Impact of the Patient Protection and Affordable Care Act on 1-year survival in glioblastoma patients
| Autor: | Nuriel Moghavem, Debora L. Oh, Eduardo J. Santiago-Rodríguez, William J Tate, Reena Thomas, Scarlett Lin Gomez |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Proportional hazards model Affordable Care Act Medicaid Hazard ratio glioblastoma Retrospective cohort study Confidence interval outcomes research SEER 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Health care Epidemiology Basic and Translational Investigations Medicine AcademicSubjects/MED00300 AcademicSubjects/MED00310 030212 general & internal medicine Outcomes research business |
| Zdroj: | Neuro-oncology Advances |
| ISSN: | 2632-2498 |
| Popis: | Background Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ACA was subsequently associated with changes in 1-year survival in GBM is not known. Methods A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients with the primary diagnosis of GBM between 2008 and 2016. A multivariable-adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine the main outcome: the 1-year cumulative probability of death by state expansion status. Results A total of 25 784 patients and 14 355 deaths at 1 year were identified and included in the analysis, 49.7% were older than 65 at diagnosis. Overall 1-year cumulative probability of death for GBM patients in non-expansion versus expansion states did not significantly worsen over the 2 time periods (2008–2010: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.04–1.19; 2014–2016: HR 1.18, 95% CI 1.09–1.27). In GBM patients younger than age 65 at diagnosis, there was a nonsignificant trend toward the poorer 1-year cumulative probability of death in non-expansion versus expansion states (2008–2010: HR 1.09, 95% CI 0.97–1.22; 2014–2016: HR 1.23, 95% CI 1.09–1.40). Conclusions No differences were found over time in survival for GBM patients in expansion versus non-expansion states. Further study may reveal whether GBM patients diagnosed younger than age 65 in expansion states experienced improvements in 1-year survival. |
| Databáze: | OpenAIRE |
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