Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
JAMA Netw Open. 2024 Jan 2;7(1):e2351529. doi: 10.1001/jamanetworkopen.2023.51529.
Medicaid expansion under the Patient Protection and Affordable Care Act is associated with gains in health insurance coverage, earlier stage diagnosis, and improved survival among patients with cancer.
To examine the association of Medicaid expansion with changes in early mortality among adults undergoing surgical resection of non-small cell lung cancer (NSCLC), a setting in which access to care is a major determinant of survival.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the National Cancer Database to identify 14 984 adults 45 to 64 years of age who underwent surgical resection of NSCLC between 2008 and 2019. Analysis was conducted between March 28, 2021, and September 1, 2023.
State of residence Medicaid expansion status.
Descriptive statistics were used to compare study population characteristics by Medicaid expansion status of patients' state of residence. Difference-in-differences analyses were used to evaluate the association between Medicaid expansion and postoperative mortality before implementation of the ACA (2008-2013) vs after (2014-2019).
Among 14 984 adults included, the mean (SD) age was 56.3 (5.1) years, 54.6% were women, and 62.1% lived in Medicaid expansion states. Both 30-day (from 0.97% to 0.26%) and 90-day (from 2.63% to 1.32%) postoperative mortality decreased from before the ACA to after among patients residing in Medicaid expansion states (both P < .001) but not in nonexpansion states (30-day mortality before the ACA, 0.75% vs after the ACA, 0.68%; P = .74; and 90-day mortality before the ACA, 2.43% vs after the ACA, 2.20%; P = .57), leading to a difference-in-differences of -0.64 percentage points (95% CI, -1.19 to -0.08; P = .03) for 30-day mortality and -1.08 percentage points (95% CI, -2.08 to -0.08; P = .03) for 90-day mortality. The difference-in-differences for in-hospital mortality was not significant (P = .34) between expansion states (1.41% before the ACA to 0.77% after the ACA; 0.63 percentage point decrease; P = .004) and nonexpansion states (1.49% before the ACA to 1.20% after the ACA; 0.30 percentage point decrease; P = .29).
In this cohort study of patients with NSCLC, Medicaid expansion was associated with declines in 30- and 90-day postoperative mortality following hospital discharge. These findings suggest that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes in this population.
《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act）下的医疗补助扩大计划与医疗保险覆盖范围的增加、癌症患者更早的诊断和生存率的提高有关。
研究医疗补助扩大计划与非小细胞肺癌（NSCLC）接受手术切除的成年人早期死亡率变化之间的关联，在这种情况下，获得医疗服务是生存的主要决定因素。
设计、地点和参与者：本队列研究使用国家癌症数据库（National Cancer Database）确定了 14984 名 45 至 64 岁的成年人，他们在 2008 年至 2019 年间接受了 NSCLC 的手术切除。分析于 2021 年 3 月 28 日至 2023 年 9 月 1 日进行。
居住州的医疗补助扩大状况。
使用描述性统计比较了患者居住州医疗补助扩大状况的研究人群特征。采用差异分析评估了 ACA 实施前（2008-2013 年）与实施后（2014-2019 年）医疗补助扩大与术后死亡率之间的关联。
在纳入的 14984 名成年人中，平均（SD）年龄为 56.3（5.1）岁，54.6%为女性，62.1%居住在医疗补助扩大的州。在医疗补助扩大的州，30 天（从 0.97%降至 0.26%）和 90 天（从 2.63%降至 1.32%）的术后死亡率均从 ACA 实施前降至实施后（均 P<0.001），但在非扩大州则没有（30 天死亡率 ACA 实施前为 0.75%，实施后为 0.68%；P=0.74；90 天死亡率 ACA 实施前为 2.43%，实施后为 2.20%；P=0.57），导致 30 天死亡率的差异为-0.64 个百分点（95%CI，-1.19 至 -0.08；P=0.03），90 天死亡率的差异为-1.08 个百分点（95%CI，-2.08 至 -0.08；P=0.03）。扩大州（ACA 实施前为 1.41%，实施后为 0.77%；下降 0.63 个百分点；P=0.004）和非扩大州（ACA 实施前为 1.49%，实施后为 1.20%；下降 0.30 个百分点；P=0.29）的住院死亡率差异不显著（P=0.34）。
在这项 NSCLC 患者的队列研究中，医疗补助扩大与出院后 30 天和 90 天的术后死亡率下降有关。这些发现表明，医疗补助扩大可能是改善该人群获得医疗服务和癌症结果的有效策略。
