引言胃癌,一个重大的公共卫生问题,仍然是最具挑战性的恶性肿瘤之一,以有效地治疗。在美国,胃癌的生存率历来很低,部分原因是晚期诊断和获得护理的差距。《平价医疗法案》(ACA)试图通过扩大医疗保健覆盖面和改善获得预防和早期治疗服务的机会来解决这种差距。目的本研究旨在确定ACA实施对胃癌生存率的因果影响,专注于美国两个不同州之间的比较分析:新泽西州,完全接受ACA条款,格鲁吉亚,它没有采取这项政策,截至2023年。方法回顾性分析,我们利用了监控的数据,流行病学,和最终结果计划(SEER)注册表,以评估ACA对胃癌患者癌症特异性生存率(CSS)的影响。该研究涵盖了2000年至2020年的时期,分为ACA前(2000-2013年)和ACA后(2016-2020年),为期两年的清洗(2013-2015)。我们使用差异差异(DiD)方法将佐治亚州(非扩张状态)与新泽西州(自2014年以来的扩张状态)进行了比较。我们根据病人的人口统计进行了调整,收入,大都市地位,疾病阶段,和治疗方式。结果在25,061例患者中,58.7%在新泽西州(14,711),而41.3%在格鲁吉亚(10,350)。ACA前期包括18,878名患者(佐治亚州为40.0%,新泽西州为60.0%),6,183例患者处于ACA后阶段(乔治亚州占45.2%,新泽西州占54.8%)。在胃癌患者中,ACA后时期与死亡率风险降低20%相关。无论居住状态如何(HR=0.80,95%CI:0.73-0.88)。与ACA后居住在佐治亚州的患者相比,新泽西州居民的患者的死亡率降低了12%(HR=0.88,95%CI:0.78-0.99)。与生存结果改善相关的其他因素包括手术(OR=0.30,95%CI:0.28-0.34)和女性(OR=0.83,95%CI:0.76-0.91)。结论本研究强调了ACA对胃癌患者CSS的潜在积极影响,强调医疗政策干预对改善患者预后的重要性。
Introduction Gastric cancer, a significant public health concern, remains one of the most challenging malignancies to treat effectively. In the United States, survival rates for gastric cancer have historically been low, partly due to late-stage diagnosis and disparities in access to care. The Affordable Care Act (ACA) sought to address such disparities by expanding healthcare coverage and improving access to preventive and early treatment services. Objective This study aims to determine the causal effects of the ACA\'s implementation on gastric cancer survival rates, focusing on a comparative analysis between two distinct U.S. states: New Jersey, which fully embraced ACA provisions, and Georgia, which has not adopted the policy, as of 2023. Methods In this retrospective analysis, we utilized data from the Surveillance, Epidemiology, and End Results Program (SEER) registry to assess the impact of the ACA on cancer-specific survival (CSS) among gastric cancer patients. The study spanned the period from 2000 to 2020, divided into pre-ACA (2000-2013) and post-ACA (2016-2020) periods, with a two-year washout (2013-2015). We compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014) using a Difference-in-Differences (DiD) approach. We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. Results Among 25,061 patients, 58.7% were in New Jersey (14,711), while 41.3% were in Georgia (10,350). The pre-ACA period included 18,878 patients (40.0% in Georgia and 60.0% in New Jersey), and 6,183 patients were in the post-ACA period (45.2% in Georgia and 54.8% in New Jersey). The post-ACA period was associated with a 20% reduction in mortality hazard among gastric cancer patients, irrespective of the state of residence (HR = 0.80, 95% CI: 0.73-0.88). Patients who were residents of New Jersey experienced a 12% reduction in mortality hazard compared to those who resided in Georgia in the post-ACA period (HR = 0.88, 95% CI: 0.78-0.99). Other factors linked to improved survival outcomes included surgery (OR = 0.30, 95% CI: 0.28-0.34) and female gender (OR=0.83, 95% CI: 0.76-0.91). Conclusion The study underscores the ACA\'s potential positive impact on CSS among gastric cancer patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.