Roth Michael, Andersen Clark R, Berkman Amy, Siegel Stuart, Cuglievan Branko, Livingston J Andrew, Hildebrandt Michelle, Estrada Jaime, Bleyer Archie
Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2025 Jan 1;131(1):e35538. doi: 10.1002/cncr.35538. Epub 2024 Oct 7.
The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?
The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative survival data of patients who were diagnosed with cancer were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results regions representing 42%-44% of the country.
Joinpoint analysis identified the DCE-eligible cohort as the only age group of the three groups evaluated that have had improvements in both cancer survival and death rate trends after ACA implementation and that 2010, the year the ACA was passed, was the inflection year for both survival and deaths. By 6 years, the relative survival after cancer diagnosis was 2.6 and 3.9 times greater in the DCE-eligible age group than in the younger and older control groups, respectively (both p < .001), and the cancer death rate in the DCE-eligible age group improved 2.1 and 1.5 times greater than in the younger and older control age groups, respectively (both p < .01).
During the first decade of the ACA, eligible young adults with cancer have had significantly improved survival and mortality. Additional policies expanding insurance coverage and enabling earlier cancer diagnosis among young adults are needed.
The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19-25 years to remain on their parents' health insurance plans until age 26 years. The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE-eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more. During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer. Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults.
《患者保护与平价医疗法案》（ACA）允许19至25岁的美国人继续留在其父母的医疗保险计划中，直至26岁（受抚养人护理扩展[DCE]）。癌症诊断患者从中受益了吗？
将ACA颁布前后19至25岁这一ACE DCE的7岁年龄范围的癌症生存率和死亡率变化与更年轻和更年长的组（分别为7岁年龄跨度：12至18岁和26至32岁）进行比较。美国的癌症死亡数据来自疾病控制与预防中心，被诊断患有癌症患者的相对生存数据来自代表该国42%-44%的国家癌症研究所监测、流行病学和最终结果区域。
连接点分析确定符合DCE条件的队列是所评估的三个年龄组中唯一一个在ACA实施后癌症生存率和死亡率趋势均有所改善的年龄组，且2010年（ACA通过的年份）是生存率和死亡率的转折点。到6年时，符合DCE条件的年龄组癌症诊断后的相对生存率分别比年轻和年长对照组高2.6倍和3.9倍（均p<0.001），符合DCE条件的年龄组的癌症死亡率分别比年轻和年长对照年龄组改善了2.1倍和1.5倍（均p<0.01）。
在ACA实施的第一个十年中，符合条件的患有癌症的年轻成年人的生存率和死亡率有显著改善。需要更多政策来扩大保险覆盖范围并使年轻成年人能够更早地进行癌症诊断。
2011年在美国开始实施的《患者保护与平价医疗法案》（ACA）的受抚养人护理扩展（DCE）允许19至25岁的年轻成年人继续留在其父母的医疗保险计划中，直至26岁。与年轻和年长年龄组相比，符合DCE条件的年龄组中被诊断患有癌症的年轻成年患者6年时的生存率高2.6至3.9倍，癌症死亡率改善了1.5至2.1倍。在ACA实施的第一个十年中，符合条件组中的患有癌症的年轻成年人的生存时间显著延长，癌症死亡人数减少。需要更多政策来扩大保险覆盖范围并使年轻成年人能够更早地诊断癌症。
