The Affordable Care Act and suicide incidence among adults with cancer.

Autor: Barnes JM; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA. justinbarnes@wustl.edu., Graboyes EM; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA., Adjei Boakye E; Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.; Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA., Kent EE; Departments of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA., Scherrer JF; Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA., Park EM; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.; Comprehensive Cancer Support Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Rosenstein DL; Comprehensive Cancer Support Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Mowery YM; Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA.; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.; Duke Cancer Institute, Durham, NC, USA., Chino JP; Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA.; Duke Cancer Institute, Durham, NC, USA., Brizel DM; Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA.; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.; Duke Cancer Institute, Durham, NC, USA., Osazuwa-Peters N; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.; Duke Cancer Institute, Durham, NC, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Jazyk: angličtina
Zdroj: Journal of cancer survivorship : research and practice [J Cancer Surviv] 2023 Apr; Vol. 17 (2), pp. 449-459. Date of Electronic Publication: 2022 Apr 04.
DOI: 10.1007/s11764-022-01205-z
Abstrakt: Background: Patients with cancer are at an increased suicide risk, and socioeconomic deprivation may further exacerbate that risk. The Affordable Care Act (ACA) expanded insurance coverage options for low-income individuals and mandated coverage of mental health care. Our objective was to quantify associations of the ACA with suicide incidence among patients with cancer.
Methods: We identified US patients with cancer aged 18-74 years diagnosed with cancer from 2011 to 2016 from the Surveillance, Epidemiology, and End Results database. The primary outcome was the 1-year incidence of suicide based on cumulative incidence analyses. Difference-in-differences (DID) analyses compared changes in suicide incidence from 2011-2013 (pre-ACA) to 2014-2016 (post-ACA) in Medicaid expansion relative to non-expansion states. We conducted falsification tests with 65-74-year-old patients with cancer, who are Medicare-eligible and not expected to benefit from ACA provisions.
Results: We identified 1,263,717 patients with cancer, 812 of whom died by suicide. In DID analyses, there was no change in suicide incidence after 2014 in Medicaid expansion vs. non-expansion states for nonelderly (18-64 years) patients with cancer (p = .41), but there was a decrease in suicide incidence among young adults (18-39 years) (- 64.36 per 100,000, 95% CI =  - 125.96 to - 2.76, p = .041). There were no ACA-associated changes in suicide incidence among 65-74-year-old patients with cancer.
Conclusions: We found an ACA-associated decrease in the incidence of suicide for some nonelderly patients with cancer, particularly young adults in Medicaid expansion vs. non-expansion states. Expanding access to health care may decrease the risk of suicide among cancer survivors.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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