Effects of the affordable care act on young women with gynecologic cancers

Anna Jo Bodurtha Smith, Amanda Nickles Nickles Fader

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. METHODS: We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. RESULTS: A total of 1,912 gynecologic cancer cases pre- ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI 24.0 to 0.1, P5.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P5.03) for women aged 21-26 years. Receipt of fertilitysparing treatment increased for women in both age groups post-ACA (P for trend5.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). CONCLUSIONS: Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.

Original languageEnglish (US)
Pages (from-to)966-976
Number of pages11
JournalObstetrics and gynecology
Volume131
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Patient Protection and Affordable Care Act
Neoplasms
Fertility
Insurance Coverage
Insurance
Age Groups
Vaginal Neoplasms
Vulvar Neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Effects of the affordable care act on young women with gynecologic cancers. / Smith, Anna Jo Bodurtha; Nickles Fader, Amanda Nickles.

In: Obstetrics and gynecology, Vol. 131, No. 6, 01.06.2018, p. 966-976.

Research output: Contribution to journalArticle

@article{ab7d0c0f54e14ff594da773313ceeea7,
title = "Effects of the affordable care act on young women with gynecologic cancers",
abstract = "OBJECTIVE: To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. METHODS: We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. RESULTS: A total of 1,912 gynecologic cancer cases pre- ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2{\%}, 95{\%} CI 24.0 to 0.1, P5.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6{\%}, 95{\%} CI 0.4-6.9, P5.03) for women aged 21-26 years. Receipt of fertilitysparing treatment increased for women in both age groups post-ACA (P for trend5.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). CONCLUSIONS: Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.",
author = "Smith, {Anna Jo Bodurtha} and {Nickles Fader}, {Amanda Nickles}",
year = "2018",
month = "6",
day = "1",
doi = "10.1097/AOG.0000000000002592",
language = "English (US)",
volume = "131",
pages = "966--976",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Effects of the affordable care act on young women with gynecologic cancers

AU - Smith, Anna Jo Bodurtha

AU - Nickles Fader, Amanda Nickles

PY - 2018/6/1

Y1 - 2018/6/1

N2 - OBJECTIVE: To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. METHODS: We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. RESULTS: A total of 1,912 gynecologic cancer cases pre- ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI 24.0 to 0.1, P5.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P5.03) for women aged 21-26 years. Receipt of fertilitysparing treatment increased for women in both age groups post-ACA (P for trend5.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). CONCLUSIONS: Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.

AB - OBJECTIVE: To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. METHODS: We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. RESULTS: A total of 1,912 gynecologic cancer cases pre- ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI 24.0 to 0.1, P5.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P5.03) for women aged 21-26 years. Receipt of fertilitysparing treatment increased for women in both age groups post-ACA (P for trend5.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). CONCLUSIONS: Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.

UR - http://www.scopus.com/inward/record.url?scp=85057369027&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057369027&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000002592

DO - 10.1097/AOG.0000000000002592

M3 - Article

VL - 131

SP - 966

EP - 976

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 6

ER -