Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Ann Surg Oncol. 2022 Mar;29(3):1763-1769. doi: 10.1245/s10434-021-11137-0. Epub 2021 Nov 27.
The objective of this study is to understand the effect of Medicaid expansion under the Affordable Care Act (ACA) on patterns of surgical care among low-income breast cancer patients. Emerging literature suggests cancer patients in Medicaid expansion states are presenting with earlier stages of disease. However, less is known regarding the implications of Medicaid expansion on patterns of surgical care in low-income women.
We compared nonmetastatic 30-64-year-old uninsured or Medicaid-insured Ohio breast cancer patients diagnosed 4 years before and 4 years after the state's 2014 Medicaid expansion (study group); the control group was the privately insured. Time-to-surgery (TTS) was defined as days from diagnosis to surgery. Demographic and treatment variables before and after expansion were examined in multivariate analysis.
There was a 10.4% point increase in breast conservation therapy (BCT) in the study group (pre-ACA 26.3%, post-ACA 36.7%; p < 0.01) compared with a 5.8% point increase in the control group (pre-ACA 36.0%, post-ACA 41.8%; p < 0.01). Disparities in reconstruction narrowed between the study (pre-ACA 21.4%, post-ACA 34.5%; p < 0.01) and the control (37.0% pre-ACA, 44.1% post-ACA group p < 0.01) groups. There was no statistically significant change in mean TTS in the study group (pre-ACA 42.1 days, post-ACA 43.1 days p = 0.18) but there was an increase in TTS in the control group (pre-ACA 35.0 days, post ACA 37.0 days; p < 0.01).
Medicaid expansion appears to have narrowed disparities in the utilization of BCT and reconstruction in low-income women. However, there was no improvement in surgical delay.
本研究旨在了解平价医疗法案（ACA）下的医疗补助扩张对低收入乳腺癌患者手术护理模式的影响。新出现的文献表明，医疗补助扩张州的癌症患者呈现出疾病早期阶段。然而，对于医疗补助扩张对低收入女性手术护理模式的影响知之甚少。
我们比较了俄亥俄州在该州 2014 年医疗补助扩张（研究组）前后 4 年诊断的 30-64 岁未参保或医疗补助参保的非转移性乳腺癌患者与私人参保者（对照组）。手术时间（TTS）定义为从诊断到手术的天数。在多元分析中检查了扩张前后的人口统计学和治疗变量。
与对照组（ACA 前 36.0%，ACA 后 41.8%；p < 0.01）相比，研究组的保乳治疗（BCT）增加了 10.4 个百分点（ACA 前 26.3%，ACA 后 36.7%；p < 0.01）。研究组（ACA 前 21.4%，ACA 后 34.5%；p < 0.01）和对照组（37.0%ACA 前，44.1%ACA 后组 p < 0.01）之间的重建差距缩小。研究组的平均 TTS 没有统计学意义上的变化（ACA 前 42.1 天，ACA 后 43.1 天 p = 0.18），但对照组的 TTS 增加（ACA 前 35.0 天，ACA 后 37.0 天；p < 0.01）。
医疗补助扩张似乎缩小了低收入妇女中 BCT 和重建利用率的差距。然而，手术延迟并没有改善。
