Where you live matters: A National Cancer Database study of Medicaid expansion and endometrial cancer outcomes.
Where you live matters: A National Cancer Database study of Medicaid expansion and endometrial cancer outcomes.
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DOI：
10.1016/j.ygyno.2020.05.018
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发表时间：
2020-08
影响因子：
4.7
通讯作者：
Felix AS
中科院分区：
文献类型：
--
作者：
Barrington DA;Sinnott JA;Calo C;Cohn DE;Cosgrove CM;Felix AS
目的：确定采用医疗补助扩展计划(ME)与子宫内膜癌(EC)妇女的保险状况、早期诊断和癌症存活率变化之间的关系。国家癌症数据库查询2004年至2015年间被诊断为40岁-之间的EC患者。差异分析量化了ME对有保险的新EC诊断的比例(与未投保的比例)、诊断为I期的比例(与II-IV阶段的比例)以及总体存活率的影响。共纳入156,253名患者。在65,019名生活在ME州的妇女中，ME与EC病例的投保率增加1.4%有关(95%CI 0.9-2.0%，p<；0.0001)，在西班牙裔妇女、收入最低四分位数的妇女和第二年龄四分位数的妇女(53-57岁)中影响最大。虽然在53-57岁的女性中观察到早期诊断增加了2.4%(95%可信区间为0.3-4.5%，p=0.022)，但ME对分期没有总体影响。ME有改善总体存活率的趋势，这在53-57岁的女性中最为明显(HR=0.83，95%CI为0.70-0.99，p=0.037)。在患有EC的妇女中，ME对保险覆盖率产生了积极影响，这是获得医疗保健的一个重要障碍。在53-57岁的女性中，ME与早期诊断和生存改善有关，这表明保险覆盖面改善的幅度可能与重要的临床结果相关。应继续努力了解阻碍获得医疗保健的障碍的复杂性，并制定有效的战略来克服这些障碍。
To determine associations between adoption of Medicaid expansion (ME) and changes in insurance status, early stage diagnosis, and cancer survival among women with endometrial carcinoma (EC). The National Cancer Database (NCDB) was queried for patients diagnosed with EC between the age 40–64 from 2004 to 2015. Difference-in-differences analysis quantified the impact of ME on the proportion of new EC diagnoses with insurance (vs. uninsured), the proportion diagnosed with stage I (vs. II-IV), and overall survival. 156,253 patients were included. Among 65,019 women living in ME states, ME is associated with an increase in the percent of EC cases who are insured of 1.4% (95% CI 0.9–2.0%, p < 0.0001), with strongest effects among Hispanic women, women in the lowest income quartile, and women in the second age quartile (age 53–57). There was no overall impact of ME on stage, though an increase of early stage diagnoses by 2.4% (95% CI 0.3–4.5%, p = 0.022) was observed among women age 53–57. There was a trend towards improved overall survival with ME, which was strongest in women age 53–57 (HR = 0.83, 95% CI 0.70–0.99, p = 0.037). Among women with EC, ME positively impacted insurance coverage, an important hurdle in accessing health care. In women aged 53–57, ME was associated with earlier stage at diagnosis and improved survival, suggesting that the magnitude of the improvement in insurance coverage may correlate with important clinical outcomes. Efforts should continue to understand the complexity of barriers to health care access and to develop effective strategies to surmount them.
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DOI：
10.1016/s1470-2045(18)30079-2
发表时间：
2018-03
期刊：
The Lancet. Oncology
影响因子：
--
作者：
de Boer SM;Powell ME;Mileshkin L;Katsaros D;Bessette P;Haie-Meder C;Ottevanger PB;Ledermann JA;Khaw P;Colombo A;Fyles A;Baron MH;Jürgenliemk-Schulz IM;Kitchener HC;Nijman HW;Wilson G;Brooks S;Carinelli S;Provencher D;Hanzen C;Lutgens LCHW;Smit VTHBM;Singh N;Do V;D'Amico R;Nout RA;Feeney A;Verhoeven-Adema KW;Putter H;Creutzberg CL;PORTEC study group
通讯作者：
PORTEC study group
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
158.5
作者：
Matei, Daniela;Filiaci, Virginia;Miller, David S.
通讯作者：
Miller, David S.
影响因子：
6.2
作者：
Maxwell, G. Larry;Tian, Chunqiao;Brewster, Wendy R.
通讯作者：
Brewster, Wendy R.
影响因子：
4.7
作者：
Moss, Haley A.;Havrilesky, Laura J.;Chino, Junzo
通讯作者：
Chino, Junzo