Evaluating the Impact of Medicaid Dental Coverage on Early-Stage Oral Cancer Detection

评估医疗补助牙科保险范围对早期口腔癌检测的影响

基本信息

批准号：
10652997
负责人：
Jason Semprini
金额：
$ 1.84万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2023-08-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10652997
关键词：
Accounting Address Adult Affect Back California Cancer Control Cancer Detection Characteristics Collaborations Complex County Data Data Files Data Set Dedications Dental Dental Care Dentistry Dentists Detection Diagnosis Disease Drops Early Diagnosis Economics Enrollment Exposure to Face Future Goals Hawaii Health Insurance Health Policy Health Services Accessibility Incidence Insurance Interdisciplinary Study Iowa Knowledge Link Literature Low income Malignant Neoplasms Measures Mediating Medicaid Mentors Mentorship Methodology Methods Modeling Oral Stage Oral health Outcome Physicians Policies Population Probability Provider Public Health Quality of life Race Research Research Methodology Research Personnel Rest Risk Factors Role SEER Program Sampling Screening for Oral Cancer Selection Bias Staging Subgroup System Testing Time Training Universities Utah Variant beneficiary cancer diagnosis cancer health disparity career college data quality data registry design health care service health equity high risk improved malignant mouth neoplasm mortality neoplasm registry novel participant enrollment population based population health prevent prognostic of survival programs routine screening rurality screening sex skills sociodemographic factors standard of care

项目摘要

ABSTRACT Oral cancer kills more than 10,000 adults each year. Earlier detection could improve survival and quality of life, but less than 30% of oral cancers are detected at early stages. While previous research has investigated whether access to health insurance could lead to earlier detection, my preliminary evidence suggests these previous studies miss a critical feature of oral cancer control: access to dental services. Physicians are not recommended to systematically screen for oral cancer, whereas dentists routinely screen for oral cancer as standard of care. My preliminary findings affirm the critical role of dentists in oral cancer control systems. Yet, despite the importance of dental services for detecting oral cancer early, low-income adults face financial barriers to accessing dental services. In fact, the lack of affordable dental coverage leads adults to delay or forgo necessary dental care more than any other healthcare service. Medicaid has filled the dental coverage gap for many adults, but states are not required to provided dental benefits to their adult Medicaid beneficiaries. Consequently, adult Medicaid dental programs have changed over time and vary by state. The volatility of Medicaid dental coverage could be further exacerbating delays in oral cancer detection for low-income adults. To inform policies improving population oral health, this proposal evaluates the impact of access to Medicaid dental services on early-stage oral cancer. Under guided mentorship, I will be among the first to evaluate Medicaid dental policies by analyzing population-based cancer registry data. This novel data includes verified Medicaid enrollment indicators, allowing me to select a valid sample of low-income adults. Aim 1 hypothesizes that Medicaid enrollees exposed to a change in state-level Medicaid dental coverage will change their probability of being diagnosed with oral cancer at an early-stage. Using advances in causal inference methodology, this aim leverages the longitudinal and state-by-state variation of adult Medicaid dental policies to avoid selection bias confounding our estimates. Next, we aim to infer an effect of access to Medicaid dental services on early-stage diagnoses by accounting for county-level dentists per capita. Aim 2 hypothesizes that the effect of changing Medicaid dental coverage on the probability of an early-stage diagnosis is mediated by the number of available dentists. Both research aims will improve the field’s knowledge of oral cancer disparities by identifying heterogenous effects and testing for effect differences across cancer characteristics, sociodemographic factors, and rurality status. By quantifying how access to dental coverage and dental providers affects early-stage oral cancer diagnoses, our evidence will advance policies aiming to control and prevent oral cancer mortality by increasing early detection. Future research can then identify how to alleviate any remaining early-stage oral cancer detection gaps. Collaborating with my interdisciplinary research team at the University of Iowa College of Public Health and College of Dentistry will advance my career as an independent investigator.

抽象的口腔癌每年杀死10,000多名成年人。较早的检测可以提高生存和质量生命，但在早期阶段发现了不到30％的口服癌症。虽然先前的研究已经调查我的初步证据表明，获得健康保险是否可能导致较早发现先前的研究错过了口腔癌控制的关键特征：获得牙科服务。医师不是建议系统地筛查口腔癌，而牙医通常将口腔癌筛选为护理标准。我的初步发现肯定了牙医在口腔癌控制系统中的关键作用。然而，尽管牙科服务对于早期检测口腔癌很重要，但低收入成年人面临财务获得牙科服务的障碍。实际上，缺乏负担得起的牙齿覆盖范围会导致成年人延迟或放弃比其他任何医疗服务都要多必要的牙科护理。医疗补助填补了牙科覆盖差距许多成年人，但不需要各州为其成人医疗补助受益人提供牙科福利。因此，成人医疗补助牙科计划随着时间的流逝而变化，并且因州而异。波动性医疗补助牙齿覆盖范围可能会进一步加剧低收入成年人口腔癌检测的延迟。为了为改善人口健康的政策提供信息，该提案评估了在早期口腔癌中获得医疗补助牙科服务。在指导的指导下，我将在第一个通过分析基于人群的癌症注册表数据来评估医疗补助牙科政策的公司之一。这新数据包括经过验证的医疗补助注册指标，使我可以选择有效的低收入样本成年人。 AIM 1假设医疗补助招募了发生变化的州级医疗补助牙科覆盖范围将改变他们在早期诊断患有口腔癌的可能性。利用催化的进步推论方法，此目标利用了成人医疗补助的纵向和州的纵向变化避免选择偏见的牙科政策会使我们的估计混淆。接下来，我们旨在推断出访问的影响医疗补助牙科服务在早期诊断方面，通过计算人均县级牙齿。目标2 假设改变医疗补助牙齿覆盖范围对早期诊断可能性的影响由可用牙医的数量介导。这两种研究目标都将改善该领域的口头知识癌症分布通过鉴定异源作用并测试癌症的影响差异特征，社会人口统计学因素和粗糙度状态。通过量化如何获得牙齿覆盖范围和牙科提供者会影响早期口腔癌的诊断，我们的证据将促进政策旨在控制并通过增加早期检测来预防口腔癌死亡率。然后，未来的研究可以确定如何减轻任何剩余的早期口腔癌检测差距。与我的跨学科研究合作爱荷华大学公共卫生学院和牙科学院的团队将促进我的职业生涯独立研究者。