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Affordable Care Act and cancer stage at diagnosis in an underserved population.
Lu, Yan; Jackson, Bradford E; Gehr, Aaron W; Cross, Deanna; Neerukonda, Latha; Tanna, Bhavna; Ghabach, Bassam; Ojha, Rohit P.
Afiliación
  • Lu Y; JPS Center for Outcomes Research, JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, United States of America. Electronic address: YLu01@JPSHealth.org.
  • Jackson BE; Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States of America.
  • Gehr AW; JPS Center for Outcomes Research, JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, United States of America.
  • Cross D; Institute of Molecular Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States of America.
  • Neerukonda L; JPS Center for Cancer Care, JPS Health Network, 610 W. Terrell Ave., Fort Worth, TX 76104, United States of America.
  • Tanna B; JPS Center for Cancer Care, JPS Health Network, 610 W. Terrell Ave., Fort Worth, TX 76104, United States of America.
  • Ghabach B; JPS Center for Cancer Care, JPS Health Network, 610 W. Terrell Ave., Fort Worth, TX 76104, United States of America.
  • Ojha RP; JPS Center for Outcomes Research, JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, United States of America; Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United State
Prev Med ; 126: 105748, 2019 09.
Article en En | MEDLINE | ID: mdl-31195020
The Patient Protection and Affordable Care Act (ACA) has increased insurance coverage among underserved individuals, but the effect of ACA on cancer diagnosis is currently debated, particularly in Medicaid non-expansion states. Therefore, we aimed to assess the effect of ACA implementation on stage at diagnosis among underserved cancer patients in Texas, a Medicaid non-expansion state. We used data from the institutional registry of the JPS Center for Cancer Care, which serves an urban population of underserved cancer patients. Eligible individuals were aged 18 to 64 years and diagnosed with a first primary invasive solid tumor between 2008 and 2015. We used a natural experiment framework and interrupted time-series analysis to assess level (i.e. immediate) and slope (over time) changes in insurance coverage and cancer stage at diagnosis between pre- and post-ACA periods. Our study population comprised 4808 underserved cancer patients, of whom 51% were racial/ethnic minorities. The prevalence of uninsured cancer patients did not immediately change after ACA implementation but modestly decreased over time (PR = 0.94; 95% CL: 0.90, 0.98). The prevalence of early- and advanced-stage diagnosis did not appreciably change overall or when stratified by screen-detectable cancers. Our results suggest that ACA implementation decreased the prevalence of uninsured cancer patients but had little effect on cancer stage at diagnosis in an underserved population. Given that Texas is a Medicaid non-expansion state, Medicaid expansion and alternative approaches may need to be further explored to improve earlier cancer diagnosis among underserved individuals.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pacientes no Asegurados / Detección Precoz del Cáncer / Patient Protection and Affordable Care Act / Grupos Minoritarios / Estadificación de Neoplasias / Neoplasias Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Determinantes_sociais_saude Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Prev Med Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pacientes no Asegurados / Detección Precoz del Cáncer / Patient Protection and Affordable Care Act / Grupos Minoritarios / Estadificación de Neoplasias / Neoplasias Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Determinantes_sociais_saude Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Prev Med Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos