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)

• 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
• 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' 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

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岁时被诊断出患有癌症）滞后 在改善年轻人和年龄较大人群中的癌症生存中。主要障碍 改善癌症结果是缺乏获得医疗保健的机会 该年龄段的不保险率很高。统一也驱动了 癌症生存中的社会人口统计学（种族/种族，社会经济，城市农村）差异， 总体和AYA人口。 《平价医疗法案》（ACA）为 各州将医疗补助覆盖范围扩大到收入≤138％的联邦贫困水平的成年人。 扩大医疗补助覆盖范围可以减少年轻人以及在 青少年通过向成年父母扩展覆盖范围。迄今为止，还没有事先 研究以检查ACA医疗补助扩张对增加取消访问的影响 护理或与早期检测，及时治疗和AYA的生存改善的关联。 我们将利用国家癌症数据库（NCDB）检查约246,000 AYAS的队列 在2010年至2016年之间在美国所有州和华盛顿州国家AYA中被诊断出患有癌症 队列将允许一种严格的准实验方法来确定ACA的净效应 医疗补助扩展对AYA的及时性，结果和公平性，以及8 最常见的癌症（女性乳腺癌，睾丸癌，黑色素瘤，大肠癌， 甲状腺癌，宫颈癌，霍奇金淋巴瘤和非霍奇金淋巴瘤）。 NCDB 在美国捕获> 80％的新AYA癌症病例，并将使我们能够产生 全国范围内对ACA医疗补助扩张对癌症结局的影响的估计， 包括治疗计划和生存时间。此外，我们将评估PRE和 社会人口统计学因素（种族/种族，社会经济地位， 城市农村）强调不同的结果。这项研究将为政策干预提供信息 癌症控制降低AYA癌症的差异。