Impact of the Affordable Care Act and Medicaid Expansion Among Patients With HIV-Associated Aggressive B-Cell Non-Hodgkin Lymphomas.

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2024-10-17 DOI:10.1200/OP.24.00354
Naveen Premnath, Yulun Liu, Heather Reves, Urvashi Pandey, Rasmi G Nair, Julia Anderson, Aimaz Afrough, Larry D Anderson, Stephen S Chung, Gurbakhash Kaur, Adeel M Khan, Kiran A Kumar, Yazan F Madanat, Heather R Wolfe, Elif Yilmaz, Farrukh T Awan, John Sweetenham, Praveen Ramakrishnan Geethakumari
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Abstract

Purpose: To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma.

Methods: We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion.

Results: We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02).

Conclusion: Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.

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平价医疗法案》和医疗补助扩展对艾滋病毒相关侵袭性 B 细胞非霍奇金淋巴瘤患者的影响。
目的:研究《可负担医疗法案》(ACA)政策及其医疗补助扩展对侵袭性淋巴瘤艾滋病患者的保险状况和生存期的影响:我们利用基于医院的国家癌症数据库(National Cancer Database)对 2007 年至 2016 年期间确诊的 18-64 岁成人艾滋病相关侵袭性 B 细胞非霍奇金淋巴瘤(HIV-a-B-NHL)患者进行了鉴定。我们对居住在医疗补助扩容州和非扩容州、有所在地数据的 HIV-a-B-NHL 患者子集进行了生存分析。采用准实验性差异模型,比较了采用 ACA 扩大医疗补助计划的州与未采用该计划的州调整后 2 年生存率的差异:我们确定了 8,231 名艾滋病毒-a-B-NHL 患者和 50,650 名非艾滋病毒 a-B-NHL 患者。我们发现,与未扩大医保范围的州相比,扩大医保范围的州在确诊时未参加医保的人数比例较低。我们还发现,在采用 ACA 政策的州,未参保的艾滋病 a-B-NHL 患者比例在扩展州降低了 34.9%,而在未采用扩展政策的州,这一比例仅为 15.9%。在采用 ACA 后,扩大保险范围的州与未扩大保险范围的州相比,HIV-a-B-NHL 患者的 2 年存活率有了统计学意义上的显著提高(7.17% 对 1.58%,P = .02):通过使用一种新颖的准实验模型,我们发现,与未实行医疗补助扩展的州相比,在实行 ACA 政策的州内,HIV-a-B-NHL 患者的生存率得到了更大的改善。我们认为,在未来的政策制定中应考虑到这一证据。
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