Spada Neal G, Geramita Emily M, Zamanian Maryam, van Londen G J, Sun Zhaojun, Sabik Lindsay M
Department of Medicine and University of Pittsburgh, Pennsylvania, USA.
Department of Health Policy and Management, University of Pittsburgh, Pennsylvania, USA.
J Womens Health (Larchmt). 2021 Mar;30(3):324-331. doi: 10.1089/jwh.2020.8478. Epub 2020 Sep 28.
This study sought to determine if increased access to health insurance following the Affordable Care Act (ACA) resulted in an increased proportion of early-stage breast cancer diagnosis among women in Pennsylvania, particularly minorities, rural residents, and those of lower socioeconomic status. Data on 35,735 breast cancer cases among women 50-64 and 68-74 years of age in Pennsylvania between 2010 and 2016 were extracted from the Pennsylvania Cancer Registry and analyzed in 2019. Women 50-64 years of age were subdivided by race/ethnicity, area of residence, and socioeconomic status as measured by area deprivation index (ADI). We compared the proportions of early-stage breast cancer diagnosis pre-ACA (2010-2013) and post-ACA (2014-2016) for all women 50-64 years of age to all women 68-74 years of age. This comparison was also made between paired sociodemographic subgroups for women 50-64 years of age. Multivariable logistic regression models were constructed to assess how race, area of residence, ADI, and primary care physician (PCP) density interacted to impact breast cancer diagnosis post-ACA. The proportion of early-stage breast cancer diagnosis increased by 1.71% post-ACA among women 50-64 years of age ( < 0.01), whereas women 68-74 years of age saw no change. Multivariable logistic regression analysis demonstrated that minority women had lower odds of early-stage breast cancer diagnosis pre-ACA, but not post-ACA, when controlling for ADI. Meanwhile, increased area-level socioeconomic advantage was associated with higher odds of being diagnosed with early-stage breast cancer pre- and post-ACA irrespective of controlling for race, area of residence, or PCP density. Enhanced access to health insurance under the ACA was associated with an increased proportion of early-stage breast cancer diagnosis in Pennsylvanian women 50-64 years of age and may have reduced racial, but not socioeconomic, disparities in breast cancer diagnosis.
本研究旨在确定《平价医疗法案》（ACA）实施后医保覆盖范围的扩大是否导致宾夕法尼亚州女性（尤其是少数族裔、农村居民以及社会经济地位较低者）早期乳腺癌诊断比例上升。2019年，从宾夕法尼亚州癌症登记处提取了2010年至2016年间该州50 - 64岁及68 - 74岁女性的35735例乳腺癌病例数据并进行分析。50 - 64岁的女性按种族/族裔、居住地区以及通过地区贫困指数（ADI）衡量的社会经济地位进行细分。我们将所有50 - 64岁女性在ACA实施前（2010 - 2013年）和实施后（2014 - 2016年）的早期乳腺癌诊断比例与所有68 - 74岁女性进行了比较。对于50 - 64岁的女性，还在配对的社会人口学亚组之间进行了这种比较。构建了多变量逻辑回归模型，以评估种族、居住地区、ADI和初级保健医生（PCP）密度如何相互作用，从而影响ACA实施后的乳腺癌诊断情况。50 - 64岁女性在ACA实施后早期乳腺癌诊断比例增加了1.71%（<0.01），而68 - 74岁女性则没有变化。多变量逻辑回归分析表明，在控制ADI的情况下，少数族裔女性在ACA实施前早期乳腺癌诊断几率较低，但在实施后并非如此。同时，无论是否控制种族、居住地区或PCP密度，地区层面社会经济优势的增加都与ACA实施前后被诊断为早期乳腺癌的较高几率相关。ACA下医保覆盖范围的扩大与宾夕法尼亚州50 - 64岁女性早期乳腺癌诊断比例的增加相关，并且可能减少了乳腺癌诊断中的种族差异，但未减少社会经济差异。
