Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion.
Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion.
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DOI：
10.1016/j.amepre.2020.06.020
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发表时间：
2021-01
影响因子：
5.5
通讯作者：
Drake C
中科院分区：
文献类型：
--
作者：
Lin L;Soni A;Sabik LM;Drake C
医疗保险的扩大可能会增加癌症的早期发现，并减少晚期癌症的发病率。该研究评估了《平价医疗法案》（Affordable Care Act）扩大医疗补助对实施后3年内早期和晚期癌症诊断率的影响。从2010-2016年监测、流行病学和最终结果项目的癌症登记数据中，对732个县的非老年人进行了基于人群的准实验分析。估计多变量事件研究回归比较了扩大医疗补助和未扩大医疗补助的州的县级癌症诊断率的年度变化。数据分析时间为2019年5月至10月。医疗补助扩大后的第一年，每10万人中有21.3人的早期癌症诊断增加（95% CI=2.9, 35.2）或9.14%；第2年和第3年的估计值也是正的，但较小，没有统计学意义。在医疗补助扩大3年后，每10万人中有8.7人的晚期诊断率略有显著下降（95% CI= - 25.0, 3.4），或相对于基线下降5.7%。扩张对总诊断没有可检测到的影响。医疗补助扩大在扩大的第一年增加了早期癌症的诊断，但在随后的几年里效果消失了，这表明在扩大后立即对被压抑的患者对筛查和诊断服务的需求做出了回应。也有证据表明，在医疗补助扩大的第三年，晚期诊断减少，突出了公共医疗保险在改善非老年人癌症预后方面的潜在作用。
Health insurance expansions may increase early detection of cancer and reduce late-stage cancer incidence. The study assesses the effects of the Affordable Care Act Medicaid expansions on rates of early- and late-stage cancer diagnosis up to 3 years after implementation. Population-based quasi-experimental analysis of non-elderly adults was conducted in 732 counties from the 2010–2016 Surveillance, Epidemiology, and End Results Program cancer registry data. Multivariate event study regressions were estimated to compare annual changes in county-level rates of cancer diagnoses in states that expanded Medicaid versus those that did not. Data analysis was performed from May to October 2019. Medicaid expansion was associated with an increase in early-stage cancer diagnoses of 21.3 per 100,000 population (95% CI=2.9, 35.2) or 9.14% in its first year; estimates for Years 2 and 3 were also positive but smaller and not statistically significant. There was a marginally significant reduction in late-stage diagnoses of 8.7 per 100,000 population (95% CI= −25.0, 3.4), or 5.7% relative to baseline, 3 years after Medicaid expansion. There was no detectable effect of expansion on total diagnoses. Medicaid expansions increased early-stage cancer diagnosis in the first year of expansion, but effects dissipated in subsequent years, suggesting a response to pent-up patient demand for screening and diagnostic services immediately following expansion. There was also suggestive evidence of reductions in late-stage diagnosis in the third year of Medicaid expansion, highlighting the potential role of public health insurance in improving cancer outcomes among non-elderly adults.
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影响因子：
12.7
作者：
Soni, Aparna;Simon, Kosali;Sabik, Lindsay
通讯作者：
Sabik, Lindsay
影响因子：
45.3
作者：
Jemal, Ahmedin;Lin, Chun Chieh;Han, Xuesong
通讯作者：
Han, Xuesong
影响因子：
3.4
作者：
Sabik, Lindsay M.;Tarazi, Wafa W.;Bradley, Cathy J.
通讯作者：
Bradley, Cathy J.
影响因子：
28.4
作者：
Han, Xuesong;Yabroff, Robin;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
5.5
作者：
Sabik, Lindsay M.;Tarazi, Wafa W.;Bradley, Cathy J.
通讯作者：
Bradley, Cathy J.