Salami Aitua Charles, Yu Daohai, Lu Xiaoning, Martin Jeremiah, Erkmen Cherie P, Bakhos Charles T
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Biomedical Education and Data Science, Center for Biostatistics and Epidemiology, Temple University, Philadelphia, PA, USA.
J Thorac Dis. 2024 Sep 30;16(9):5604-5614. doi: 10.21037/jtd-24-786. Epub 2024 Sep 12.
Healthcare disparities significantly affect access to care and outcomes in lung cancer patients. The Patient Protection and Affordable Care Act (ACA) Medicaid expansion (ME) was enacted with the aim of improving access to quality and affordable healthcare. This study aims to determine the impact of ME on access to care and outcomes for patients with lung cancer.
We conducted a retrospective analysis of adults (ages 40-64 years) diagnosed with non-small cell lung cancer (NSCLC) in the National Cancer Database between 2009-2019. The study population was divided into a pre-expansion era (A: 2009-2013) and a post-expansion era (B: 2015-2019). The exposure of interest was residence in a state that expanded Medicaid in 2014 (ME) non-expansion (NE). Outcomes were insurance coverage, clinical stage at diagnosis, treatment facility, and survival. Propensity score analysis was used to determine the association between ME and survival.
A total of 202,003 patients were included (era B, 51.6%). The median age was 58 years, the majority of patients were male (53.0%), White (79.7%), had no comorbidities (62.0%) and adenocarcinoma (57.4%). From era A to B, insurance coverage increased to 96.7% (+6.6%), stage I disease to 25.3% (+6.5%), and treatment at an academic facility to 43.9% (+3.5%) in the ME group. For the NE group, the increases were up to 88.3% (+4.3%), 21.6% (+4.0%), and 28.6% (+0.2%), respectively. The increase in stage I cancer diagnosis was most noticeable in females. Following risk adjustment, era B was associated with an improvement in survival outcomes irrespective of ME status.
Disparities in lung cancer care seem to have improved after ME. Ongoing monitoring is still necessary to confirm the program's long-term impact on lung cancer survival.
医疗保健差异显著影响肺癌患者获得医疗服务的机会和治疗结果。《患者保护与平价医疗法案》（ACA）的医疗补助扩大计划（ME）旨在改善获得优质且可负担医疗保健的机会。本研究旨在确定医疗补助扩大计划对肺癌患者获得医疗服务的机会和治疗结果的影响。
我们对2009年至2019年期间在国家癌症数据库中被诊断为非小细胞肺癌（NSCLC）的成年人（40 - 64岁）进行了回顾性分析。研究人群分为扩大前时代（A组：2009 - 2013年）和扩大后时代（B组：2015 - 2019年）。感兴趣的暴露因素是居住在2014年扩大医疗补助的州（ME）或未扩大医疗补助的州（NE）。结果指标包括保险覆盖情况、诊断时的临床分期、治疗机构和生存率。倾向得分分析用于确定医疗补助扩大计划与生存率之间的关联。
共纳入202,003例患者（B组占51.6%）。中位年龄为58岁，大多数患者为男性（53.0%）、白人（79.7%）、无合并症（62.0%）且为腺癌（57.4%）。从A组到B组，医疗补助扩大计划组的保险覆盖率增至96.7%（增加6.6%），I期疾病比例增至25.3%（增加6.5%），在学术机构接受治疗的比例增至43.9%（增加3.5%）。对于未扩大医疗补助组，相应的增加分别为88.3%（增加4.3%）、21.6%（增加4.0%）和28.6%（增加0.2%）。I期癌症诊断的增加在女性中最为明显。经过风险调整后，无论医疗补助扩大计划状态如何，B组均与生存结果的改善相关。
医疗补助扩大计划实施后，肺癌治疗的差异似乎有所改善。仍需持续监测以确认该计划对肺癌生存的长期影响。
