Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E 68th St, New York, NY, 10065, USA.
Department of Healthcare Policy and Research, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
Am J Surg. 2021 Sep;222(3):562-569. doi: 10.1016/j.amjsurg.2021.01.016. Epub 2021 Jan 18.
The Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage and improved various cancer outcomes. Its impact in papillary thyroid cancer (PTC) remains unclear.
Non-elderly patients (40-64 years-old) with PTC living in low-income areas either in a 2014 expansion, or a non-expansion state were identified from the National Cancer Database between 2010 and 2016. Insurance coverage, stage at diagnosis, and RAI administration were analyzed using a difference-in-differences analysis.
10,644 patients were included. Compared with non-expansion states, the percentage of uninsured patients (adjusted-DD -2.6% [95%-CI -4.3to-0.8%],p = 0.004) and patients with private insurance decreased, and those with Medicaid coverage increased (adjusted-DD 9.7% [95%-CI 6.9-12.5%],p < 0.001) in expansion states after ACA implementation. The percentage of patients with pT1 did not differ between expansion and non-expansion states; neither did the use of RAI.
Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment.
平价医疗法案（ACA）的医疗补助计划扩大覆盖范围，改善了各种癌症的预后。但其对甲状腺乳头状癌（PTC）的影响尚不清楚。
从 2010 年至 2016 年，国家癌症数据库中确定了居住在低收入地区、年龄在 40-64 岁之间的患有 PTC 的非老年患者，这些患者要么在 2014 年的医疗补助计划扩大地区，要么在非扩大地区。使用差异分析（difference-in-differences analysis）分析保险覆盖范围、诊断时的分期和放射性碘治疗的应用情况。
共纳入 10644 例患者。与非扩大地区相比，ACA 实施后，扩大地区的未参保患者比例（调整差异分析-2.6%[95%CI-4.3 至-0.8%]，p=0.004）和私人保险患者比例下降，而医疗补助保险患者比例增加（调整差异分析 9.7%[95%CI 6.9-12.5%]，p<0.001）。扩大地区和非扩大地区之间的 pT1 患者比例没有差异；放射性碘治疗的应用也没有差异。
医疗补助计划扩大覆盖范围使 PTC 患者中的未参保人群比例缩小，但疾病的早期表现或放射性碘治疗方式并未改变。
