Hu Xin, Yang Nuo Nova, Fan Qinjin, Yabroff K Robin, Han Xuesong
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22911, United States.
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, United States.
Health Aff Sch. 2024 Jan 11;2(1):qxad083. doi: 10.1093/haschl/qxad083. eCollection 2024 Jan.
Having health insurance coverage is a strong determinant of cancer care access and survival in the United States. The expansion of Medicaid income eligibility under the Affordable Care Act has increased insurance coverage for working-age adults. Using data from the Cancer Incidence in North America (CiNA) in 2010-2019, we identified 6 432 117 incident cancer cases with known insurance status diagnosed at age 18-64 years from population-based registries of 49 states. Considerable variation in Medicaid coverage and uninsured rate exists across states, especially by Medicaid expansion status. Among expansion states, Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019, while the Medicaid coverage rate remained lower (range = 11.7% - 12.7%) in non-expansion states. The uninsured rate decreased from 4.9% to 2.1% in expansion states, while in non-expansion states, the uninsured rate decreased slightly from 9.5% to 8.1%. In 2019, 111 393 cancer cases (16.9%) had Medicaid coverage at diagnosis (range = 7.6%-37.9% across states), and 48 357 (4.4%) were uninsured (range = 0.5%-13.2%). These estimates suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage. State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations.
在美国，拥有医疗保险是获得癌症治疗和生存的一个重要决定因素。《平价医疗法案》（Affordable Care Act）扩大了医疗补助收入资格范围，增加了劳动年龄成年人的保险覆盖范围。利用2010 - 2019年北美癌症发病率（CiNA）的数据，我们从49个州的基于人群的登记处确定了6432117例18 - 64岁确诊的、已知保险状况的新发癌症病例。各州之间医疗补助覆盖范围和未参保率存在很大差异，尤其是根据医疗补助扩大状况来看。在扩大医疗补助的州中，医疗补助覆盖范围从2010年的14.1%增至2019年的19.9%，而在未扩大医疗补助的州，医疗补助覆盖率仍然较低（范围为11.7% - 12.7%）。在扩大医疗补助的州中，未参保率从4.9%降至2.1%，而在未扩大医疗补助的州，未参保率仅从9.5%略微降至8.1%。2019年，111393例癌症病例（16.9%）在确诊时享有医疗补助（各州范围为7.6% - 37.9%），48357例（4.4%）未参保（各州范围为0.5% - 13.2%）。这些估计表明，许多癌症患者可能在获得治疗和维持治疗连续性方面面临挑战，尤其是在新冠疫情对医疗补助覆盖的保护措施解除之后。需要开展州一级的癌症预防和控制工作，以减轻弱势群体之间的癌症治疗差距。
