《平价医疗法案》中路易斯安那州医疗补助扩张计划对乳腺癌女性的积极影响。
Positive impact of the Patient Protection and Affordable Care Act Medicaid expansion on Louisiana women with breast cancer.
机构信息
Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana.
Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana.
出版信息
Cancer. 2021 Mar 1;127(5):688-699. doi: 10.1002/cncr.33265. Epub 2020 Nov 3.
BACKGROUND
Louisiana is one of the few Southern states that enacted the Medicaid expansion of the Patient Protection and Affordable Care Act (ACA). To the authors' knowledge, the issue of how this has affected the breast cancer landscape in Louisiana is unknown. The authors have postulated that ACA expansion had a positive impact for Louisiana women diagnosed with breast cancer.
METHODS
Data from the Louisiana Tumor Registry regarding 14,640 women aged 20 to 64 years who resided in Louisiana and were diagnosed with American Joint Committee on Cancer stage 0 to stage IV breast cancer between 2012 and 2018 were analyzed. The study period was divided into 2 groups: 1) before ACA expansion (January 1, 2012-May 31, 2016); and 2) after ACA expansion (June 1, 2016-December 31, 2018). The chi-square test and multivariable logistic regression models were used to assess the impact of ACA expansion. A P value <.05 was considered statistically significant.
RESULTS
After ACA expansion, the rate of uninsured patients decreased from 5.4% to 3.0% (P < .0001), and the rate of Medicaid recipients increased from 11.6% to 17.7% (P < .0001). The diagnosis of stage I breast cancer increased from 36.8% to 44.7% (P < .0001), whereas the diagnosis of stage III breast cancer decreased from 10.7% to 8.5% (P < .0001). The receipt of radiotherapy after breast-conserving surgery increased from 81.2% to 84.0% (P = .0035), and the receipt of radiotherapy within 90 days increased from 57.2% to 61.7% (P = .0012). After adjustment for sociodemographic and clinical variables, the models demonstrated that ACA expansion decreased the uninsured rate by 48% (odds ratio [OR], 0.52; 95% CI, 0.43-0.63), increased the diagnosis of early-stage disease (stage0 to stage II) by 27% (OR, 1.27; 95% CI, 1.15-1.41), increased receipt of radiotherapy after breast-conserving surgery by 19% (OR, 1.19; 95% CI, 1.03-1.37), and reduced the delay of receipt of radiotherapy by 16% (OR, 0.84; 95% CI, 0.74-0.95).
CONCLUSIONS
ACA expansion in Louisiana reduced the uninsured rate, increased the diagnosis of early-stage disease, and increased access to treatment.
背景
路易斯安那州是南部几个实施《平价医疗法案》（ACA）扩大医疗补助的州之一。据作者所知，这对路易斯安那州乳腺癌患者的影响尚不清楚。作者推测，ACA 的扩大对路易斯安那州被诊断患有乳腺癌的女性产生了积极影响。
方法
作者分析了 2012 年至 2018 年间居住在路易斯安那州、年龄在 20 至 64 岁之间、被诊断为美国癌症联合委员会 0 期至 4 期乳腺癌的 14640 名女性的路易斯安那州肿瘤登记处的数据。研究期间分为两组：1）ACA 扩大前（2012 年 1 月 1 日至 2016 年 5 月 31 日）；2）ACA 扩大后（2016 年 6 月 1 日至 2018 年 12 月 31 日）。采用卡方检验和多变量逻辑回归模型评估 ACA 扩大的影响。P 值<.05 被认为具有统计学意义。
结果
ACA 扩大后，未参保患者的比例从 5.4%降至 3.0%（P<.0001），医疗补助受益人的比例从 11.6%升至 17.7%（P<.0001）。I 期乳腺癌的诊断率从 36.8%上升至 44.7%（P<.0001），而 III 期乳腺癌的诊断率从 10.7%降至 8.5%（P<.0001）。保乳手术后接受放疗的比例从 81.2%上升至 84.0%（P=.0035），90 天内接受放疗的比例从 57.2%上升至 61.7%（P=.0012）。在调整社会人口统计学和临床变量后，模型表明 ACA 扩大使未参保率降低了 48%（比值比[OR]，0.52；95%置信区间[CI]，0.43-0.63），使早期疾病（0 期至 II 期）的诊断率增加了 27%（OR，1.27；95%CI，1.15-1.41），使保乳手术后接受放疗的比例增加了 19%（OR，1.19；95%CI，1.03-1.37），使放疗延迟的比例降低了 16%（OR，0.84；95%CI，0.74-0.95）。
结论
路易斯安那州的 ACA 扩大降低了未参保率，增加了早期疾病的诊断，并增加了治疗机会。
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