State Medicaid Expansion Decisions and Disparities in Women's Cancer Screening
State Medicaid Expansion Decisions and Disparities in Women's Cancer Screening
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DOI：
10.1016/j.amepre.2014.08.015
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发表时间：
2015-01-01
影响因子：
5.5
通讯作者：
Bradley, Cathy J.
中科院分区：
文献类型：
--
作者：
Sabik, Lindsay M.;Tarazi, Wafa W.;Bradley, Cathy J.
背景：由于缺乏医疗保险，乳腺癌和宫颈癌筛查存在很大差异。尽管《平价医疗法案》(ACA)将保险覆盖范围扩大到许多美国人，但医疗补助的覆盖范围在各州之间存在差异。目的：通过评估目前扩大和未扩大到低收入成年人的ACA前乳腺癌和宫颈癌筛查，了解医疗补助扩大对低收入女性预防保健差异的潜在影响。方法：使用2012年行为风险因素监测系统(2014年分析)的数据来考虑建议筛查的女性在人口统计学方面的差异，包括扩大和不扩大两个州的收入和种族/民族。对未参保者和低收入女性的自我报告筛查与州总体扩张状况进行了比较。结果：没有扩大医疗补助的州的妇女接受推荐的乳房X光检查(OR=0.87，95%CI=0.79，0.95)或巴氏检查(OR=0.87，95%CI=0.79，0.95)的几率显著较低(OR=0.87，95%CI=0.79，0.95)。在未参保的人群中差异更大(乳腺X光摄影的OR=0.72，95%CI=0.56，0.91；巴氏试验的OR=0.78，95%CI=0.65，0.94)。结论：由于处于非扩张状态的妇女仍未参保，而其他人获得了保险，按种族和社会经济地位进行癌症筛查的现有差异可能会扩大。在正在进行的关于扩张的辩论中，必须考虑到服务不足人群的健康风险和相关成本。(C)《2015美国预防医学杂志》
Background: There are substantial disparities in breast and cervical cancer screening that stem from lack of health insurance. Although the Affordable Care Act (ACA) expands insurance coverage to many Americans, there are differences in availability of Medicaid coverage across states.Purpose: To understand the potential impact of Medicaid expansions on disparities in preventive care for low-income women by assessing pre-ACA breast and cervical cancer screening across states currently expanding and not expanding Medicaid to low-income adults.Methods: Data from the 2012 Behavioral Risk Factor Surveillance System (analyzed in 2014) were used to consider differences in demographics among women for whom screening is recommended, including income and race/ethnicity, across expansion and nonexpansion states. Self-reported screening was compared by state expansion status overall, for the uninsured, and for low-income women. Logistic regressions were estimated to assess differences in self-reported screening across expansion and nonexpansion states controlling for demographics.Results: Women in states that are not expanding Medicaid had significantly lower odds of receiving recommended mammograms (OR=0.87, 95% CI=0.79, 0.95) or Pap tests (OR=0.87, 95% CI=0.79, 0.95). The difference was larger among the uninsured (OR=0.72, 95% CI=0.56, 0.91 for mammography; OR=0.78, 95% CI=0.65, 0.94 for Pap tests).Conclusions: As women in nonexpansion states remain uninsured and others gain coverage, existing disparities in cancer screening by race and socioeconomic status are likely to widen. Health risks and associated costs to underserved populations must be taken into account in ongoing debates over expansion. (C) 2015 American Journal of Preventive Medicine