Laughlin Amy I, Li Tingting, Yu Qingzhao, Wu Xiao-Cheng, Yi Yong, Hsieh Mei-Chin, Havron William, Shoup Margo, Chu Quyen D
From the Orlando Health Cancer Institute, Orlando, FL (Laughlin, Havron, Shoup, Chu).
Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA (Li, Yu, Wu, Yi, Hsieh).
J Am Coll Surg. 2023 Apr 1;236(4):838-845. doi: 10.1097/XCS.0000000000000550. Epub 2023 Mar 15.
Medicaid expansion impacted patients when assessed at a national level. However, of the 32 states that expanded Medicaid, only three were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of Medicaid expansion on breast cancer diagnosis and treatment in 8 Southern states in the US.
We identified uninsured or Medicaid patients (age 40 to 64 years) diagnosed with invasive breast cancer from 2011 to 2018 in Southern states from the North American Association of Central Cancer Registries-Cancer in North America Research Dataset. Medicaid-expanded states ([MES], Louisiana, Kentucky, Arkansas) were compared with non-MES ([NMES], Tennessee, Alabama, Mississippi, Texas, Oklahoma) using multivariate logistic regression and differences-in-differences analyses during pre- and postexpansion periods; p < 0.05 was considered statistically significant.
Among 21,974 patients, patients in MES had increased odds of Medicaid insurance by 43% (odds ratio 1.43, p < 0.01) and decreased odds of distant-stage disease by 7% (odds ratio 0.93, p = 0.03). After Medicaid expansion, Medicaid patients increased by 10.6% in MES (Arkansas, Kentucky), in contrast to a 1.3% decrease in NMES (differences-in-differences 11.9%, p < 0. 0001, adjusting for age, race/ethnicity, rural-urban status, and poverty status). MES (Arkansas, Kentucky) had 2.3% fewer patients diagnosed with distant-stage disease compared with a 0.5% increase in NMES (differences-in-differences 2.8%, p = 0.01, after adjustment). Patients diagnosed in MES had higher odds of receiving treatment (odds ratio 2.27, p = 0.03).
Unlike NMES, MES experienced increased Medicaid insured, increased treatment, and decreased distant-stage disease at diagnosis. Medicaid expansion in the South leads to earlier and more comprehensive treatment of breast cancer.
在全国范围内进行评估时，医疗补助计划的扩大对患者产生了影响。然而，在32个扩大了医疗补助计划的州中，只有三个是南方州。这些结果是否适用于具有相似地缘政治观点的南方州仍不明确。我们旨在评估美国8个南方州医疗补助计划扩大对乳腺癌诊断和治疗的影响。
我们从北美中央癌症登记协会-北美癌症研究数据集中确定了2011年至2018年在南方州被诊断为浸润性乳腺癌的未参保或参加医疗补助计划的患者（年龄40至64岁）。使用多变量逻辑回归和扩张前后的差异分析，将医疗补助计划扩大的州（[MES]，路易斯安那州、肯塔基州、阿肯色州）与非医疗补助计划扩大的州（[NMES]，田纳西州、阿拉巴马州、密西西比州、得克萨斯州、俄克拉何马州）进行比较；p<0.05被认为具有统计学意义。
在21974名患者中，医疗补助计划扩大州的患者获得医疗补助保险的几率增加了43%（优势比1.43，p<0.01），远处转移期疾病的几率降低了7%（优势比0.93，p = 0.03）。医疗补助计划扩大后，医疗补助计划扩大州（阿肯色州、肯塔基州）的医疗补助计划患者增加了10.6%，相比之下，非医疗补助计划扩大州减少了1.3%（差异为11.9%，p<0.0001，调整年龄、种族/族裔、城乡状况和贫困状况后）。与非医疗补助计划扩大州增加0.5%相比，医疗补助计划扩大州（阿肯色州、肯塔基州）被诊断为远处转移期疾病的患者减少了2.3%（调整后差异为2.8%，p = 0.01）。在医疗补助计划扩大州被诊断的患者接受治疗的几率更高（优势比2.27，p = 0.03）。
与非医疗补助计划扩大州不同，医疗补助计划扩大州的医疗补助参保人数增加，治疗增加，诊断时远处转移期疾病减少。南方的医疗补助计划扩大导致乳腺癌的治疗更早、更全面。
