Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.
Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
Cancer Causes Control. 2020 Nov;31(11):1039-1048. doi: 10.1007/s10552-020-01343-8. Epub 2020 Aug 30.
Out-of-pocket costs may significantly dampen patients' willingness to adopt preventive procedures. This is especially true for colonoscopies, which typically involved relatively high cost-sharing requirements prior to the Affordable Care Act (ACA) implementation in 2011.
We aim to examine the effects of income-related disparities in colonoscopy use in the years prior to and immediately after the implementation of the ACA. Further, we quantify the contributions of different factors in explaining the disparities in the use of colonoscopies among elderly population with health insurance coverage.
Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk Factor Surveillance System data were utilized. To examine income-related disparities in the use of CRC, individuals aged 65-75 were included, and the concentration index (CI) was calculated before and after the implementation of ACA. To identify and quantify the contribution of different factors, a decomposition analysis of CI was conducted.
CIs decreased from 0.1935 in pre-ACA years to 0.1813 in the post-ACA years among the elderly, indicating that the disparities in the use of colonoscopy was relatively low and the disparities index declined after the implementation of ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational level, higher level of income and educational attainment were major contributors to the observed disparities in colonoscopy use.
Our findings indicate that the ACA's removal of financial barriers may have contributed toward the reduction in disparities of colonoscopy use. More direct interventions, e.g., improved knowledge, better access and lower indirect cost will be helpful in improving screening among low-income and low-educational attainment households.
自付费用可能会显著降低患者接受预防措施的意愿。这在结肠镜检查中尤其如此，因为在 2011 年《平价医疗法案》（ACA）实施之前，此类检查通常涉及相对较高的费用分担要求。
我们旨在研究在实施 ACA 之前和之后的几年中，与收入相关的结肠镜检查使用差异的影响。此外，我们量化了不同因素在解释具有医疗保险覆盖的老年人群中结肠镜检查使用差异方面的贡献。
利用了五个周期（2008 年、2010 年、2012 年、2014 年和 2016 年）的行为风险因素监测系统数据。为了研究使用 CRC 的与收入相关的差异，纳入了年龄在 65-75 岁的个体，并在实施 ACA 之前和之后计算了集中指数（CI）。为了确定和量化不同因素的贡献，进行了 CI 的分解分析。
在老年人中，ACA 实施前的 CIs 为 0.1935，ACA 实施后的 CIs 为 0.1813，这表明结肠镜检查使用的差异相对较低，并且在实施 ACA 后，差异指数下降。分解分析表明，尽管差异的减少主要来自收入和教育水平，但较高的收入和教育程度是观察到的结肠镜检查使用差异的主要原因。
我们的研究结果表明，ACA 消除财务障碍可能有助于减少结肠镜检查使用的差异。更多的直接干预措施，例如提高知识、更好的获得途径和降低间接成本，将有助于改善低收入和低教育程度家庭的筛查。
