Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of otorhinolaryngology- Head and Neck surgery, University of Pennsylvania, Philadelphia, PA, USA.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102464. doi: 10.1016/j.amjoto.2020.102464. Epub 2020 Mar 17.
This study was done to determine the direct impact implementation of the Affordable Care Act (ACA) on patients with Head and Neck Cancer (HNCA) in states that chose to expand Medicaid compared to in states that did not, as well as assess whether this impact varied among different demographic groups.
The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of HNCA diagnosed from 2011 to 2014. Rates of uninsured status were compared before and after Medicaid expansion and contrasted between states that did and did not expand coverage, stratified by patient and tumor characteristics, and assessed via multivariate regression.
Overall rates of uninsured status (UR) were decreased by 63.08% in states that expanded coverage (ES) but only by 2.6% in states that did not (NS). In NS, there was an increase in proportion of black patients who were uninsured over the study period (13.7%, p = 0.077) whereas in ES, this proportion decreased by 73.3%. When stratified by primary site, patients with laryngeal cancer had the highest UR with an increase by 16.7% in NS and a decrease by 70.5% in ES. Multivariate analysis yielded predictors of uninsured status including residence in a NS, Hispanic ethnicity, and black race.
Implementation of the ACA resulted in expanded insurance coverage for patients diagnosed with HNCA concentrated mainly in states that expanded Medicaid coverage and for patients derived from vulnerable populations, including black and Hispanic patients. In states that did not expand Medicaid, vulnerable populations were disproportionately affected.
本研究旨在确定平价医疗法案（ACA）的实施对选择扩大医疗补助的州与未扩大医疗补助的州的头颈部癌症（HNCA）患者的直接影响，并评估这种影响是否因不同的人口统计学群体而有所不同。
通过监测、流行病学和最终结果（SEER）数据库，检索了 2011 年至 2014 年期间诊断为 HNCA 的病例。比较了医疗补助扩大前后的未参保率，并在扩大和未扩大覆盖范围的州之间进行了对比，按患者和肿瘤特征进行分层，并通过多变量回归进行评估。
在扩大覆盖范围的州（ES），未参保率总体下降了 63.08%，而在未扩大覆盖范围的州（NS）仅下降了 2.6%。在 NS，未参保的黑人患者比例在研究期间有所增加（13.7%，p=0.077），而在 ES，这一比例下降了 73.3%。按原发部位分层，喉癌患者的未参保率最高，在 NS 增加了 16.7%，在 ES 减少了 70.5%。多变量分析得出了未参保状态的预测因素，包括居住在 NS、西班牙裔和黑人种族。
ACA 的实施使 HNCA 患者的保险覆盖范围扩大，主要集中在扩大医疗补助覆盖范围的州，以及包括黑人和西班牙裔在内的弱势群体患者。在未扩大医疗补助的州，弱势群体受到了不成比例的影响。
