Loma Linda University Health, Loma Linda, CA, USA.
Ann Surg Oncol. 2021 Oct;28(10):5558-5567. doi: 10.1245/s10434-021-10495-z. Epub 2021 Jul 28.
Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction.
Non-Hispanic Black (NHB) and White (NHW) breast cancer patients undergoing mastectomy +/- reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010-2013), 2014 (1/2014), late (after 1/2014), or no expansion.
Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income < $40,227, and 17.1% (n = 75,718) were in the lowest education quartile. In non-expansion states, lower proportions of NHB patients underwent reconstruction than NHW patients in all years, with the smallest disparity (NHB% - NHW%) (- 6.4%) in 2017. Decreases in disparities between NHB and NHW patients were seen with the smallest difference observed in 2014 (- 2.5%) in early-expansion states, in 2017 (- 0.7%) in 1/2014 expansion states, and in 2017 (- 4.5%) in late-expansion states. Similar findings for convergence of reconstruction utilization rates for the lowest two education levels and lowest two income quartiles were found with Medicaid expansion, with no convergence seen in non-expansion states over the study period.
Some improvement in breast reconstruction disparities followed Medicaid expansion. Failure to improve parity without Medicaid expansion should be a consideration with any modifications to Medicaid access.
根据《平价医疗法案》，2014 年 1 月 1 日生效的医疗补助扩大计划旨在增加获得医疗保健的机会。我们试图确定医疗补助扩大与乳房重建利用方面差异的关联。
从国家癌症数据库中选择了 2010 年至 2017 年间接受乳房切除术 +/-重建的非西班牙裔黑人（NHB）和白人（NHW）乳腺癌患者。通过差异差异回归分析，根据医疗补助扩大状况评估种族、收入和教育程度的乳房重建利用的年度趋势。根据扩大日期，将医疗补助扩大分为早期（2010-2013 年）、2014 年（1/2014 年）、晚期（1/2014 年之后）或无扩大。
在 443607 名患者中，36.3%（n = 161128）接受了重建，13.1%（n = 58249）是非西班牙裔黑人，16.8%（n = 74430）的中位收入<40227 美元，17.1%（n = 75718）处于最低教育四分位数。在非扩张州，非西班牙裔黑人患者接受重建的比例低于白人患者，在所有年份中差异最小（NHB%-NHW%）（-6.4%）为 2017 年。与非西班牙裔黑人患者相比，观察到与西班牙裔黑人患者之间的差异缩小，最早扩张州观察到最小差异（2014 年为-2.5%），1/2014 扩张州为-0.7%，2017 年扩张州为-4.5%。随着医疗补助的扩大，对于最低两个教育水平和最低两个收入四分位数的重建利用率趋同的类似发现，在整个研究期间，非扩张州没有观察到趋同。
医疗补助扩大后，乳房重建差异有所改善。如果没有医疗补助扩大，就没有平等性的提高，这应该是对医疗补助准入进行任何修改的考虑因素。
