Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study.
Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study.
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DOI：
10.1002/cncr.28685
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发表时间：
2014-08-01
期刊：
影响因子：
6.2
通讯作者：
Keegan, Theresa H. M.
中科院分区：
文献类型：
--
作者：
Parsons, Helen M.;Schmidt, Susanne;Harlan, Linda C.;Kent, Erin E.;Lynch, Charles F.;Smith, Ashley W.;Keegan, Theresa H. M.
关键词：
在美国，年轻人历来是最不可能拥有健康保险的。之前对儿童癌症幸存者的研究发现，与兄弟姐妹相比，他们的保险率较低，获得医疗护理的机会也较少；然而，尚无研究探讨青少年和年轻人 (AYA) 癌症诊断后保险的连续性。利用 AYA 健康结果和患者体验研究（来自参与监测、流行病学和最终结果登记的 465 名 15-39 岁人群），我们使用卡方检验和多变量逻辑回归评估了诊断后健康保险覆盖范围和赞助商的变化、医生推荐测试的覆盖范围以及与诊断后缺乏保险相关的因素。超过 25% (n=118) 的 AYA 癌症幸存者在诊断后长达 35 个月的一段时间内没有保险。诊断后第一年的保险率较高（6-14 个月；93.3%），但在随访期间大幅下降（15-35 个月；85.2%）。最常见的健康保险赞助者是雇主/学校保险（43.7%）。多变量分析表明，年龄较大的幸存者（25-39 vs. 15-19；优势比 (OR)：3.35，p<0.01）和受教育程度较低的幸存者（高中或以下 vs. 大学毕业生；OR：2.80，p<0.01）更有可能在诊断后经历一段没有保险的时期。此外，超过 20% 的幸存者表示保险未承保医生推荐的检查/治疗，但超过 80% 的幸存者无论承保范围如何都接受了这些检查/治疗。 AYA 癌症幸存者的保险费率随着诊断时间的推移而降低。未来的研究应该研究《平价医疗法案》下的新政策如何将获取和保险范围扩大到初始治疗之外。
Young adults have historically been the least likely to have health insurance in the United States. Previous studies of childhood cancer survivors found lower rates of insurance and less access to medical care compared to siblings; however, no studies have examined continuity of insurance after cancer diagnosis in adolescents and young adults (AYAs). Using the AYA Health Outcomes and Patient Experience study, a cohort of 465 15-39 year-olds from participating Surveillance, Epidemiology and End Results registries, we evaluated changes in and sponsors of health insurance coverage after diagnosis, coverage of doctor-recommended tests, and factors associated with lack of insurance post-diagnosis using chi-square tests and multivariable logistic regression. Over 25% (n=118) of AYA cancer survivors experienced some period without insurance up to 35 months post-diagnosis. Insurance rates were high in the initial year after diagnosis (6-14 months; 93.3%) but decreased substantially at follow-up (15-35 months; 85.2%). The most common sponsor of health insurance was employer/school-coverage (43.7%). Multivariable analysis indicated that older survivors (25-39 vs. 15-19; Odds Ratio (OR): 3.35, p<0.01) and those with less education (high school or less vs. college graduate; OR: 2.80, p<0.01) were more likely to experience a period without insurance after diagnosis. Furthermore, >20% of survivors indicated there were doctor-recommended tests/treatments not covered by insurance, but >80% received them regardless of coverage. Insurance rates decrease with time since diagnosis in AYA cancer survivors. Future studies should examine how new policies under the Affordable Care Act extend access and insurance coverage beyond initial treatment.
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影响因子：
7.2
作者：
Miilunpalo, S;Vuori, I;Urponen, H
通讯作者：
Urponen, H
影响因子：
8
作者：
Adams, Sally H.;Newacheck, Paul W.;Irwin, Charles E., Jr.
通讯作者：
Irwin, Charles E., Jr.
DOI：
10.1007/s11764-011-0173-y
发表时间：
2011-09
期刊：
Journal of cancer survivorship : research and practice
影响因子：
--
作者：
Harlan LC;Lynch CF;Keegan TH;Hamilton AS;Wu XC;Kato I;West MM;Cress RD;Schwartz SM;Smith AW;Deapen D;Stringer SM;Potosky AL;AYA HOPE Study Collaborative Group
通讯作者：
AYA HOPE Study Collaborative Group
DOI：
10.1002/mpo.1316
发表时间：
2002-04-01
期刊：
MEDICAL AND PEDIATRIC ONCOLOGY
影响因子：
--
作者：
Robison, LL;Mertens, AC;Zeltzer, LK
通讯作者：
Zeltzer, LK
影响因子：
45.3
作者：
Parsons, Helen M.;Harlan, Linda C.;Keegan, Theresa H. M.
通讯作者：
Keegan, Theresa H. M.