Arshad Sumaiyya, Akinyemi Oluwasegun A, Fasokun Mojisola, Cornwell Edward E, Levy Gal
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Department of Epidemiology, University of Alabama, Birmingham, AL, USA.
Am Surg. 2025 Jul;91(7):1086-1092. doi: 10.1177/00031348251339526. Epub 2025 May 13.
IntroductionThis study assesses the impact of the Affordable Care Act (ACA) on lung cancer stage at diagnosis and cancer-specific survival, focusing on whether increased access to care for minorities and low-income individuals improves detection and outcomes.MethodologyA retrospective analysis of SEER database data (2007-2020) compared lung cancer cases in pre-ACA (2007-2013) and post-ACA (2014-2020) periods. California, a Medicaid expansion state, and Texas, a non-expansion state, were analyzed. Patients aged 18-64 years were followed for up to 6 years. Difference-in-differences and multinomial logistic regression were used to evaluate the ACA Medicaid expansion impact on disease stage and cancer-specific mortality.ResultsAmong 104,415 lung cancer patients, 59,825 (57.3%) were diagnosed pre-ACA, and 44,590 (42.7%) post-ACA. The cohort was predominantly White (63.7%) and male (52.9%), with an average age of 56.8 years. In California, ACA implementation led to a 1.2 percentage point increase in localized disease (95% CI: 0.2%-2.2%, < 0.001) and a 2.8 percentage point reduction in metastatic disease (95% CI: -4.1% to -1.4%, < 0.001) compared to Texas. Cancer-specific mortality in California decreased by 15.9% (95% CI: -23.9% to -7.8%, < 0.001) vs Texas.ConclusionACA Medicaid expansion in California resulted in earlier lung cancer detection, reduced metastatic disease, and lower cancer-specific mortality compared to Texas. These improvements spanned all racial and ethnic groups, underscoring the benefits of Medicaid expansion in improving cancer outcomes.
引言
本研究评估了《平价医疗法案》（ACA）对肺癌诊断分期及癌症特异性生存率的影响，重点关注增加少数族裔和低收入人群获得医疗服务的机会是否能改善疾病检测及治疗结果。
方法
对监测、流行病学和最终结果（SEER）数据库2007 - 2020年的数据进行回顾性分析，比较《平价医疗法案》实施前（2007 - 2013年）和实施后（2014 - 2020年）的肺癌病例。分析了加利福尼亚州（一个扩大医疗补助的州）和得克萨斯州（一个未扩大医疗补助的州）的数据。对18 - 64岁的患者进行了长达6年的随访。采用双重差分法和多项逻辑回归分析来评估ACA医疗补助扩大对疾病分期和癌症特异性死亡率的影响。
结果
在104,415例肺癌患者中，59,825例（57.3%）在《平价医疗法案》实施前被诊断，44,590例（42.7%）在实施后被诊断。该队列主要为白人（63.7%）和男性（52.9%），平均年龄为56.8岁。与得克萨斯州相比，在加利福尼亚州，ACA的实施使局限性疾病的比例增加了1.2个百分点（95%置信区间：0.2% - 2.2%，P < 0.001），转移性疾病的比例降低了2.8个百分点（95%置信区间：-4.1%至-1.4%，P < 0.001）。与得克萨斯州相比，加利福尼亚州的癌症特异性死亡率下降了15.9%（95%置信区间：-23.9%至-7.8%，P < 0.001）。
结论
与得克萨斯州相比，加利福尼亚州扩大ACA医疗补助导致肺癌检测更早、转移性疾病减少且癌症特异性死亡率降低。这些改善涵盖了所有种族和族裔群体，凸显了扩大医疗补助在改善癌症治疗结果方面的益处。
