Abstract：
The United States Patient Protection and Affordable Care Act allocated funds for states to expand Medicaid coverage. However, several states declined expansion. We aim to determine whether Medicaid expansion is associated with healthcare coverage, cancer stage at diagnosis, treatment, and survival among patients with rhinologic cancer. Rhinologic cancer was defined to include cancer of the nasal cavity, paranasal sinus, nasopharynx, or olfactory nerve.
Cohort study.
Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income/education was utilized to examine associations between Medicaid expansion/insurance status and stage at diagnosis, treatment, and survival. Overall and disease-specific survival were examined using Kaplan-Meier analysis.
Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, P < .001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (N = 2,364; OR = 1.27, 95% CI 1.01-1.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR = 1.75, 95% CI 1.41-2.22) and increased risk of disease-specific death (HR = 1.54, 95% CI 1.32-1.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion.
Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings.
3 Laryngoscope, 133:43-50, 2023.
Cohort study.
Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income/education was utilized to examine associations between Medicaid expansion/insurance status and stage at diagnosis, treatment, and survival. Overall and disease-specific survival were examined using Kaplan-Meier analysis.
Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, P < .001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (N = 2,364; OR = 1.27, 95% CI 1.01-1.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR = 1.75, 95% CI 1.41-2.22) and increased risk of disease-specific death (HR = 1.54, 95% CI 1.32-1.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion.
Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings.
3 Laryngoscope, 133:43-50, 2023.
摘要：
目的：《美国患者保护和平价医疗法案》为各州分配了资金，以扩大医疗补助覆盖范围。然而,几个州拒绝扩张。我们的目标是确定医疗补助扩大是否与医疗保险有关。诊断时的癌症阶段，治疗,和鼻癌患者的生存率。鼻癌被定义为包括鼻腔癌，鼻旁窦,鼻咽部,或者嗅神经.
方法：队列研究。
方法：从美国国家癌症研究所监测中提取了2007年至2016年之间诊断为原发性鼻恶性肿瘤的患者，流行病学,结束结果(SEER)注册表。根据2014年之前和之后的诊断（当医疗补助扩大生效时）以及他们的状态是否扩大了医疗补助，对患者进行分组。多变量逻辑回归控制年龄，性别,种族,种族,和收入/教育被用来检查医疗补助扩展/保险状态和诊断阶段之间的关联，治疗,和生存。使用Kaplan-Meier分析检查总体和疾病特异性存活。
结果：分析包括10,164名患者。与2014年之前（4.8%，2014年后未参保患者比例下降（2.4%），P<.001)。2014年后，与扩张状态的患者相比，非扩张状态的患者更有可能被诊断为晚期疾病（N=2,364；OR=1.27，95％CI1.01-1.60）。在任何状态下没有保险都与诊断时的晚期疾病相关（OR=1.75，95％CI1.41-2.22）和疾病特异性死亡风险增加（HR=1.54，95％CI1.32-1.82）。生存指标与2014年前后的诊断或Medicaid扩展无关。
结论：缺乏保险或处于非扩张状态的患者更有可能出现晚期鼻癌。纵向研究应该验证这些发现。
方法：3喉镜，133:43-50,2023.
方法：队列研究。
方法：从美国国家癌症研究所监测中提取了2007年至2016年之间诊断为原发性鼻恶性肿瘤的患者，流行病学,结束结果(SEER)注册表。根据2014年之前和之后的诊断（当医疗补助扩大生效时）以及他们的状态是否扩大了医疗补助，对患者进行分组。多变量逻辑回归控制年龄，性别,种族,种族,和收入/教育被用来检查医疗补助扩展/保险状态和诊断阶段之间的关联，治疗,和生存。使用Kaplan-Meier分析检查总体和疾病特异性存活。
结果：分析包括10,164名患者。与2014年之前（4.8%，2014年后未参保患者比例下降（2.4%），P<.001)。2014年后，与扩张状态的患者相比，非扩张状态的患者更有可能被诊断为晚期疾病（N=2,364；OR=1.27，95％CI1.01-1.60）。在任何状态下没有保险都与诊断时的晚期疾病相关（OR=1.75，95％CI1.41-2.22）和疾病特异性死亡风险增加（HR=1.54，95％CI1.32-1.82）。生存指标与2014年前后的诊断或Medicaid扩展无关。
结论：缺乏保险或处于非扩张状态的患者更有可能出现晚期鼻癌。纵向研究应该验证这些发现。
方法：3喉镜，133:43-50,2023.
