Associations of Early Medicaid Expansion With Insurance Status and Stage at Diagnosis Among Cancer Patients Receiving Radiation Therapy
Associations of Early Medicaid Expansion With Insurance Status and Stage at Diagnosis Among Cancer Patients Receiving Radiation Therapy
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DOI：
10.1016/j.prro.2019.10.003
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发表时间：
2020-07-01
影响因子：
3.3
通讯作者：
Perkins, Stephanie M.
中科院分区：
文献类型：
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作者：
Barnes, Justin M.;Srivastava, Amar J.;Perkins, Stephanie M.
目的：2014 年医疗补助扩大与保险覆盖范围和癌症患者诊断分期的改善有关。然而，人们对 2010 年至 2011 年早期医疗补助扩张对放射治疗接受者的结果的影响知之甚少。本研究的目的是评估早期医疗补助扩大对放射治疗接受者的保险状况和诊断阶段的影响。方法和材料：对监测、流行病学和最终结果数据库进行了查询，查找 2007 年至 2013 年诊断出的首次原发性恶性肿瘤并接受放射治疗的病例，年龄为 18 岁至 64 岁。使用双重差分分析来比较 2007 年至 2009 年以及 2011 年至 2013 年扩张状态相对于非扩张状态保险覆盖范围和诊断阶段的变化。 结果：扩张状态相对于非扩张状态的未参保人数减少了 -0.48（95% 置信区间 [CI]，-0.84 至 -0.13；P = .007）百分点 (PP)，主要是受教育程度较低的县（-1.73 PP；95% CI，-2.72 至 -0.75）。总体而言，扩张状态的早期诊断相对于非扩张状态有所增加，在乳腺癌（1.56 PP；95% CI，0.45-2.68；P = .006）、结直肠癌（3.72 PP；95% CI，0.33-7.12；P = .032）和肺（1.49 PP；95% CI， 0.25-2.72；P = .018) 癌症。宫颈癌（-5.91 PP；95% CI，-9.58 至 -2.25；P = .002）、结直肠癌（-2.72 PP；95% CI，-5.43 至 -0.01；P = .05）和肺癌（-3.28 PP；95% CI，-5.47 至 -1.1；P = .05）的晚期诊断有所下降。 .003) 癌症。结论：对于放射治疗接受者来说，早期医疗补助扩张与未参保比例下降相关，特别是在教育程度较低的县，以及可筛查癌症的早期诊断。因此，早期医疗补助的扩张可能会改善放射治疗接受者获得护理的机会并减少差异。 (C) 2019 年美国放射肿瘤学会。由爱思唯尔公司出版。保留所有权利。
Purpose: Medicaid expansion in 2014 is associated with improved insurance coverage and stage at diagnosis in cancer patients. However, little is known about the effect of early Medicaid expansions in 2010 to 2011 on outcomes in radiation therapy recipients. The objective of this study was to estimate the effect of early Medicaid expansion on insurance status and stage at diagnosis among radiation therapy recipients.Methods and Materials: The Surveillance, Epidemiology, and End Results database was queried for cases aged 18 to 64 diagnosed in 2007 to 2013 with a first primary malignancy treated with radiation therapy. Difference-in-differences analyses were used to compare changes in insurance coverage and stage at diagnosis from 2007 to 2009 and 2011 to 2013 in expansion relative to nonexpansion states.Results: There was a -0.48 (95% confidence interval [CI], -0.84 to -0.13; P = .007) percentage point (PP) reduction in uninsured in expansion relative to nonexpansion states, primarily among counties with lower educational attainment (-1.73 PP; 95% CI, -2.72 to -0.75). Increases in early stage diagnoses in expansion relative to nonexpansion states were found overall and in breast (1.56 PP; 95% CI, 0.45-2.68; P = .006), colorectal (3.72 PP; 95% CI, 0.33-7.12; P = .032), and lung (1.49 PP; 95% CI, 0.25-2.72; P = .018) cancers. Decreases in late stage diagnoses were found in cervical (-5.91 PP; 95% CI, -9.58 to -2.25; P = .002), colorectal (-2.72 PP; 95% CI, -5.43 to -0.01; P = .05), and lung (-3.28 PP; 95% CI, -5.47 to -1.1; P = .003) cancers.Conclusions: For radiation therapy recipients, early Medicaid expansion was associated with decreased percent uninsured, particularly among low education counties, and earlier stage diagnoses for screenable cancers. Thus, early Medicaid expansion may improve access to care and decrease disparities for radiation therapy recipients. (C) 2019 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.