Evaluating the Impact of Medicaid Dental Coverage on Early-Stage Oral Cancer Detection

摘要 口腔癌每年导致超过10，000名成年人死亡。早期发现可以提高生存率和质量， 口腔癌的发病率是终身的，但只有不到30%的口腔癌是在早期发现的。虽然以前的研究已经调查了 是否获得医疗保险可以导致早期发现，我的初步证据表明，这些 以前的研究忽略了口腔癌控制的一个关键特征：获得牙科服务。医生不是 建议系统地筛查口腔癌，而牙医常规筛查口腔癌， 护理标准。我的初步研究结果肯定了牙医在口腔癌控制系统中的关键作用。然而， 尽管牙科服务对早期发现口腔癌很重要，但低收入成年人仍面临经济困难。 获得牙科服务的障碍。事实上，缺乏负担得起的牙科保险导致成年人推迟或放弃 比任何其他医疗保健服务都需要更多的牙科护理。医疗补助填补了牙科保险的空白， 许多成年人，但国家不需要提供牙科福利，他们的成年医疗补助受益人。 因此，成人医疗补助牙科计划随着时间的推移而变化，并因州而异。的波动性 医疗补助牙科保险可能会进一步加剧低收入成年人口腔癌检测的延迟。 为了为改善人口口腔健康的政策提供信息，本提案评估了以下方面的影响： 获得医疗补助牙科服务的早期口腔癌。在指导指导下，我将 是第一批通过分析基于人群的癌症登记数据来评估医疗补助牙科政策的人。这 新的数据包括经过验证的医疗补助登记指标，使我能够选择一个有效的低收入样本， 成年人了目标1假设医疗补助注册者暴露于州一级医疗补助牙科保险的变化 将改变他们在早期被诊断出患有口腔癌的概率。利用因果关系方面的进展 推理方法，这一目标利用了成人医疗补助的纵向和逐州变化 牙科政策，以避免选择偏见混淆我们的估计。接下来，我们的目标是推断访问的影响， 按县一级牙医人均数计算的医疗补助牙科服务对早期诊断的影响。目的2 假设改变医疗补助牙科覆盖范围对早期诊断概率的影响 取决于牙医的数量这两个研究目标将提高该领域的知识， 通过识别异质性效应和测试癌症之间的效应差异来确定癌症差异 特征、社会人口因素和农村状况。通过量化如何获得牙科保险， 牙科提供者影响早期口腔癌诊断，我们的证据将推动旨在控制 并通过增加早期发现来预防口腔癌死亡率。未来的研究可以确定如何 缓解任何剩余的早期口腔癌检测差距。与我的跨学科研究合作 爱荷华州大学公共卫生学院和牙科学院的团队将推动我的职业生涯， 独立调查员

ABSTRACT Oral cancer kills more than 10,000 adults each year. Earlier detection could improve survival and quality of life, but less than 30% of oral cancers are detected at early stages. While previous research has investigated whether access to health insurance could lead to earlier detection, my preliminary evidence suggests these previous studies miss a critical feature of oral cancer control: access to dental services. Physicians are not recommended to systematically screen for oral cancer, whereas dentists routinely screen for oral cancer as standard of care. My preliminary findings affirm the critical role of dentists in oral cancer control systems. Yet, despite the importance of dental services for detecting oral cancer early, low-income adults face financial barriers to accessing dental services. In fact, the lack of affordable dental coverage leads adults to delay or forgo necessary dental care more than any other healthcare service. Medicaid has filled the dental coverage gap for many adults, but states are not required to provided dental benefits to their adult Medicaid beneficiaries. Consequently, adult Medicaid dental programs have changed over time and vary by state. The volatility of Medicaid dental coverage could be further exacerbating delays in oral cancer detection for low-income adults. To inform policies improving population oral health, this proposal evaluates the impact of access to Medicaid dental services on early-stage oral cancer. Under guided mentorship, I will be among the first to evaluate Medicaid dental policies by analyzing population-based cancer registry data. This novel data includes verified Medicaid enrollment indicators, allowing me to select a valid sample of low-income adults. Aim 1 hypothesizes that Medicaid enrollees exposed to a change in state-level Medicaid dental coverage will change their probability of being diagnosed with oral cancer at an early-stage. Using advances in causal inference methodology, this aim leverages the longitudinal and state-by-state variation of adult Medicaid dental policies to avoid selection bias confounding our estimates. Next, we aim to infer an effect of access to Medicaid dental services on early-stage diagnoses by accounting for county-level dentists per capita. Aim 2 hypothesizes that the effect of changing Medicaid dental coverage on the probability of an early-stage diagnosis is mediated by the number of available dentists. Both research aims will improve the field’s knowledge of oral cancer disparities by identifying heterogenous effects and testing for effect differences across cancer characteristics, sociodemographic factors, and rurality status. By quantifying how access to dental coverage and dental providers affects early-stage oral cancer diagnoses, our evidence will advance policies aiming to control and prevent oral cancer mortality by increasing early detection. Future research can then identify how to alleviate any remaining early-stage oral cancer detection gaps. Collaborating with my interdisciplinary research team at the University of Iowa College of Public Health and College of Dentistry will advance my career as an independent investigator.