J Health Care Poor Underserved. 2022;33(3):1322-1336. doi: 10.1353/hpu.2022.0115.
The purpose was to examine the change in percent uninsured and if there is change in T-stage, N-stage and overall-stage among nonelderly patients with newly diagnosed head and neck squamous cell carcinoma after the Affordable Care Act (ACA). The National Cancer Database was used for this study. Patients were divided between pre-ACA and post-ACA implementation with stratification between areas of ACA expansion versus non-expansion. A quasi-experimental difference-in-difference study design was undertaken. A total of 15,037 patients met the inclusion criteria. Between the pre-ACA and post-ACA periods, there was increase in proportion of percent insured with Medicaid coverage in patients residing in expansion region. There was a decrease in the proportion of patients who had advanced Tumor stage and Nodal stage decreased after implementation of ACA. With the implementation of ACA expansion, there is increased Medicaid coverage, corresponding to a decreased proportion of patients presenting with advanced T-stage and N-stage.
目的是研究平价医疗法案（ACA）实施后，新诊断为头颈部鳞状细胞癌的非老年患者中未参保比例的变化，以及 T 分期、N 分期和总分期是否有变化。本研究使用了国家癌症数据库。根据 ACA 的实施情况，将患者分为 ACA 实施前和实施后，并在 ACA 扩展区和非扩展区之间进行分层。采用准实验差异中差异研究设计。共有 15037 名患者符合纳入标准。在 ACA 实施前和实施后期间，居住在扩展区的患者中，有医疗保险覆盖的患者比例有所增加。在 ACA 实施后，肿瘤分期和淋巴结分期较前进展的患者比例下降。随着 ACA 扩展的实施，医疗补助覆盖范围增加，相应地，出现晚期 T 分期和 N 分期的患者比例下降。
