PDF(Pubmed)
Abstract：
Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act\'s (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity.
Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage.
The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]).
While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA\'s Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage.
The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]).
While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA\'s Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
摘要：
背景：虽然可以通过筛查来预防，美国印第安人和阿拉斯加土著妇女（AIAN）的宫颈癌发病率和死亡率高于白人妇女。《患者保护和负担得起的医疗法案》（ACA）的医疗补助扩展可能会独特地影响AIAN女性宫颈癌筛查的获取和使用，并最终缓解这种差异。
方法：使用符合医疗补助标准的AIAN（N=4681）和白人（N=57,661）女性，年龄从2010-2020行为危险因素监测系统，我们实施了差异差异回归分析,以评估Medicaid扩展计划与遵循指南的宫颈癌筛查和医疗保健覆盖率之间的关联.
结果：Medicaid扩展与指南粘附性宫颈癌筛查无关（AIAN：-1个百分点[ppt][95％置信区间，CI：-4，2分]；白色：3分[95%CI：-0，6分])，但在过去5年中，白人女性进行了子宫颈抹片测试，增加了2ppt（95％CI：0，4ppt）。医疗补助计划的扩大还与健康计划的增加有关（AIAN：5分[95％CI：1，9]；白色：11分[95％CI：7，15]），以及由于费用而避免医疗的减少（AIAN：-8分[95％CI：-13，-2]；白色：-6分[95％CI：-9，-4]）。
结论：虽然我们观察到医疗保健覆盖率有所改善，我们没有观察到ACA的Medicaid扩展后指南粘附性宫颈癌筛查的变化.鉴于AIAN妇女中宫颈癌的负担不成比例，应优先确定改善宫颈癌筛查吸收和交付的方法，以减少可预防的死亡。
方法：使用符合医疗补助标准的AIAN（N=4681）和白人（N=57,661）女性，年龄从2010-2020行为危险因素监测系统，我们实施了差异差异回归分析,以评估Medicaid扩展计划与遵循指南的宫颈癌筛查和医疗保健覆盖率之间的关联.
结果：Medicaid扩展与指南粘附性宫颈癌筛查无关（AIAN：-1个百分点[ppt][95％置信区间，CI：-4，2分]；白色：3分[95%CI：-0，6分])，但在过去5年中，白人女性进行了子宫颈抹片测试，增加了2ppt（95％CI：0，4ppt）。医疗补助计划的扩大还与健康计划的增加有关（AIAN：5分[95％CI：1，9]；白色：11分[95％CI：7，15]），以及由于费用而避免医疗的减少（AIAN：-8分[95％CI：-13，-2]；白色：-6分[95％CI：-9，-4]）。
结论：虽然我们观察到医疗保健覆盖率有所改善，我们没有观察到ACA的Medicaid扩展后指南粘附性宫颈癌筛查的变化.鉴于AIAN妇女中宫颈癌的负担不成比例，应优先确定改善宫颈癌筛查吸收和交付的方法，以减少可预防的死亡。
