Nguyen David-Dan, Paciotti Marco, Marchese Maya, Cole Alexander P, Cone Eugene B, Kibel Adam S, Ortega Gezzer, Lipsitz Stuart R, Weissman Joel S, Trinh Quoc-Dien
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
JCO Oncol Pract. 2021 May;17(5):e654-e665. doi: 10.1200/OP.21.00010.
We sought to investigate the association between Medicaid expansion under the Affordable Care Act and access to stage-appropriate definitive treatment for breast, colon, non-small-cell lung, and prostate cancer for underserved racial and ethnic minorities and at minority-serving hospitals (MSHs).
We conducted a retrospective, difference-in-differences study including minority patients with nonmetastatic breast, colon, non-small-cell lung, and prostate cancer and patients treated at MSHs between the age of 40 and 64, with tumors at stages eligible for definitive treatment from the National Cancer Database. We not only defined non-Hispanic Black and Hispanic cancer patients as racial and ethnic minorities but also report findings for non-Hispanic Black cancer patients separately. We examined the effect of Medicaid expansion on receipt of stage-appropriate definitive therapy, time to treatment initiation (TTI) within 30 days of diagnosis, and TTI within 90 days of diagnosis.
Receipt of definitive treatment for minorities in expansion states did not change compared with minority patients in nonexpansion states. The proportion of racial and ethnic minorities in expansion states receiving treatment within 30 days increased (difference-in-differences: +3.62%; 95% CI, 1.63 to 5.61; < .001) compared with minority patients in nonexpansion states; there was no change for TTI within 90 days. Analysis focused on Black cancer patients yielded similar results. In analyses stratified by MSH status, there was no change in receipt of definitive therapy, TTI within 30 days, and TTI within 90 days when comparing MSHs in expansion states with MSHs in nonexpansion states.
In our cohort of cancer patients with treatment-eligible disease, we found no significant association between Medicaid expansion and changes in receipt of definitive treatment for breast, prostate, lung, and colon cancer for racial and ethnic minorities and at MSHs. Medicaid expansion was associated with improved TTI at the patient level for racial and ethnic minorities, but not at the facility level for MSHs. Targeted interventions addressing the needs of MSHs are still needed to continue mitigating national facility-level disparities in cancer outcomes.
我们试图研究《平价医疗法案》下的医疗补助扩大计划与服务不足的种族和少数族裔以及少数族裔服务医院（MSH）中乳腺癌、结肠癌、非小细胞肺癌和前列腺癌患者获得符合分期的确定性治疗之间的关联。
我们进行了一项回顾性的差异分析研究，纳入年龄在40至64岁之间、患有非转移性乳腺癌、结肠癌、非小细胞肺癌和前列腺癌且肿瘤分期符合国家癌症数据库中确定性治疗条件的少数族裔患者，以及在MSH接受治疗的患者。我们不仅将非西班牙裔黑人和西班牙裔癌症患者定义为种族和少数族裔，还分别报告非西班牙裔黑人癌症患者的研究结果。我们研究了医疗补助扩大计划对接受符合分期的确定性治疗、诊断后30天内开始治疗的时间（TTI）以及诊断后90天内TTI的影响。
与非扩大州的少数族裔患者相比，扩大州的少数族裔接受确定性治疗的情况没有变化。与非扩大州的少数族裔患者相比，扩大州接受30天内治疗的种族和少数族裔比例有所增加（差异：+3.62%；95%置信区间，1.63至5.61；P<0.001）；90天内的TTI没有变化。针对黑人癌症患者的分析得出了类似的结果。在按MSH状态分层的分析中，将扩大州的MSH与非扩大州的MSH进行比较时，确定性治疗的接受情况、30天内的TTI和90天内的TTI均无变化。
在我们这个患有符合治疗条件疾病的癌症患者队列中，我们发现医疗补助扩大计划与种族和少数族裔以及MSH中乳腺癌、前列腺癌、肺癌和结肠癌患者接受确定性治疗的变化之间没有显著关联。医疗补助扩大计划与种族和少数族裔患者个体层面的TTI改善相关，但与MSH机构层面的TTI改善无关。仍需要有针对性的干预措施来满足MSH的需求，以继续缓解全国机构层面在癌症治疗结果上的差异。
