Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act
Abstract Background Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. Methods Men with intermediate‐ and hi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6419 |
| _version_ | 1797672424914812928 |
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| author | James R. Janopaul‐Naylor Taylor J. Corriher Jeffrey Switchenko Sheela Hanasoge Ashanda Esdaille Brandon A. Mahal Christopher P. Filson Sagar A. Patel |
| author_facet | James R. Janopaul‐Naylor Taylor J. Corriher Jeffrey Switchenko Sheela Hanasoge Ashanda Esdaille Brandon A. Mahal Christopher P. Filson Sagar A. Patel |
| author_sort | James R. Janopaul‐Naylor |
| collection | DOAJ |
| description | Abstract Background Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. Methods Men with intermediate‐ and high‐risk PCa diagnosed 2010–2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran–Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. Results Of 422,506 eligible men, 18,720 (4.4%) experienced >180‐day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72–1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28–1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84–1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52–0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58–0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. Conclusions Non‐White and Medicaid‐insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA. |
| first_indexed | 2024-03-11T21:29:51Z |
| format | Article |
| id | doaj.art-5a4d47bc31864364864e1168cd05c0ef |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-11T21:29:51Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-5a4d47bc31864364864e1168cd05c0ef2023-09-27T11:46:08ZengWileyCancer Medicine2045-76342023-09-011217182581826810.1002/cam4.6419Disparities in time to prostate cancer treatment initiation before and after the Affordable Care ActJames R. Janopaul‐Naylor0Taylor J. Corriher1Jeffrey Switchenko2Sheela Hanasoge3Ashanda Esdaille4Brandon A. Mahal5Christopher P. Filson6Sagar A. Patel7Department of Radiation Oncology Winship Cancer Institute at Emory University Atlanta Georgia USADepartment of Radiation Oncology Winship Cancer Institute at Emory University Atlanta Georgia USADepartment of Biostatistics and Bioinformatics Rollins School of Public Health Atlanta Georgia USADepartment of Radiation Oncology Winship Cancer Institute at Emory University Atlanta Georgia USADepartment of Urology Emory University School of Medicine Atlanta Georgia USADepartment of Radiation Oncology University of Miami Miller School of Medicine Miami Florida USADepartment of Urology Emory University School of Medicine Atlanta Georgia USADepartment of Radiation Oncology Winship Cancer Institute at Emory University Atlanta Georgia USAAbstract Background Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. Methods Men with intermediate‐ and high‐risk PCa diagnosed 2010–2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran–Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. Results Of 422,506 eligible men, 18,720 (4.4%) experienced >180‐day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72–1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28–1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84–1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52–0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58–0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. Conclusions Non‐White and Medicaid‐insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.https://doi.org/10.1002/cam4.6419ACAdisparitiesObamacareprostate cancertreatment delay |
| spellingShingle | James R. Janopaul‐Naylor Taylor J. Corriher Jeffrey Switchenko Sheela Hanasoge Ashanda Esdaille Brandon A. Mahal Christopher P. Filson Sagar A. Patel Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act Cancer Medicine ACA disparities Obamacare prostate cancer treatment delay |
| title | Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act |
| title_full | Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act |
| title_fullStr | Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act |
| title_full_unstemmed | Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act |
| title_short | Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act |
| title_sort | disparities in time to prostate cancer treatment initiation before and after the affordable care act |
| topic | ACA disparities Obamacare prostate cancer treatment delay |
| url | https://doi.org/10.1002/cam4.6419 |
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