Tinglin Jillian, McLeod M Chandler, Williams Courtney P, Tipre Meghan, Rocque Gabrielle, Crouse Andrew B, Krontiras Helen, Gutnik Lily
University of Alabama (UAB) Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35233, USA.
UAB Department of Surgery, Birmingham, AL, 35233, USA.
J Racial Ethn Health Disparities. 2024 Sep 5. doi: 10.1007/s40615-024-02104-y.
Black women are less likely to receive screening mammograms, are more likely to develop breast cancer at an earlier age, and more likely to die from breast cancer when compared to White women. Affordable Care Act (ACA) provisions decreased cost sharing for women's preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race.
This retrospective, quasi-experimental study examined the ACA's impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003 to 02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI).
Two thousand seven hundred and sixty-seven patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05-1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97-1.01) but decreased by 17% per year for Black patients (IRR 0.83, 95% CI 0.74-0.92).
Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.
与白人女性相比，黑人女性接受乳腺钼靶筛查的可能性更低，更有可能在更年轻的时候患上乳腺癌，也更有可能死于乳腺癌。《平价医疗法案》（ACA）的条款降低了女性预防性筛查的费用分担，有可能减少筛查差异。我们按种族分层研究了ACA实施前后一个高风险筛查项目的登记情况。
这项回顾性、准实验性研究考察了2003年2月28日至2019年2月28日期间ACA对一家高风险乳腺癌筛查诊所患者人口统计学特征的影响。患者人口统计学数据从电子病历中提取，并在ACA实施前后的时间段进行描述性比较。使用泊松回归的中断时间序列（ITS）分析通过发病率比（IRR）和95%置信区间（CI）按种族评估每年的诊所登记率。
2767名患者登记进入该诊所。患者平均年龄为46岁（标准差，±12），82%有商业保险，8%生活在高度贫困社区。在考虑时间趋势的ITS模型中，在ACA实施之前，白人患者登记情况稳定（IRR 1.01，95% CI 1.00 - 1.02），而黑人患者登记人数每年增长13%（IRR 1.13，95% CI 1.05 - 1.22）。与ACA实施前的登记期相比，ACA实施后白人患者的登记率保持不变（IRR 0.99，95% CI 0.97 - 1.01），但黑人患者的登记率每年下降17%（IRR 0.83，95% CI 0.74 - 0.92）。
与ACA实施前相比，ACA实施后一家高风险乳腺癌筛查诊所的黑人患者登记人数减少，这表明需要确定导致诊所登记中种族差异的因素。
