Elmore Leisha C, Li Meng, Lin Heather, Shen Yu, Shaitelman Simona F, Babiera Gildy, Tamirisa Nina, Bedrosian Isabelle
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ann Surg Open. 2022 Aug 24;3(3):e194. doi: 10.1097/AS9.0000000000000194. eCollection 2022 Sep.
To determine whether Medicaid expansion under the 2010 Affordable Care Act affected rates of breast cancer surgery.
Data regarding the impact of Medicaid expansion on access to surgical treatment of breast cancer are limited.
Patients in the National Cancer Database diagnosed with non-metastatic breast cancer between January 1, 2010 and December 31, 2017 and residing in a state that expanded Medicaid in January 2014 or in a state that opted out of expansion were included. A quasi-experimental, difference-in-differences (DID) approach was used to assess rate of omission of surgical treatment.
Of 624,237 patients diagnosed with invasive breast cancer, 24,728 (4%) patients did not undergo surgical treatment. Overall, no significant differences in rates of omission of surgery over time were seen based on Medicaid expansion status. Significant findings were noted based on patient residential location. In rural areas, Medicaid expansion was associated with lower rates of omission of surgery (adjusted DID -2.47%, 95% confidence interval [CI] -4.01% to -0.94%; = 0.002). In urban area, rates of omission of surgery increased over time for both groups, but the relative increase was lower in expansion states (adjusted DID -0.72%, 95% CI -1.25% to -0.20%; = 0.007). In metro areas, changes in rates of surgery over time were comparable across expansion and non-expansion states (adjusted DID -0.08%, 95% CI -0.32% to 0.16%; = 0.512).
Medicaid expansion had no measurable effect on the receipt of surgery for breast cancer in the overall cohort. Medicaid expansion was associated with higher rates of surgery in rural areas, representing the minority of the population.
确定2010年《平价医疗法案》下的医疗补助扩大计划是否影响乳腺癌手术率。
关于医疗补助扩大计划对乳腺癌手术治疗可及性影响的数据有限。
纳入国家癌症数据库中2010年1月1日至2017年12月31日期间诊断为非转移性乳腺癌且居住在2014年1月扩大医疗补助的州或选择不扩大的州的患者。采用准实验性的差异-in-差异（DID）方法评估手术治疗遗漏率。
在624237例诊断为浸润性乳腺癌的患者中，24728例（4%）患者未接受手术治疗。总体而言，基于医疗补助扩大状态，随时间推移手术遗漏率未见显著差异。基于患者居住地点有显著发现。在农村地区，医疗补助扩大与较低的手术遗漏率相关（调整后的DID为-2.47%，95%置信区间[CI]为-4.01%至-0.94%；P = 0.002）。在城市地区，两组的手术遗漏率均随时间增加，但扩大州的相对增加较低（调整后的DID为-0.72%，95%CI为-1.25%至-0.20%；P = 0.007）。在大都市地区，扩大和未扩大州随时间推移的手术率变化相当（调整后的DID为-0.08%，95%CI为-0.32%至0.16%；P = 0.512）。
医疗补助扩大对整个队列中乳腺癌手术的接受情况没有可测量的影响。医疗补助扩大与农村地区较高的手术率相关，农村地区人口占少数。
