PDF(Pubmed)
Abstract：
BACKGROUND: The Affordable Care Act expanded Medicaid coverage for people with low income in the United States. Expanded insurance coverage could promote more timely access to cancer treatment, which could improve overall survival (OS), yet the long-term effects of Medicaid expansion (ME) remain unknown. We evaluated whether ME was associated with improved timely treatment initiation (TTI) and 3-year OS among patients with breast, cervical, colon, and lung cancers who were affected by the policy.
METHODS: Medicaid-insured or uninsured patients aged 40-64 with stage I-III breast, cervical, colon, or non-small cell lung cancer within the National Cancer Database (NCDB). A difference-in-differences (DID) approach was used to compare changes in TTI (within 60 days) and 3-year OS between patients in ME states versus nonexpansion (NE) states before (2010-2013) and after (2015-2018) ME. Adjusted DID estimates for TTI and 3-year OS were calculated using multivariable linear regression and Cox proportional hazards regression models, respectively.
RESULTS: ME was associated with a relative increase in TTI within 60 days for breast (DID = 4.6; p < 0.001), cervical (DID = 5.0 p = 0.013), and colon (DID = 4.0, p = 0.008), but not lung cancer (p = 0.505). In Cox regression analysis, ME was associated with improved 3-year OS for breast (DID hazard ratio [HR] = 0.82, p = 0.009), cervical (DID-HR = 0.81, p = 0.048), and lung (DID-HR = 0.87, p = 0.003). Changes in 3-year OS for colon cancer were not statistically different between ME and NE states (DID-HR, 0.77; p = 0.075).
CONCLUSIONS: Findings suggest that expanded insurance coverage can improve treatment and survival outcomes among low income and uninsured patients with cancer. As the debate surrounding ME continues nationwide, our findings serve as valuable insights to inform the development of policies aimed at fostering accessible and affordable healthcare for all.
METHODS: Medicaid-insured or uninsured patients aged 40-64 with stage I-III breast, cervical, colon, or non-small cell lung cancer within the National Cancer Database (NCDB). A difference-in-differences (DID) approach was used to compare changes in TTI (within 60 days) and 3-year OS between patients in ME states versus nonexpansion (NE) states before (2010-2013) and after (2015-2018) ME. Adjusted DID estimates for TTI and 3-year OS were calculated using multivariable linear regression and Cox proportional hazards regression models, respectively.
RESULTS: ME was associated with a relative increase in TTI within 60 days for breast (DID = 4.6; p < 0.001), cervical (DID = 5.0 p = 0.013), and colon (DID = 4.0, p = 0.008), but not lung cancer (p = 0.505). In Cox regression analysis, ME was associated with improved 3-year OS for breast (DID hazard ratio [HR] = 0.82, p = 0.009), cervical (DID-HR = 0.81, p = 0.048), and lung (DID-HR = 0.87, p = 0.003). Changes in 3-year OS for colon cancer were not statistically different between ME and NE states (DID-HR, 0.77; p = 0.075).
CONCLUSIONS: Findings suggest that expanded insurance coverage can improve treatment and survival outcomes among low income and uninsured patients with cancer. As the debate surrounding ME continues nationwide, our findings serve as valuable insights to inform the development of policies aimed at fostering accessible and affordable healthcare for all.
摘要：
背景：《平价医疗法案》扩大了美国低收入人群的医疗补助覆盖范围。扩大保险范围可以促进更及时地获得癌症治疗，这可以提高总生存率(OS)，然而，医疗补助扩大（ME）的长期影响仍然未知。我们评估了乳腺癌患者的ME是否与改善的及时治疗开始（TTI）和3年OS相关，子宫颈,结肠,和受政策影响的肺癌。
方法：医疗补助保险或未保险的患者，年龄在40-64岁，患有I-III期乳房，子宫颈,结肠,或国家癌症数据库（NCDB）中的非小细胞肺癌。使用差异差异（DID）方法比较ME状态患者与非扩张（NE）状态患者之间TTI（60天内）和3年OS的变化（2010-2013年）和（2015-2018年）ME之前。使用多变量线性回归和Cox比例风险回归模型计算TTI和3年OS的调整后DID估计值，分别。
结果：ME与60天内乳腺TTI的相对增加相关（DID=4.6；p<0.001），宫颈（DID=5.0p=0.013），和冒号（DID=4.0，p=0.008），但不是肺癌（p=0.505）。在Cox回归分析中，ME与改善乳房的3年OS相关（DID危险比[HR]=0.82，p=0.009），宫颈（DID-HR=0.81，p=0.048），和肺(DID-HR=0.87,p=0.003)。结肠癌的3年OS变化在ME和NE状态之间没有统计学差异(DID-HR，0.77；p=0.075）。
结论：研究结果表明，扩大保险范围可以改善低收入和无保险癌症患者的治疗和生存结果。随着围绕我的辩论在全国范围内继续，我们的研究结果为制定旨在促进人人享有和负担得起的医疗保健的政策提供了宝贵的见解。
方法：医疗补助保险或未保险的患者，年龄在40-64岁，患有I-III期乳房，子宫颈,结肠,或国家癌症数据库（NCDB）中的非小细胞肺癌。使用差异差异（DID）方法比较ME状态患者与非扩张（NE）状态患者之间TTI（60天内）和3年OS的变化（2010-2013年）和（2015-2018年）ME之前。使用多变量线性回归和Cox比例风险回归模型计算TTI和3年OS的调整后DID估计值，分别。
结果：ME与60天内乳腺TTI的相对增加相关（DID=4.6；p<0.001），宫颈（DID=5.0p=0.013），和冒号（DID=4.0，p=0.008），但不是肺癌（p=0.505）。在Cox回归分析中，ME与改善乳房的3年OS相关（DID危险比[HR]=0.82，p=0.009），宫颈（DID-HR=0.81，p=0.048），和肺(DID-HR=0.87,p=0.003)。结肠癌的3年OS变化在ME和NE状态之间没有统计学差异(DID-HR，0.77；p=0.075）。
结论：研究结果表明，扩大保险范围可以改善低收入和无保险癌症患者的治疗和生存结果。随着围绕我的辩论在全国范围内继续，我们的研究结果为制定旨在促进人人享有和负担得起的医疗保健的政策提供了宝贵的见解。
