Abstract：
Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC.
This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis.
The study included 4991 (92.3% White, n = 4605; 7.7% Black, n = 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black-White patient disparity in timely receipt of MIBC treatment (95% confidence interval = 0.5% to 26.8%; P < .01).
Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis.
The study included 4991 (92.3% White, n = 4605; 7.7% Black, n = 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black-White patient disparity in timely receipt of MIBC treatment (95% confidence interval = 0.5% to 26.8%; P < .01).
Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
摘要：
背景：多学科癌症治疗（新辅助化疗+根治性膀胱切除术（NAC+RC）或三联疗法（TMT））对于肌层浸润性膀胱癌（MIBC）的预后至关重要，一种可能可以治愈的疾病.通过平价医疗法案（ACA）扩大医疗补助增加了保险范围，尤其是在少数民族患者中。这项研究旨在调查MIBC中医疗补助扩大与及时治疗的种族差异之间的关系。
方法：这项准实验研究分析了18-64岁的患有II期和III期膀胱癌的黑人和白人，这些人接受了2008-2018年国家癌症数据库的NACRC或TMT治疗。主要结果是在癌症诊断后45天内开始及时治疗。种族差异是黑人和白人患者之间的百分比差异。使用差异差异（DID）和差异差异差异（DDD）分析比较扩张和非扩张状态的患者，控制年龄，性别,地区一级收入，临床分期,合并症，大都市地位，治疗类型,和诊断年份。
结果：该研究包括4991名患者（92.3％的白人，N=4605；7.7%黑色，N=386）。在Medicaid扩展状态下，ACA后，黑人患者接受及时护理的百分比增加（ACA前的54.5％对ACA后的57.4％），而在非扩展状态下则减少（ACA前的69.9％对ACA后的53.7％）。调整协变量后，医疗补助扩大与及时接受MIBC治疗的黑白差异净减少13.7个百分点相关(95CI:0.5%-26.8%;p<.01)。
结论：在MIBC的及时多学科治疗中，扩大医疗补助与黑人和白人患者之间种族差异的统计学显著减少相关。
方法：这项准实验研究分析了18-64岁的患有II期和III期膀胱癌的黑人和白人，这些人接受了2008-2018年国家癌症数据库的NACRC或TMT治疗。主要结果是在癌症诊断后45天内开始及时治疗。种族差异是黑人和白人患者之间的百分比差异。使用差异差异（DID）和差异差异差异（DDD）分析比较扩张和非扩张状态的患者，控制年龄，性别,地区一级收入，临床分期,合并症，大都市地位，治疗类型,和诊断年份。
结果：该研究包括4991名患者（92.3％的白人，N=4605；7.7%黑色，N=386）。在Medicaid扩展状态下，ACA后，黑人患者接受及时护理的百分比增加（ACA前的54.5％对ACA后的57.4％），而在非扩展状态下则减少（ACA前的69.9％对ACA后的53.7％）。调整协变量后，医疗补助扩大与及时接受MIBC治疗的黑白差异净减少13.7个百分点相关(95CI:0.5%-26.8%;p<.01)。
结论：在MIBC的及时多学科治疗中，扩大医疗补助与黑人和白人患者之间种族差异的统计学显著减少相关。
