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（AYAs;在15-39岁诊断患有癌症） 年轻人和老年人癌症存活率的改善。一个主要障碍 癌症预后改善的原因是缺乏医疗保健， 这个年龄段的高失业率不保险也推动了 癌症存活率的社会人口统计学（种族/民族、社会经济、城乡）差异， 总体而言，在AYA人群中。《平价医疗法案》（ACA）提供了一种选择， 各州将医疗补助覆盖范围扩大到收入≤联邦贫困线138%的成年人。 扩大医疗补助覆盖范围可以减少年轻人的不保险， 将覆盖范围扩大到成年父母。迄今为止，没有任何先前的 研究ACA医疗补助扩展对增加癌症可及性的影响 护理或其与AYA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）检查约246，000名AYA的队列 在2010年至2016年期间，美国所有州和华盛顿特区被诊断患有癌症。 队列将允许一种严格的准实验方法来确定ACA的净效应 医疗补助计划对AYAs癌症护理的及时性、结果和公平性的扩展， 最常见的癌症（女性乳腺癌，睾丸癌，黑色素瘤，结肠直肠癌， 甲状腺癌、宫颈癌、霍奇金淋巴瘤和非霍奇金淋巴瘤）。NCDB 捕获了美国所有新的AYA癌症病例的80%，并将使我们能够产生 全国范围内对ACA医疗补助计划扩展对癌症结果影响的估计， 包括治疗开始和存活的时间。此外，我们还将评估术前和术后的队列， 社会人口因素（种族/民族，社会经济地位， 城市-农村），以强调不同的结果。这项研究将为政策干预提供信息， 癌症控制，以减少AYA癌症的差异。

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.