Understanding the impact of the Affordable Care Act on cancer treatment and outcomes for adolescents and young adults (AYA)

了解《平价医疗法案》对青少年和年轻人的癌症治疗和结果的影响 (AYA)

基本信息

批准号：
10201216
负责人：
SHARON MARIE CASTELLINO
金额：
$ 8.58万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-03-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10201216
关键词：
Adolescent Adolescent and Young Adult Adult Affordable Care Act Age Attention COVID-19 pandemic Cancer Control Cancer Intervention Cancer Patient Cessation of life Childhood Cohort Studies Colorectal Cancer Data Databases Development Diagnosis Early Diagnosis Economics Ethnic Origin Female Breast Carcinoma Funding Opportunities Future Geographic state Health Health Care Reform Health Insurance Health Services Accessibility Hodgkin Disease Improve Access Income Insurance Coverage Intervention Lead Life Literature Malignant Neoplasms Malignant neoplasm of cervix uteri Malignant neoplasm of testis Malignant neoplasm of thyroid Manuscripts Medicaid Non-Hodgkin&apos s Lymphoma Older Population Outcome Parents Patients Policies Population Population Research Preventive Public Health Quasi-experiment Race Research Risk Role Rural Screening for cancer Socioeconomic Status Stage at Diagnosis Survival Rate Testing Time Treatment outcome Underinsured Uninsured Youth age group cancer care cancer diagnosis cancer health disparity cancer survival cancer therapy cancer type cohort disease diagnosis disparity reduction federal poverty level health care availability improved melanoma mortality risk patient population pressure racial and ethnic rural disparities secondary analysis social sociodemographic factors sociodemographic group sociodemographics socioeconomics young adult

项目摘要

Adolescents and young adults (AYAs; diagnosed with cancer at ages 15-39 years) have lagged in improvements in cancer survival seen among younger and older populations. A major barrier to improvement in cancer outcomes is the lack of access to healthcare, historically associated with the high rates of uninsurance in this age group. Uninsurance also drives the sociodemographic (racial/ethnic, socioeconomic, urban-rural) disparities in cancer survival, overall and among AYA populations. The Affordable Care Act (ACA) provides an option for states to expand Medicaid coverage to adults with income ≤138% of the federal poverty level. Expanding Medicaid coverage can reduce uninsurance in young adults, as well as in adolescents via extending coverage to their adult parents. To date, there has been no prior study to examine the impact of the ACA Medicaid expansion on increasing access to cancer care or its association with early detection, timely treatment, and survival improvement in AYAs. We will utilize the National Cancer Database (NCDB) to examine a cohort of ~246,000 AYAs diagnosed with cancer between 2010 and 2016 across all US states and D.C. The national AYA cohort will allow a rigorous, quasi-experimental approach to determine the net effect of the ACA Medicaid expansion on the timeliness, outcome, and equity of cancer care for AYAs with the 8 most common cancers (female breast cancer, testis cancer, melanoma, colorectal cancer, thyroid cancer, cervical cancer, Hodgkin lymphoma, and non-Hodgkin lymphoma). The NCDB captures >80% of all new AYA cancer cases in the US, and will enable us to generate nationwide estimates of the impact of the ACA Medicaid expansion on cancer outcomes, including time to treatment initiation and survival. In addition, we will evaluate the cohort pre and post Medicaid expansion by sociodemographic factors (race/ethnicity, socioeconomic status, urban-rural) to underline disparate outcomes. This research will inform policy interventions for cancer control toward reducing disparities in AYA cancer.

青少年和年轻人（AYA；在 15-39 岁被诊断患有癌症）已经滞后年轻人和老年人癌症生存率的改善是一个主要障碍。癌症结果的改善是缺乏获得医疗保健的机会，这在历史上是相关的这个年龄段的高无保险率也推动了这一趋势。癌症生存率的社会人口（种族/民族、城市、城乡）差异，总体而言，以及 AYA 人群中，平价医疗法案 (ACA) 为以下人群提供了一个选择：各州将医疗补助覆盖范围扩大到收入≤联邦贫困线 138% 的成年人。扩大医疗补助覆盖范围可以减少年轻人以及老年人的无保险情况迄今为止，还没有通过将覆盖范围扩大到成年父母来覆盖青少年的情况。研究探讨 ACA 医疗补助扩大对增加癌症治疗机会的影响护理或其与 AYA 早期发现、及时治疗和生存改善的关系。我们将利用国家癌症数据库 (NCDB) 来检查约 246,000 名 AYA 的队列 2010 年至 2016 年间，美国各州和华盛顿特区被诊断患有癌症的人。队列将允许采用严格的、准实验性的方法来确定 ACA 的净效应医疗补助扩大了 AYA 癌症护理的及时性、结果和公平性，包括 8 个项目最常见的癌症（女性乳腺癌、睾丸癌、黑色素瘤、结直肠癌、甲状腺癌、宫颈癌、霍奇金淋巴瘤和非霍奇金淋巴瘤）。捕获了美国所有新 AYA 癌症病例的 80% 以上，并使我们能够产生 ACA 医疗补助扩大对癌症结果影响的全国估计，包括治疗开始时间和生存时间。此外，我们将评估队列的治疗前和生存期。医疗补助扩大后的社会人口因素（种族/民族、社会人口状况、城乡），以强调不同的结果。这项研究将为政策干预提供信息。癌症控制旨在减少 AYA 癌症的差异。