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

作　　者：Gerald Fletcher Joan Culpepper-Morgan Alvaro Genao Eric Alatevi 

机构地区：[1]Department of Gastroenterology,NYC Health+Hospitals/Harlem,New York,NY 10037,United States [2]Department of Gastroenterology,NYC Health+Hospitals/Harlem,506 Lenox Ave,New York,NY 10037,United States

出　　处：《World Journal of Gastrointestinal Oncology》2023年第9期1653-1661,共9页世界胃肠肿瘤学杂志（英文版）（电子版）

摘　　要：BACKGROUND Colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite 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 individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM 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 States.METHODS 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 responses.The 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 variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS 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 Blacks,or Multiracial.There was an increase in uti

关 键 词：Medicaid expansion Colorectal cancer screening LOW-INCOME DISPARITIES MINORITIES Affordable care act 

分 类 号：R735.34[医药卫生—肿瘤]