Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act.
Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act.
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DOI：
10.1093/jncics/pkac006
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发表时间：
2022-01-05
影响因子：
4.4
通讯作者：
Han X
中科院分区：
文献类型：
--
作者：
Ji X;Hu X;Castellino SM;Mertens AC;Yabroff KR;Han X
尽管在为儿童提供全民医疗保险方面取得了进展，但覆盖范围仍然存在差距。使用来自国家癌症数据库的全国儿童和青少年癌症患者样本，我们使用多项Logistic回归分析了2014年《平价医疗法案》(ACA)实施的效果，以评估18岁以下患者(n=63 377)在2010-2013年(ACA前)和2014-2017年(ACA后)之间的保险变化。所有的统计检验都是双侧的。在ACA之后，医疗补助和儿童健康保险计划覆盖的患者的总体百分比增加(从351%到36.9%；调整后的绝对百分比变化[APC]=2.01个百分点[ppt]，95%的可信区间[CI]=1.31到2.71；P<；.001)，部分被私人保险的百分比下降所抵消(从62.7%到61.2%；调整后的APC=−1.67ppt，95%CI=−2.37到−0.97；P<；.001)，导致未投保状态减少15%(从2.2%降至1.9%；调整后的APC=−0.34ppt，95%CI=−0.56Ppt−0.12ppt；P=.003)。未参保状况下降幅度最大的是西班牙裔患者(下降23%；调整后的APC=−0.95ppt，95%CI=−1.67−0.23ppt；P=.009)和居住在低收入地区的患者(下降35%；调整后的APC=−1.22ppt，95%CI=−2.22−0.21ppt；P=0.02)。实施ACA后，全国范围内的儿童和青少年癌症患者获得了保险收益，其中少数民族和低收入地区的保险收益更大。
Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children’s Health Insurance Program–covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = −1.67 ppt, 95% CI = −2.37 to −0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = −0.34 ppt, 95% CI = −0.56 −0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = −0.95 ppt, 95% CI = −1.67−0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = −1.22 ppt, 95% CI = −2.22−0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas.
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