Acharya Mahip, Zorn Kristin K, Simonson Melinda E, Bimali Milan, Moore Gary W, Peng Cheng, Martin Bradley C
Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Education II Building 6253, 4301 W. Markham Street, slot 522, Little Rock, AR-72205, United States.
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States.
Hered Cancer Clin Pract. 2022 May 23;20(1):19. doi: 10.1186/s13053-022-00226-0.
Early identification of hereditary cancer risk would save lives, but genetic testing (GT) has been inadequate. We assessed i) trends for hereditary breast and ovarian cancer (HBOC), Lynch syndrome, and other GT and ii) factors associated with receipt of GT.
We used data from the Arkansas All-Payer Claims Database from January 2013 through June 2018 (commercial, Medicaid), December 2017 (state employee), or December 2016 (Medicare) and identified enrollees with ≥1 month of enrollment. Using Current Procedural Terminology (CPT-4) codes, rates for GT were calculated per 100,000 person-quarters and time series regressions estimated. Second, GT and covariate information for enrollees with 24 months of continuous enrollment were used to estimate separate logistic regression models for each GT category.
Among 2,520,575 unique enrollees, HBOC testing rates were 2.2 (Medicaid), 22.0 (commercial), 40.4 (state employee), and 13.1(Medicare) per 100,000 person-quarters and increased linearly across all plans. Older age (OR=1.24; 95%CI 1.20 - 1.28), female sex (OR=18.91; 95%CI 13.01 - 28.86), higher comorbidity burden (OR=1.08; 95%CI 1.05 - 1.12), mental disorders (OR=1.53; 95%CI 1.15 - 2.00), and state employee coverage (OR=1.65; 95%CI 1.37 - 1.97) were positively associated with HBOC testing. Less than 1 of 10,000 enrollees received Lynch syndrome testing, while < 5 of 10,000 received HBOC testing.
GT rates for hereditary cancer syndromes have increased in Arkansas but remain low. Receipt of GT was explained with high discrimination by sex and plan type.
Expansion of GT for hereditary cancer risk in Arkansas is needed to identify high-risk individuals who could benefit from risk-reduction strategies.
早期识别遗传性癌症风险可挽救生命，但基因检测（GT）一直不足。我们评估了：i）遗传性乳腺癌和卵巢癌（HBOC）、林奇综合征及其他基因检测的趋势，以及ii）与接受基因检测相关的因素。
我们使用了阿肯色州全支付方索赔数据库2013年1月至2018年6月（商业保险、医疗补助）、2017年12月（州政府雇员保险）或2016年12月（医疗保险）的数据，并确定了参保时间≥1个月的登记参保人员。使用现行程序术语（CPT - 4）编码，计算每100,000人季度的基因检测率，并进行时间序列回归估计。其次，对于连续参保24个月的登记参保人员，使用基因检测和协变量信息，为每个基因检测类别估计单独的逻辑回归模型。
在2,520,575名独特的登记参保人员中，HBOC检测率分别为每100,000人季度2.2（医疗补助）、22.0（商业保险）、40.4（州政府雇员）和13.1（医疗保险），且在所有保险计划中呈线性上升。年龄较大（OR = 1.24；95%CI 1.20 - 1.28）、女性（OR = 18.91；95%CI 13.01 - 28.86）、较高的合并症负担（OR = 1.08；95%CI 1.05 - 1.12）、精神障碍（OR = 1.53；95%CI 1.15 - 2.00）以及州政府雇员保险（OR = 1.65；95%CI 1.37 - 1.97）与HBOC检测呈正相关。每10,000名登记参保人员中接受林奇综合征检测的不到1人，而接受HBOC检测的不到5人。
阿肯色州遗传性癌症综合征的基因检测率有所上升，但仍然较低。基因检测的接受情况在性别和保险计划类型方面存在高度差异。
阿肯色州需要扩大遗传性癌症风险的基因检测，以识别可能从降低风险策略中受益的高危个体。
