Impact of Affordable Care Act dependent coverage provision on cancer stage at diagnosis Open Access

Xiong, Ka Zang (2015)

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BACKGROUND: Young adults have traditionally been found to have the highest uninsured rate of any age group. On September 23rd, 2010, the Affordable Care Act (ACA) dependent coverage provision increased the age at which dependents can remain on their parents' insurance to 26. Post-expansion studies have found the general trend in improvement of insurance uptake and health service utilization. Previous studies have shown that insurance status was associated with cancer stage at diagnosis. This study looks at this relationship in terms of the ACA dependent coverage expansion in 2010.

METHODS: Data from the Surveillance Epidemiology and End Results Program in years 2008, 2009, and 2011, were used to estimate the average difference in early stage diagnosis (stages I and II) between 19-25 and 26-29 year olds pre- and post-ACA (n=17,891) within a difference-in-differences framework. This was repeated for cancers common in young adults (n=12,477). Models controlled for sex, race and ethnicity, age at diagnosis, residence in rural/urban county, marital status at diagnosis, and county-level % persons with less than a high school education.

RESULTS: The ACA dependent expansion provision increased early stage diagnosis in 19-25 year olds by 2.11 percentage points (95% CI: -0.96 to 5.18, p-value=0.1774). After adjustment, the proportion of early stage diagnosis increase was 1.97 percentage points (95% CI: -1.12 to 5.05, p value=0.2118). Analyzing just cancers common in AYA, the proportion of early stage diagnosis was 2.61 (95% CI: -0.53 to 5.74, p-value=0.1032), and after adjustment, 2.61 (95% CI: -0.24 to 6.08, p-value=0.0701).

CONCLUSIONS: Early stage cancer diagnosis increased in 19-25 year olds analyzing all cancers and all cancers common in young adults, although none of the estimates were statistically significant. However, there is a general trend in the increase of the proportion of early stage diagnosis in 19-25 year olds after the ACA dependent coverage expansion in 2010. Future studies with more updated data are necessary to assess the impact of coverage expansion on stage at cancer diagnosis in the target young adult population.

Table of Contents

Background/Literature Review. 1

Methods. 7

Results. 11

Discussion. 17

References. 19

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