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Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act

Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logist...

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Autores principales: Ji, Xu, Hu, Xin, Castellino, Sharon M, Mertens, Ann C, Yabroff, K Robin, Han, Xuesong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877169/
https://www.ncbi.nlm.nih.gov/pubmed/35699500
http://dx.doi.org/10.1093/jncics/pkac006
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author Ji, Xu
Hu, Xin
Castellino, Sharon M
Mertens, Ann C
Yabroff, K Robin
Han, Xuesong
author_facet Ji, Xu
Hu, Xin
Castellino, Sharon M
Mertens, Ann C
Yabroff, K Robin
Han, Xuesong
author_sort Ji, Xu
collection PubMed
description Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children’s Health Insurance Program–covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = −1.67 ppt, 95% CI = −2.37 to −0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = −0.34 ppt, 95% CI = −0.56 [Formula: see text] −0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = −0.95 ppt, 95% CI = −1.67 [Formula: see text] −0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = −1.22 ppt, 95% CI = −2.22 [Formula: see text] −0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas.
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spelling pubmed-88771692022-02-28 Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act Ji, Xu Hu, Xin Castellino, Sharon M Mertens, Ann C Yabroff, K Robin Han, Xuesong JNCI Cancer Spectr Brief Communications Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children’s Health Insurance Program–covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = −1.67 ppt, 95% CI = −2.37 to −0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = −0.34 ppt, 95% CI = −0.56 [Formula: see text] −0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = −0.95 ppt, 95% CI = −1.67 [Formula: see text] −0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = −1.22 ppt, 95% CI = −2.22 [Formula: see text] −0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas. Oxford University Press 2022-02-04 /pmc/articles/PMC8877169/ /pubmed/35699500 http://dx.doi.org/10.1093/jncics/pkac006 Text en © The Author(s) 2022. Published by Oxford University Press. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Brief Communications
Ji, Xu
Hu, Xin
Castellino, Sharon M
Mertens, Ann C
Yabroff, K Robin
Han, Xuesong
Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title_full Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title_fullStr Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title_full_unstemmed Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title_short Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act
title_sort narrowing insurance disparities among children and adolescents with cancer following the affordable care act
topic Brief Communications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877169/
https://www.ncbi.nlm.nih.gov/pubmed/35699500
http://dx.doi.org/10.1093/jncics/pkac006
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