Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV-type and generosity of dental benefits.
Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV-type and generosity of dental benefits.
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DOI：
10.1002/cnr2.1840
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发表时间：
2023-08
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十多年的证据支持这样一种说法，即通过扩大医疗补助扩大获得保险的机会可以改善癌症的早期发现。然而，将医疗补助的扩大与口腔和咽部头颈部癌症(HNC)的早期检测联系起来的证据可能会受到限制，因为缺乏对人乳头状瘤病毒(HPV)病原学的关注，牙科覆盖的慷慨，以及分析州癌症登记数据的有效推断。这项研究重新审查了医疗补助扩大对提供广泛牙科福利的州早期检测HPV+/−血细胞癌的影响。来自监测、流行病学和最终结果(SEER)计划的专门数据被分析，以说明以前无法测量的与HPV相关的HNC的不同检测模式。然后，为了确定在各州之间潜在的非共同趋势中，提高医疗补助资格对提供广泛福利的州的分期模式的影响，采用“三重差异”设计，确定医疗补助扩大(包括牙科覆盖)对HPV阴性HNC的不同影响相对于HPV阳性HNC的变化。为了对癌症登记数据中的少量状态簇(12)进行有效推断，每个回归模型应用一个野生簇引导。研究发现，医疗补助资格的扩大与HPV(−)HNC远程诊断比例的下降有关，但仅限于在医疗补助扩大时增加医疗补助牙科慷慨的州。这些结果表明，增加广泛的医疗补助牙科福利是影响HNC检测的主要机制。这项研究强调了政策的潜在积极溢出效应，这些政策增加了低收入成年人获得公共牙科保险的机会，同时也显示了获得牙科服务的限制，以改善HPV+HNC的早期检测。
Over a decade of evidence supports the claim that increased access to insurance through Medicaid expansions improves early detection of cancer. Yet, evidence linking Medicaid expansions to early detection of head and neck cancers (HNC) of the oral cavity and pharynx, specifically, may be limited by the lack of attention to Human Papillomavirus (HPV) etiology, generosity of dental coverage, and valid inference analyzing state cancer registry data. This study reexamined the effect of Medicaid expansion on early detection of HPV+/− HNC in states offering extensive dental benefits. Specialized data from the Surveillance, Epidemiology, and End Results (SEER) program was analyzed to account for, previously unmeasurable, differential detection patterns of HNCs associated with HPV. Then, to identify the effect of increasing Medicaid eligibility on staging patterns in states offering extensive benefits amidst potentially non‐common trends between states, a “Triple Differences” design identifies the differential effect of Medicaid Expansion (with dental coverage) on HPV‐negative HNCs relative to the change in HPV‐positive HNCs. For valid inference analyzing a small number of state clusters (12) in cancer registry data, each regression model applies a Wild Cluster Bootstrap. Expanding Medicaid eligibility was found to be associated with a decrease in the proportion of distant‐stage diagnoses of HPV(−) HNCs, but only among states which increased Medicaid dental generosity at the time of Medicaid expansion. These results suggest that adding extensive Medicaid dental benefits was the primary mechanism impacting HNC detection. This study highlights the potential positive spillover effects of policies which increase access to public dental coverage for low‐income adults, while also showing the limitation of access to dental services for improving early detection of HPV+ HNCs.