Mobley Erin M, Tfirn Ian, Guerrier Christina, Gutter Michael S, Vigal Kim, Pather Keouna, Baskovich Brett, Awad Ziad T, Parker Alexander S
From the Department of Surgery (Mobley, Pather, Awad), University of Florida, Jacksonville, FL.
Center for Data Solutions (Tfirn, Guerrier, Vigal), University of Florida, Jacksonville, FL.
J Am Coll Surg. 2022 Jan 1;234(1):75-84. doi: 10.1097/XCS.0000000000000018.
This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival.
We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival.
In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt).
Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
本研究考察了医疗补助扩大计划对非老年成年人胰腺癌1年生存率的影响。我们进一步评估了社会人口统计学和县域特征是否会改变医疗补助扩大计划与1年生存率之间的关联。
我们从监测、流行病学和最终结果数据集获取了2007年至2015年被诊断为胰腺癌的个体的数据。采用差异-in-差异模型，比较了早期采用州和非早期采用州在采用（2014年）之前和之后的情况，同时考虑社会人口统计学和县域特征，以估计医疗补助扩大计划对1年生存率的影响。
在单变量差异-in-差异模型中，医疗补助扩大计划实施后，来自扩大计划州的胰腺癌患者1年生存概率增加了4.8个百分点（ppt）（n = 35347）。在对协变量进行调整后，1年生存概率降至0.8 ppt。有趣的是，在多变量调整后，生活在扩大计划州对1年生存率的影响在男性和女性中相似（男性为0.6 ppt，女性为1.2 ppt），在白人中也相似（2.6 ppt），在其他种族中更高（5.9 ppt），但在黑人中有所下降（-2.0 ppt）。已参保者（-0.1 ppt）或未参保者（-2.2 ppt）的1年生存概率下降；然而，诊断时参加医疗补助的患者1年生存概率增加（7.4 ppt）。
2014年期间或之后的医疗补助扩大计划与胰腺癌患者1年生存概率的增加相关；然而，在对社会人口统计学特征进行调整后，这种影响减弱。值得注意的是，在某些关键协变量类别中，这种正相关更为明显，这表明应进一步关注这些亚组。
