Understanding the impact of the Affordable Care Act on cancer treatment and outcomes for adolescents and young adults (AYA)

青少年和年轻人(AYA；15-39岁被诊断为癌症)落后于 在年轻和老年人群中看到的癌症存活率的改善。一大障碍 癌症预后改善的原因是缺乏获得医疗保健的机会，这与历史上 这个年龄段的失保率很高。没有保险也推动了 癌症存活率的社会人口学(种族/民族、社会经济、城乡)差异， 总体而言，在阿雅人中也是如此。《平价医疗法案》(ACA)为 各州将医疗补助覆盖范围扩大到收入≤为联邦贫困水平138%的成年人。 扩大医疗补助覆盖范围可以减少年轻人的未参保情况，以及 通过将覆盖范围扩大到其成年父母，为青少年提供服务。到目前为止，还没有以前的 检查ACA医疗补助扩大对增加癌症发病率的影响的研究 护理或其与AYAS的早期发现、及时治疗和生存改善的相关性。 我们将利用国家癌症数据库(NCDB)来检查约246,000名AYA的队列 在2010至2016年间，美国各州和华盛顿特区被诊断出患有癌症。 队列将允许一种严格的准实验方法来确定ACA的净影响 医疗补助在AYA癌症护理的及时性、结果和公平性方面的扩展 最常见的癌症(女性乳腺癌、睾丸癌、黑色素瘤、结直肠癌、 甲状腺癌、宫颈癌、霍奇金淋巴瘤和非霍奇金淋巴瘤)。新开发银行 捕获了美国80%的新的Aya癌症病例，并将使我们能够 全国范围内对ACA医疗补助扩大对癌症结果的影响的估计， 包括开始治疗和存活的时间。此外，我们将评估队列Pre和 按社会人口因素(种族/族裔、社会经济地位、 城市-农村)，强调不同的结果。这项研究将为以下政策干预提供参考 癌症控制朝着减少Aya癌症差异的方向发展。

Adolescents and young adults (AYAs; diagnosed with cancer at ages 15-39 years) have lagged in improvements in cancer survival seen among younger and older populations. A major barrier to improvement in cancer outcomes is the lack of access to healthcare, historically associated with the high rates of uninsurance in this age group. Uninsurance also drives the sociodemographic (racial/ethnic, socioeconomic, urban-rural) disparities in cancer survival, overall and among AYA populations. The Affordable Care Act (ACA) provides an option for states to expand Medicaid coverage to adults with income ≤138% of the federal poverty level. Expanding Medicaid coverage can reduce uninsurance in young adults, as well as in adolescents via extending coverage to their adult parents. To date, there has been no prior study to examine the impact of the ACA Medicaid expansion on increasing access to cancer care or its association with early detection, timely treatment, and survival improvement in AYAs. We will utilize the National Cancer Database (NCDB) to examine a cohort of ~246,000 AYAs diagnosed with cancer between 2010 and 2016 across all US states and D.C. The national AYA cohort will allow a rigorous, quasi-experimental approach to determine the net effect of the ACA Medicaid expansion on the timeliness, outcome, and equity of cancer care for AYAs with the 8 most common cancers (female breast cancer, testis cancer, melanoma, colorectal cancer, thyroid cancer, cervical cancer, Hodgkin lymphoma, and non-Hodgkin lymphoma). The NCDB captures >80% of all new AYA cancer cases in the US, and will enable us to generate nationwide estimates of the impact of the ACA Medicaid expansion on cancer outcomes, including time to treatment initiation and survival. In addition, we will evaluate the cohort pre and post Medicaid expansion by sociodemographic factors (race/ethnicity, socioeconomic status, urban-rural) to underline disparate outcomes. This research will inform policy interventions for cancer control toward reducing disparities in AYA cancer.