prereform and 36,564 postreform were identified for women aged 21-64 years compared with 31,290 cases prereform and 29,807 postreform for women aged 65 years or older. The ACA was associated with increased early-stage diagnosis detection for women aged 21-64 years compared with women 65 and older (difference-in-differences 1.4%, 95% CI 0.4-2.4). The ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (2.3%, 95% CI 1.7-3.0). Among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (difference-in-differences 2.7%, 95% CI 1.0-4.5, difference-in-differences 2.5%, 95% CI 1.2-3.8). Improvements in time to treatment were seen across race and income groups.
Implementation of the ACA was associated with earlier ovarian cancer stage at detection and treatment within 30 days of diagnosis.
评估 2010 年平价医疗法案（ACA）的实施情况如何与卵巢癌患者的诊断分期和治疗时间相关。
我们采用了一种回顾性队列研究，使用差异分析比较了在 ACA 实施前后，21-64 岁卵巢癌患者（暴露组）与 65 岁及以上患者（对照组）的诊断分期和治疗时间。我们使用了 2004-2015 年国家癌症数据库的数据，对所有患者以及按保险类型和种族进行了分析，并根据城乡、收入和教育水平、合并症、医疗距离、地区和学术中心的治疗情况进行了调整。
在 21-64 岁的女性中，ACA 实施前有 39999 例卵巢癌病例，实施后有 36564 例；在 65 岁及以上的女性中，ACA 实施前有 31290 例，实施后有 29807 例。ACA 的实施与 21-64 岁女性的早期诊断检测率增加相关，与 65 岁及以上女性相比差异为 1.4%（95%CI 0.4-2.4）。ACA 的实施与更多的女性在卵巢癌诊断后 30 天内接受治疗相关（2.3%，95%CI 1.7-3.0）。在有公共保险的女性中，ACA 的实施与早期诊断和在诊断后 30 天内接受治疗的显著改善相关（差异为 2.7%，95%CI 1.0-4.5，差异为 2.5%，95%CI 1.2-3.8）。在不同种族和收入群体中，治疗时间的改善情况均有所体现。
ACA 的实施与卵巢癌早期诊断和诊断后 30 天内接受治疗相关。
