文章：

医疗补助计划扩展提升结肠癌患者治疗率

Medicaid Expansion Increases Treatment for Patients with Colon Cancer

原文发布日期：10 January 2025

DOI: 10.3390/cancers17020207

类型: Article

开放获取: 是

英文摘要：

Introduction: Medicaid expansion (ME) has positively impacted colon cancer screening. ME’s effect on colon cancer treatment is less clear. This study analyses the effect of ME on patterns of colon cancer treatment. Methods: Patients with primary invasive colon cancer were identified using the Louisiana Tumor Registry. Patients diagnosed with colon cancer prior to ME (2014–2015) were compared to those diagnosed after (2017–2018). Coordinate variables were analyzed using Fisher’s exact test. Treatment status was modeled with multivariable logistic regression and the results are reported as adjusted odds ratios. Results: The proportion of uninsured patients decreased following ME (5.5 versus 1.9,p <0.001), with the greatest reductions among patients between 45 and 54 years old (13.5% to 3.5%,p <0.0001), African Americans (8.9 to 2.1%,p< 0.0001), and those in high-poverty neighborhoods (7.1 to 2.1%,p< 0.0001). Following ME, all patients with Stage I-III disease were more likely to receive surgery (OR = 1.95; 95%: CI 1.21–3.14)—especially the extremely impoverished (OR = 2.39; 95% CI 1.41–4.02). Young patients with Stage IV colon cancer were more likely to receive chemotherapy (OR-1.6; 95% CI 1.03–2.4). Patients with Stage IV colon cancer were less likely to receive treatment within 30 days of diagnosis (OR = 0.7; 95% CI 0.5–0.9), but, on subset analysis, this was only observed in non-Medicaid patients. Conclusion: ME is associated with increased treatment for patients with colon cancer, and it did not appear to affect time to treatment. However, it seems to affect different subsets of the population differently.

摘要翻译： 

引言：医疗补助计划扩展对结肠癌筛查产生了积极影响，但其对结肠癌治疗的影响尚不明确。本研究旨在分析医疗补助计划扩展对结肠癌治疗模式的影响。方法：通过路易斯安那州肿瘤登记处确定原发性浸润性结肠癌患者，将医疗补助计划扩展前（2014-2015年）与扩展后（2017-2018年）确诊的患者进行对比。采用Fisher精确检验分析分类变量，通过多变量逻辑回归模型评估治疗状况，结果以校正比值比呈现。结果：医疗补助计划扩展后未参保患者比例显著下降（5.5%降至1.9%，p<0.001），其中45-54岁患者（13.5%降至3.5%，p<0.0001）、非裔美国人（8.9%降至2.1%，p<0.0001）及高贫困社区人群（7.1%降至2.1%，p<0.0001）降幅最为显著。扩展后，所有I-III期患者接受手术的可能性均有所提高（OR=1.95；95%CI：1.21-3.14），极端贫困人群尤为明显（OR=2.39；95%CI：1.41-4.02）。IV期结肠癌年轻患者接受化疗的可能性更高（OR=1.6；95%CI：1.03-2.4）。IV期患者在确诊30天内接受治疗的可能性降低（OR=0.7；95%CI：0.5-0.9），但亚组分析显示该现象仅存在于非医疗补助参保患者中。结论：医疗补助计划扩展与结肠癌患者治疗率提升相关，且未影响治疗启动时间，但其对不同人群亚组的影响存在差异。

原文链接：

Medicaid Expansion Increases Treatment for Patients with Colon Cancer