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Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act

BACKGROUND: Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. METHODS: Men with intermediate‐ and high‐risk...

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Autores principales: Janopaul‐Naylor, James R., Corriher, Taylor J., Switchenko, Jeffrey, Hanasoge, Sheela, Esdaille, Ashanda, Mahal, Brandon A., Filson, Christopher P., Patel, Sagar A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10523962/
https://www.ncbi.nlm.nih.gov/pubmed/37537835
http://dx.doi.org/10.1002/cam4.6419
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author Janopaul‐Naylor, James R.
Corriher, Taylor J.
Switchenko, Jeffrey
Hanasoge, Sheela
Esdaille, Ashanda
Mahal, Brandon A.
Filson, Christopher P.
Patel, Sagar A.
author_facet Janopaul‐Naylor, James R.
Corriher, Taylor J.
Switchenko, Jeffrey
Hanasoge, Sheela
Esdaille, Ashanda
Mahal, Brandon A.
Filson, Christopher P.
Patel, Sagar A.
author_sort Janopaul‐Naylor, James R.
collection PubMed
description BACKGROUND: Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. METHODS: Men with intermediate‐ and high‐risk PCa diagnosed 2010–2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran–Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. RESULTS: Of 422,506 eligible men, 18,720 (4.4%) experienced >180‐day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72–1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28–1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84–1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52–0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58–0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. CONCLUSIONS: Non‐White and Medicaid‐insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.
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spelling pubmed-105239622023-09-28 Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act Janopaul‐Naylor, James R. Corriher, Taylor J. Switchenko, Jeffrey Hanasoge, Sheela Esdaille, Ashanda Mahal, Brandon A. Filson, Christopher P. Patel, Sagar A. Cancer Med RESEARCH ARTICLES BACKGROUND: Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. METHODS: Men with intermediate‐ and high‐risk PCa diagnosed 2010–2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran–Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. RESULTS: Of 422,506 eligible men, 18,720 (4.4%) experienced >180‐day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72–1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28–1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84–1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52–0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58–0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. CONCLUSIONS: Non‐White and Medicaid‐insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA. John Wiley and Sons Inc. 2023-08-03 /pmc/articles/PMC10523962/ /pubmed/37537835 http://dx.doi.org/10.1002/cam4.6419 Text en © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle RESEARCH ARTICLES
Janopaul‐Naylor, James R.
Corriher, Taylor J.
Switchenko, Jeffrey
Hanasoge, Sheela
Esdaille, Ashanda
Mahal, Brandon A.
Filson, Christopher P.
Patel, Sagar A.
Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title_full Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title_fullStr Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title_full_unstemmed Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title_short Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
title_sort disparities in time to prostate cancer treatment initiation before and after the affordable care act
topic RESEARCH ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10523962/
https://www.ncbi.nlm.nih.gov/pubmed/37537835
http://dx.doi.org/10.1002/cam4.6419
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