Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2023 May;68(5):1780-1790. doi: 10.1007/s10620-022-07797-x. Epub 2023 Jan 4.
Colorectal cancer screening continuously decreased its mortality and incidence. In 2010, the Affordable Care Act extended Medicaid eligibility to low-income and childless adults. Some states elected to adopt Medicaid at different times while others chose not to. Past studies on the effects of Medicaid expansion on colorectal cancer screening showed equivocal results based on short-term data following expansion.
To examine the long-term impact of Medicaid expansion on colorectal cancer screening among its targeted population at its decade mark.
Behavioral Risk Factor Surveillance System data were extracted for childless adults below 138% federal poverty level in states with different Medicaid expansion statuses from 2012 to 2020. States were stratified into very early expansion states, early expansion states, late expansion states, and non-expansion states. Colorectal cancer screening prevalence was determined for eligible respondents. Difference-in-differences analyses were used to examine the effect of Medicaid expansion on colorectal cancer screening in states with different expansion statuses.
Colorectal cancer screening prevalence in very early, early, late, and non-expansion states all increased during the study period (40.45% vs. 48.14%, 47.52% vs 61.06%, 46.06% vs 58.92%, and 43.44% vs 56.70%). Difference-in-differences analysis showed significantly increased CRC screening prevalence in very early expansion states during 2016 compared to non-expansion states (Crude difference-in-differences + 16.45%, p = 0.02, Adjusted difference-in-differences + 15.9%, p = 0.03). No statistical significance was observed among other years and groups.
Colorectal cancer screening increased between 2012 and 2020 in all states regardless of expansion status. However, Medicaid expansion is not associated with long-term increased colorectal cancer screening prevalence.
结直肠癌筛查不断降低其死亡率和发病率。2010 年，《平价医疗法案》将医疗补助资格扩大到低收入和无子女的成年人。一些州选择在不同时间扩大医疗补助，而另一些州则选择不扩大。过去关于医疗补助扩大对结直肠癌筛查影响的研究基于扩大后短期数据得出了不确定的结果。
在医疗补助扩大实施十年之际，研究医疗补助扩大对其目标人群结直肠癌筛查的长期影响。
从 2012 年到 2020 年，从不同医疗补助扩大状况的州中提取符合条件的联邦贫困线以下的 138%以下的无子女成年人的行为风险因素监测系统数据。根据医疗补助扩大的不同情况将州分为早期快速扩张州、早期扩张州、晚期扩张州和非扩张州。确定合格受访者的结直肠癌筛查率。采用差值分析比较不同扩张州医疗补助扩大对结直肠癌筛查的影响。
在研究期间，早期快速扩张州、早期扩张州、晚期扩张州和非扩张州的结直肠癌筛查率均有所增加（40.45% vs. 48.14%、47.52% vs 61.06%、46.06% vs 58.92%和 43.44% vs 56.70%）。差值分析显示，与非扩张州相比，2016 年早期快速扩张州 CRC 筛查率显著增加（未调整差值+16.45%，p=0.02，调整差值+15.9%，p=0.03）。其他年份和组间没有统计学意义。
在所有州，无论是否扩大医疗补助，2012 年至 2020 年间，结直肠癌筛查率均有所增加。然而，医疗补助扩大与长期增加的结直肠癌筛查率无关。
