University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America.
University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America.
Prev Med. 2020 Sep;138:106171. doi: 10.1016/j.ypmed.2020.106171. Epub 2020 Jun 24.
Access to care varies by sex such that interactions with insurance status result in mixed patterns of preventive services utilization. We examined sex-specific effects of ACA Medicaid expansions on receipt of CRC screening. We used Behavioral Risk Factor Surveillance System data (2008-2016) for adults aged 50-64 years with household income ≤138% of federal poverty level to examine self-reported lifetime use of guideline-recommended CRC screening services overall and by screening modality. We employed difference-in-difference models comparing changes in CRC screening in 20 Medicaid expansion states before and after the ACA to changes in 18 states that did not expand Medicaid during our study period. We divided the expansion period into implementation (2014) and post-expansion (2016) periods to account for possible lagged effects. We observed time-varying effects of Medicaid expansion that revealed relative increases in CRC screening occurring during the post-expansion period. Heterogeneous effects by sex and by screening modality were also observed: there was a significant relative increase of 16.2 percentage points (95% CI [2.2, 30.2]; p-value = 0.023) in lifetime colonoscopy use among women in expansion states relative to non-expansion states in the post-expansion period. There were no significant effects of Medicaid expansion among men. Health insurance expansion had a lagged but significant effect on CRC screening among low-income non-elderly women in Medicaid expansion states, but no effect for men. The observed increase in CRC screening among women suggests that barriers to CRC screening may differ by sex, and tailored interventions to increase CRC screening improve outcomes.
获得医疗保健的机会因性别而异，因此与保险状况的相互作用导致预防性服务利用的混合模式。我们研究了 ACA 医疗补助扩张对接受 CRC 筛查的性别特异性影响。我们使用行为风险因素监测系统数据（2008-2016 年），对收入低于联邦贫困水平 138%的 50-64 岁成年人进行了研究，以检查总体和按筛查方式自我报告的符合指南的 CRC 筛查服务的终生使用情况。我们采用差异中的差异模型，将 ACA 前后 20 个扩大医疗补助的州的 CRC 筛查变化与我们研究期间没有扩大医疗补助的 18 个州的变化进行比较。我们将扩展期分为实施期（2014 年）和后期（2016 年），以考虑可能存在的滞后效应。我们观察到医疗补助扩张的时变效应，显示在后期扩张期间 CRC 筛查的相对增加。还观察到按性别和筛查方式划分的异质性效应：在后期扩张期间，扩张州女性的结肠镜检查终生使用率相对非扩张州增加了 16.2 个百分点（95%CI[2.2,30.2]；p 值=0.023）。在男性中，医疗补助扩张没有显著影响。医疗保险扩张对医疗补助扩张州低收入非老年妇女的 CRC 筛查有滞后但显著的影响，但对男性没有影响。观察到的女性 CRC 筛查增加表明 CRC 筛查的障碍可能因性别而异，并且有针对性的干预措施可以提高 CRC 筛查的效果。
