Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act
Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act
复制标题
DOI：
10.1093/jnci/djz235
复制
发表时间：
2020-10-01
影响因子：
10.3
通讯作者：
Yabroff, K. Robin
中科院分区：
文献类型：
--
作者：
Nogueira, Leticia;Chawla, Neetu;Yabroff, K. Robin
《平价医疗法案》（ACA）下的家属覆盖扩大（DCE）对接受结直肠癌治疗的影响尚未确定。我们从2007年至2013年的国家癌症数据库中确定了新诊断的符合dce条件（19-25岁，n = 1924）和不符合dce条件（27-34岁，n = 8313）的结直肠癌患者。所有统计检验均为双侧检验。aca后，符合dce条件的患者的早期诊断率有统计学意义的增加（增加15个百分点，可信区间= 9.8,20.2;P < .001），但不符合dce条件的患者的早期诊断率没有统计学意义（P = .09）。符合dce条件的IIB-IIIC结直肠癌切除患者更有可能及时接受辅助化疗（风险比= 1.34,95%可信区间= 1.05 ~ 1.71；从手术到化疗的限制平均时间减少7.0天，P = 0.01）， aca后不符合dce条件的患者无差异（风险比= 1.10,95%可信区间= 0.98 ~ 1.24；减少2.1天，P = 0.41）。我们的研究结果强调了ACA在改善获得可能挽救生命的癌症治疗方面的作用，包括转向早期诊断和更及时地接受辅助化疗。
The effect of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE-eligible (aged 19-25 years, n = 1924) and DCE-ineligible (aged 27-34 years, n = 8313) colorectal cancer patients from the National Cancer Database from 2007 to 2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early-stage diagnosis among DCE-eligible (15 percentage point increase, confidence interval = 9.8, 20.2; P < .001), but not DCE-ineligible (P = .09), patients. DCE-eligible patients resected for IIB-IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (hazard ratio = 1.34, 95% confidence interval = 1.05 to 1.71; 7.0 days' decrease in restricted mean time from surgery to chemotherapy, P = .01), with no differences in DCE-ineligible patients (hazard ratio = 1.10, 95% confidence interval = 0.98 to 1.24; 2.1 days' decrease, P = .41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially lifesaving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.