Division of Pharmaceutical Evaluation of Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 West Markham Street Slot 522, Little Rock, AR 72205, United States.
Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E342, Bethesda, MD 20892-9762, United States.
J Cancer Policy. 2022 Mar;31:100317. doi: 10.1016/j.jcpo.2021.100317. Epub 2021 Dec 9.
To determine whether Medicaid expansion impacted racially more diverse states similarly as racially less diverse states in endocrine therapy (ET) prescriptions.
A quasi-experimental, comparative interrupted time series study of Medicaid-financed ET prescriptions from 2011 to 2018 Medicaid State Drug Utilization Database. The exposures were state's Medicaid expansion and racial diversity status. The outcome was state's quarterly number ET prescriptions per 100,000 non-elderly adult females (NAFs).
During the year of expansion, ET prescriptions increased sharply in expansion states but remained flat in nonexpansion states (slope: 11.96 vs. 0.43 prescriptions per 100,000 NAFs per quarter, p < 0.001). After that, the slopes were similar between expansion and nonexpansion states (1.75 vs. 0.24, p = 0.057) but the level of prescriptions in expansion states maintained at a higher level. When stratified by state's racial diversity status, the slope of increase in the first year was sharper for raciallymore diverse expansion states (16.49, p = 0.008) than racially less diverse expansion states (8.46, p < 0.001), resulting in significant differences in ET prescriptions between racially more diverse expansion and nonexpansion states but largely nonsignificant differences between racially less diverse expansion and nonexpansion states.
Although Medicaid expansion significantly increased ET prescriptions in expansion vs. nonexpansion states, this difference was only observed among raciallymore diverse states. Racially more diverse nonexpansion states had the lowest rates of ET prescriptions and the gaps from racially more diverse expansion states significantly widened after expansion.
Our study shows that, before expansion, racially more diverse nonexpansion states had the lowest rates of ET prescriptions. After expansion, the gaps between these states and racially more diverse expansion states significantly widened. These results highlighted the importance of continuing to examine the health impacts of states not expanding Medicaid, including the health equity impacts for low income racial/ethnic minority populations with cancer and other life-threatening diseases.
确定医疗补助计划的扩大是否对内分泌治疗（ET）处方的种族多样性州和种族较少的州产生了类似的影响。
这是一项准实验、比较性中断时间序列研究，使用 2011 年至 2018 年 Medicaid 州药物利用数据库中的 Medicaid 资助的 ET 处方数据。暴露因素是州的医疗补助计划扩大和种族多样性状况。结果是每个季度每 10 万非老年成年女性（NAF）的 ET 处方数量。
在扩大的那一年，ET 处方在扩大的州急剧增加，但在非扩大的州保持不变（斜率：每 10 万 NAF 每季度增加 11.96 比 0.43 个处方，p<0.001）。此后，扩张州和非扩张州的斜率相似（1.75 比 0.24，p=0.057），但扩张州的处方水平保持在较高水平。按州的种族多样性状况分层时，种族更为多样化的扩张州第一年的增长率更高（16.49，p=0.008），而非种族多样化的扩张州（8.46，p<0.001），导致种族多样化的扩张州和非扩张州之间的 ET 处方存在显著差异，但种族多样化的扩张州和非扩张州之间的差异基本不显著。
尽管医疗补助计划的扩大显著增加了扩张州与非扩张州的 ET 处方数量，但这一差异仅在种族更为多样化的州中观察到。种族更为多样化的非扩张州的 ET 处方率最低，扩张后，这些州与种族更为多样化的扩张州之间的差距显著扩大。
我们的研究表明，在扩大之前，种族更为多样化的非扩张州的 ET 处方率最低。扩大后，这些州与种族更为多样化的扩张州之间的差距显著扩大。这些结果强调了继续检查未扩大医疗补助计划的州的健康影响的重要性，包括对患有癌症和其他危及生命疾病的低收入少数民族群体的健康公平影响。
