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Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

World Journal of Gastrointestinal Oncology 2023年第9期15卷 1653-1661页

作者： Gerald Fletcher Joan Culpepper-Morgan alvaro genao Eric Alatevi Department of Gastroenterology NYC Health+Hospitals/HarlemNew YorkNY 10037United States Department of Gastroenterology NYC Health+Hospitals/Harlem506 Lenox AveNew YorkNY 10037United States

BACKGROUND Colorectal cancer(CRC)remains a relevant public health *** research suggests that racial,economic and geographic disparities impact *** the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income *** study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income *** working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income *** To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United *** This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million *** period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent *** analyses included stratification of the access by ethnicity/race,income,and education *** A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blac

关键词： Medicaid expansion Colorectal cancer screening Low-income Disparities Minorities Affordable care act

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