Stage at diagnosis and survival among adolescents and young adults with lymphomas following the Affordable Care Act implementation in California

2021 ◽  
Author(s):  
Renata Abrahão ◽  
Julianne J.P. Cooley ◽  
Frances B. Maguire ◽  
Arti Parikh‐Patel ◽  
Cyllene R. Morris ◽  
...  
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
Adolescents And Young Adults ◽  
Stage At Diagnosis ◽  
The Affordable Care Act

Association of the Affordable Care Act with survival among adolescents and young adults with lymphomas in California.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6532-6532
Author(s):  
Renata Abrahão ◽  
Julianne J.P. Cooley ◽  
Frances Belda Maguire ◽  
Cyllene Morris ◽  
Arti Parikh-Patel ◽  
...  
Keyword(s):  
Young Adults ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Adolescents And Young Adults ◽  
Stage At Diagnosis ◽  
Medicaid Enrollment ◽  
Race Ethnicity ◽  
The Affordable Care Act

6532 Background: Our recent study showed that the implementation of the Affordable Care Act (ACA) was associated with increased health insurance coverage among adolescents and young adults (AYAs, 15–39 years) diagnosed with lymphomas in California and decreased likelihood of late stage at diagnosis. However, AYAs of Black or Hispanic race/ethnicity (vs Whites) and those living in lower socioeconomic (SES) neighborhoods were at higher risk of presenting with advanced stage. We aimed to determine whether the increased insurance coverage under the ACA was associated with improved survival, and to identify the main predictors of survival among AYAs with lymphomas. Methods: We used data from the California Cancer Registry linked to Medicaid enrollment files on AYAs diagnosed with a primary non-Hodgkin (NHL) or Hodgkin (HL) lymphoma during March 2005–September 2010 (pre-ACA), October 2010–December 2013 (early ACA) or 2014–2017 (full ACA). Patients were followed from lymphoma diagnosis until death, loss to follow-up or end of the study (12/31/2018). Health insurance was categorized as continuous Medicaid, discontinuous Medicaid, Medicaid enrollment at diagnosis/uninsured, other public or private. We used multivariable Cox proportional regression to examine the associations between all-cause survival and era of diagnosis, adjusting for sex, age and stage at diagnosis, health insurance, race/ethnicity, neighborhood SES, treatment facility, comorbidities, and marital status. Results: Of 11,221 AYAs, 5,878 were diagnosed with NHL and 5,343 with HL. Most patients were male (56%), White (45%), presented with earlier stage (I/II, 56%), and had private insurance (57%). The proportion of AYAs who received initial care at National Cancer Institute-Designated Cancer Centers (NCI-CCs) increased from 24% pre-ACA to 31% after full ACA implementation (p < 0.001). AYAs diagnosed in the early (aHR = 0.76, 95% CI 0.67–0.88) and full ACA (aHR = 0.55, 95%CI 0.47–0.64) eras had better survival than those diagnosed pre-ACA. Compared to those with private insurance, survival was worse among patients with no insurance (HR = 2.13, 95% CI 1.83–2.49), discontinuous Medicaid (HR = 2.17, 95% CI 1.83–2.56) and continuous Medicaid (HR = 1.93, 95% CI 1.63–2.29) at diagnosis. Regardless of their insurance, older AYAs, males, unmarried, those with later stage (II–IV), residents in lower SES neighborhoods, and those of Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native race/ethnicity experienced worse survival. Conclusions: Following the ACA implementation in California, AYAs diagnosed with lymphomas experienced increased access to care at NCI-CCs and improved survival. Yet, racial/ethnic and socioeconomic survival disparities persisted. Moving forward, policy actions are required to mitigate structural and social determinants of health disparities in this population.

scholarly journals The Affordable Care Act and Cancer Stage at Diagnosis Among Young Adults

2016 ◽  
Vol 108 (9) ◽  
pp. djw058 ◽  
Author(s):  
Xuesong Han ◽  
Ka Zang Xiong ◽  
Michael R. Kramer ◽  
Ahmedin Jemal
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
The Affordable Care Act

scholarly journals The Affordable Care Act and Adolescents and Young Adults With Cancer

JAMA Oncology ◽  
2018 ◽  
Vol 4 (8) ◽  
pp. 1043 ◽  
Author(s):  
Peter Hsu ◽  
John A. Graves
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
Adolescents And Young Adults ◽  
The Affordable Care Act

Impacts of the Affordable Care Act Dependent Coverage Provision on Young Adults With Cancer

2019 ◽  
Vol 56 (5) ◽  
pp. 716-726 ◽  
Author(s):  
Justin M. Barnes ◽  
Jenine K. Harris ◽  
Derek S. Brown ◽  
Allison King ◽  
Kimberly J. Johnson
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Dependent Coverage

scholarly journals Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults

2012 ◽  
Vol 47 (5) ◽  
pp. 1773-1790 ◽  
Author(s):  
Joel C. Cantor ◽  
Alan C. Monheit ◽  
Derek DeLia ◽  
Kristen Lloyd
Keyword(s):  
Young Adults ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The Affordable Care Act

Impact of the Affordable Care Act on early-stage diagnosis and treatment for women with ovarian cancer.

2019 ◽  
Vol 37 (18_suppl) ◽  
pp. LBA5563-LBA5563
Author(s):  
Anna Jo Smith ◽  
Amanda Nickels
Keyword(s):  
Ovarian Cancer ◽  
Affordable Care Act ◽  
Early Stage ◽  
Stage At Diagnosis ◽  
Time To Treatment ◽  
Academic Center ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Affordable Care Act ◽  
The Impact

LBA5563 Background: The 2010 Affordable Care Act (ACA) expanded access to insurance and care for many Americans. Our objective was to evaluate the impact of the ACA on stage at diagnosis and time to treatment for women with ovarian cancer. Methods: We utilized a difference-in-differences (DD) approach to assess stage at diagnosis and time to treatment before and after the 2010 ACA among women with ovarian cancer ages 21-64 years compared to women ages 65 years and older. We used the National Cancer Database with the 2004-2009 surveys as the pre-reform years and the 2011-2014 surveys as the post-reform years. Outcomes were analyzed for women overall and by insurance type, adjusting for patient race, living in a rural area, area-level household income and education level, Charlson co-morbidity score, distance traveled for care, Census region, and care at an academic center. Results: A total of 35,842 ovarian cancer cases pre-reform and 37,145 post-reform were identified for women 21-64 years compared with 28,895 cases pre-reform and 30,604 post-reform for women 65 years and older. The ACA was associated with increased early-stage diagnosis for women 21-64 years compared to women 65 and older with ovarian cancer (DD=1.7%, p-for-trend=0.001). Additionally, the ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (DD=1.6%, p<0.001). Specifically, among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (DD=2.5%, p=0.003 and DD=2.5%, p=0.006). Improvements in stage at diagnosis and time to treatment were seen across race, income, and education groups. Conclusions: Under the Affordable Care Act, women with ovarian cancer were more likely to be diagnosed at an early stage and receive treatment within 30 days of diagnosis. As stage and treatment are major determinants of survival, these gains under the ACA may have long-term impacts on women with ovarian cancer.

scholarly journals Young Adults' Health Care Utilization and Expenditures Prior to the Affordable Care Act

2014 ◽  
Vol 54 (6) ◽  
pp. 663-671 ◽  
Author(s):  
Josephine S. Lau ◽  
Sally H. Adams ◽  
W. John Boscardin ◽  
Charles E. Irwin
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Health Care Utilization ◽  
Affordable Care Act ◽  
Care Utilization ◽  
The Affordable Care Act
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