The impact of dependent coverage expansion under the Affordable Care Act on time to breast cancer treatment among young women
The impact of dependent coverage expansion under the Affordable Care Act on time to breast cancer treatment among young women
复制标题
DOI：
10.1371/journal.pone.0198771
复制
发表时间：
2018-06-13
期刊：
影响因子：
3.7
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
--
作者：
Han, Xuesong;Zhao, Jingxuan;Jemal, Ahmedin
年轻女性的乳腺癌往往更具侵袭性，但并不总是能得到及时的治疗，特别是对那些没有健康保险的人。我们的目的是研究2010年实施的《平价医疗法案》（ACA-DCE）下的受抚养人覆盖范围的扩大是否与诊断为早期乳腺癌的女性治疗时间的变化相关。从国家癌症数据库中确定了2007-2009年（ACA前）和2011-2013年（ACA后）诊断为早期乳腺癌的176例患者。采用准实验设计差异中差异（DD）方法，将19-25岁（政策目标）的患者视为干预组，将26 - 34岁（不受政策影响）的患者视为对照组。以下治疗结果的变化进行了检查：从诊断到手术的时间，从手术到辅助化疗的时间，从辅助化疗到radiation.ResultsCompared与对照组的患者年龄在26-34岁，19-25岁的年轻患者经历了一个统计学上不显着的下降2.7个百分点（95%CI [-1.2，6.5]）的未保险率。这并没有转化为手术延迟的更多减少（DD = 2.7天，95% CI [-3.2，8.3]），化疗（DD = -1.0天，95% CI [-7.2，5.2]）或放疗（DD = 5.3天，95% CI [-15.6，95% CI]）26.3]）结论和相关性在年轻女性中未发现治疗时间的显著变化在实施ACA-DCE后被诊断为早期乳腺癌。未来的研究探讨医疗保健政策改革对乳腺癌护理的影响是必要的，包括低收入家庭的患者，并考虑医疗补助扩张的影响。
IntroductionBreast cancer in young women tends to be more aggressive, but timely treatment may not be always available, particularly to those without health insurance. We aim to examine whether the dependent coverage expansion under the Affordable Care Act (ACA-DCE) implemented in 2010 was associated with changes in time to treatment among women diagnosed with early stage breast cancer.MethodsA total of 7,176 patients diagnosed with early stage breast cancer in 2007-2009 (pre-ACA) and 2011-2013 (post-ACA) were identified from the National Cancer Database. A quasi experimental design difference-in-differences (DD) approach was used, with patients aged 19-25 (targeted by the policy) considered as the intervention group, and patients aged 2634 years (not affected by the policy) as the control group. Changes in the following treatment outcomes were examined: time from diagnosis to surgery, time from surgery to adjuvant chemotherapy, and time from adjuvant chemotherapy to radiation.ResultsCompared with the control group of patients aged 26-34, young patients aged 19-25 experienced a statistically nonsignificant decrease of 2.7 percentage points (95% Cl [-1.2, 6.5]) in the uninsured rate. This did not translate into more reduction in delays to surgery (DD = 2.7 days, 95% Cl [-3.2, 8.3]), chemotherapy (DD = -1.0 days, 95% CI [-7.2, 5.2]) or radiation (DD = 5.3 days, 95% Cl [-15.6, 26.3]) in the younger cohort than the older cohort.Conclusions and RelevanceNo significant changes in time to treatment were found among young women diagnosed with early stage breast cancer after the implementation of the ACA-DCE. Future studies examining impacts of health care policy reform on breast cancer care are warranted to include patients from low-income families and to consider effects from Medicaid expansion.