平价医疗法案对妇科癌症年轻女性的依赖保障规定的长期影响。

Long-term impact of the Affordable Care Act's dependent coverage mandate on young women with gynecologic cancer.

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.

University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Gynecol Oncol. 2023 Aug;175:121-127. doi: 10.1016/j.ygyno.2023.06.014. Epub 2023 Jun 23.

DOI:10.1016/j.ygyno.2023.06.014

PMID:37356312

Abstract

BACKGROUND

The dependent coverage mandate in the 2010 Affordable Care Act (ACA) allows young adults to stay on a parent's private insurance through age 26. While this mandate is associated with gains in insurance and early-stage cancer diagnosis, its long-term impact on survival is unknown.

OBJECTIVE

To compare insurance coverage, stage at diagnosis, and overall survival in patients with gynecologic cancer before and after the ACA's dependent coverage mandate.

METHODS

Using difference-in-differences (DiD) analysis, we conducted a retrospective cohort study comparing outcomes before and after the implementation of the ACA's dependent coverage mandate in young patients with gynecologic cancer, ages 18-26 years (exposure group) to patients ages 27-35 (control group). We analyzed insurance coverage, stage at diagnosis, and 1, 2, and 3-year overall survival, adjusted for age and comorbidities, utilizing the 2004-2017 National Cancer Database. IRB exemption was obtained.

RESULTS

A total of 3553 cases pre-reform and 4535 cases post-reform were identified for patients 18-26 years compared to 14,420 pre-reform and 19,821 post-reform for patients age 27-35. The ACA's dependent coverage mandate was associated with significant gains in insurance (DiD 2%, 95% CI 0.6-3.5) and early-stage diagnosis (3.1%, 95% CI 0.6-5.7). The ACA's dependent coverage mandate was associated with significant gains in 3-year survival (2.4%, 95% CI 0.4-4.3) and non-significant gains in 1 and 2-year survival.

CONCLUSION

The ACA's dependent coverage mandate is associated with improvements in early-stage diagnosis and survival for young patients with gynecologic cancer. Maintaining insurance gains-and expanding to the remaining uninsured-are critical for the health of young patients with gynecologic cancer.

摘要

背景

2010 年平价医疗法案（ACA）中的附属保险覆盖要求允许年轻人在 26 岁之前继续使用父母的私人保险。虽然这一要求与保险的增加和早期癌症诊断有关，但它对生存的长期影响尚不清楚。

目的

比较 ACA 附属保险覆盖要求实施前后患有妇科癌症的年轻患者的保险覆盖范围、诊断阶段和总体生存率。

方法

我们使用差异中的差异（DiD）分析，对年龄在 18-26 岁（暴露组）和 27-35 岁（对照组）的患有妇科癌症的年轻患者进行了回顾性队列研究，比较了 ACA 附属保险覆盖要求实施前后的结果。我们利用 2004-2017 年国家癌症数据库，对年龄和合并症进行了调整，分析了保险覆盖范围、诊断阶段以及 1、2 和 3 年的总生存率。获得了 IRB 豁免。

结果

与 27-35 岁的患者相比，18-26 岁的患者在改革前有 3553 例，改革后有 4535 例；改革前有 14420 例，改革后有 19821 例。ACA 的附属保险覆盖要求与保险（DiD2%，95%CI0.6-3.5）和早期诊断（3.1%，95%CI0.6-5.7）的显著增加有关。ACA 的附属保险覆盖要求与 3 年生存率的显著提高（2.4%，95%CI0.4-4.3）和 1 年和 2 年生存率的非显著提高有关。