Harvard Radiation Oncology Program, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Cancer Rep (Hoboken). 2021 Dec;4(6):e1407. doi: 10.1002/cnr2.1407. Epub 2021 May 2.
Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.
We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer.
Using the National Cancer Database, we performed a difference-in-differences (DID) cross-sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011-2013) and after (2014-2015) Medicaid expansion. January 1, 2014 was used as the timepoint for Medicaid expansion. The primary outcomes of interest were insurance status, stage at diagnosis, treatment within 30 and 90 days of diagnosis, and overall survival. Fifteen thousand two hundred sixty-five patients (median age 50) were included: 42% from Medicaid expansion and 58% from nonexpansion states. Medicaid expansion was significantly associated with increased Medicaid coverage (adjusted DID = 11.0%, 95%CI = 8.2, 13.8, p < .01) and decreased rates of uninsured (adjusted DID = -3.0%, 95%CI = -5.2, -0.8, p < .01) among patients in expansion states compared with non-expansion states. However, Medicaid expansion was not associated with any significant changes in cancer stage at diagnosis or timely treatment. There was no significant change in survival from the pre- to post-expansion period in either expansion or nonexpansion states, and no significant differences between the two (DID-HR = 0.95, 95%CI = 0.83, 1.09, p = .48).
Although Medicaid expansion was associated with an increase in Medicaid coverage and decrease in uninsured among patients with cervical cancer, the effects of increased coverage on diagnosis and treatment outcomes may have yet to unfold. Future studies, including longer follow-up are necessary to understand the effects of Medicaid expansion.
目前，关于《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act，简称 PPACA）的医疗补助（Medicaid）扩面对宫颈癌护理提供和结局的影响知之甚少。
我们评估了医疗补助扩面是否与宫颈癌患者的保险状况、诊断时分期、及时治疗和生存结局的变化相关。
我们使用国家癌症数据库（National Cancer Database），通过差异-差异分析（Difference-in-Differences，简称 DID）进行了一项横断面研究，比较了医疗补助扩面州和非扩面州的宫颈癌患者在医疗补助扩面之前（2011-2013 年）和之后（2014-2015 年）的保险状况、诊断时分期、诊断后 30 天和 90 天内治疗情况以及总生存结局。我们以 2014 年 1 月 1 日作为医疗补助扩面的时间点。主要结局指标为保险状况、诊断时分期、诊断后 30 天和 90 天内治疗情况以及总生存。纳入了 15265 例患者（中位年龄 50 岁）：42%来自医疗补助扩面州，58%来自非扩面州。医疗补助扩面与扩面州患者的医疗补助覆盖比例增加（调整后的 DID = 11.0%，95%CI = 8.2, 13.8，p<0.01）和未参保率下降（调整后的 DID = -3.0%，95%CI = -5.2, -0.8，p<0.01）显著相关，而与非扩面州相比，在诊断时分期或及时治疗方面，医疗补助扩面没有显著变化。在扩面州和非扩面州，从扩面前到扩面后，生存均无显著变化，且两组之间无显著差异（DID-HR = 0.95，95%CI = 0.83, 1.09，p = 0.48）。
尽管医疗补助扩面与宫颈癌患者的医疗补助覆盖增加和未参保率下降相关，但覆盖范围增加对诊断和治疗结局的影响可能尚未显现。需要进一步的研究，包括更长时间的随访，以了解医疗补助扩面的影响。
