Fiala Mark A, Ji Mengmeng, Shih Yi-Hsuan, Huber John, Wang Mei, Johnson Kimberly J, Gasoyan Hamlet, Wang Rong, Colditz Graham A, Wang Shi-Yi, Chang Su-Hsin
Division of Oncology, Washington University School of Medicine, St Louis MO.
Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO.
Clin Lymphoma Myeloma Leuk. 2025 Feb;25(2):109-115. doi: 10.1016/j.clml.2024.07.017. Epub 2024 Aug 2.
Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events.
This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date.
Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1 year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; P < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; P = .005).
Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care.
对于实体瘤患者，癌症诊断前持续的医疗补助覆盖与更早的检测和更好的治疗结果相关。在本研究中，我们旨在确定在多发性骨髓瘤患者中是否也观察到这种情况，多发性骨髓瘤是一种血液系统癌症，没有常规筛查测试，大多数患者通过急性医疗事件被诊断。
这是一项对基于索赔数据集的默克多州医疗补助数据库的分析。总共1105名65岁以下患者纳入分析。其中，66%有持续参保（骨髓瘤诊断前至少参保6个月），34%有间断参保（骨髓瘤诊断前参保2 - 6个月）。多变量Cox回归用于估计持续参保状态与索引日期后1年内接受骨髓瘤治疗之间的关联。
在所有医疗补助参保者中，仅54%在1年内接受了骨髓瘤治疗，仅12%接受了干细胞移植。持续参保者接受任何治疗的可能性较小（调整后风险比[aHR] 0.59；95%置信区间[CI] 0.59 - 0.70；P < .001），接受干细胞移植的可能性也较小（aHR 0.51；95% CI 0.32 - 0.81；P = .005）。
诊断前有持续医疗补助覆盖的患者接受骨髓瘤治疗的可能性较小。未来的研究应检查持续参加医疗补助的骨髓瘤患者是否有更多的慢性财务不稳定和/或更高的医疗需求，因此护理障碍更高。
