《平价医疗法案》依赖性覆盖扩展后年轻癌症患者的生存改善与死亡率下降

《患者保护与平价医疗法案》（ACA）允许19至25岁的美国年轻人继续使用父母的健康保险计划，直到26岁（依赖性照料扩展[DCE]）。这些癌症患者是否从中受益？我们将2011年通过的ACA对19-25岁年龄段的影响，与年龄较小（12-18岁）和较大（26-32岁）两个对照组进行比较，分析其癌症存活率和死亡率的变化。数据来源包括美国疾病控制与预防中心的全国癌症死亡数据，以及国家癌症研究所监测、流行病学和最终结果区域的癌症诊断患者的相对存活数据，覆盖全国的42%-44%。通过Joinpoint分析发现，唯一在ACA实施后存活率和死亡率趋势均有改善的年龄组是DCE符合资格的组，且2010年（ACA通过年份）为存活率和死亡率的转折点。到第6年，DCE组的相对生存率比对照组高出2.6倍和3.9倍（两者均p<0.001），癌症死亡率比对照组低1.5倍和2.1倍（两者均p<0.01）。在ACA的首个十年中，符合资格的年轻癌症患者的存活和死亡率均显著改善。未来需要制定更多政策以扩大保险覆盖范围和促进早期癌症诊断。2011年开始实施的《患者保护与平价医疗法案》依赖性照料扩展，使19-25岁的年轻患者可以继续在父母的保险计划下，直至26岁。六年随访数据显示，符合资格的年轻癌症患者的存活率比两组对照多出2.6至3.9倍，癌症死亡率降低了1.5至2.1倍。在ACA的首个十年中，符合资格的年轻癌症患者的生存期显著延长，死亡率显著降低。未来应继续通过政策扩大保险覆盖和促进早期诊断，改善年轻患者的预后。

The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative survival data of patients who were diagnosed with cancer were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results regions representing 42%-44% of the country.Joinpoint analysis identified the DCE-eligible cohort as the only age group of the three groups evaluated that have had improvements in both cancer survival and death rate trends after ACA implementation and that 2010, the year the ACA was passed, was the inflection year for both survival and deaths. By 6 years, the relative survival after cancer diagnosis was 2.6 and 3.9 times greater in the DCE-eligible age group than in the younger and older control groups, respectively (both p < .001), and the cancer death rate in the DCE-eligible age group improved 2.1 and 1.5 times greater than in the younger and older control age groups, respectively (both p < .01).During the first decade of the ACA, eligible young adults with cancer have had significantly improved survival and mortality. Additional policies expanding insurance coverage and enabling earlier cancer diagnosis among young adults are needed.The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19-25 years to remain on their parents' health insurance plans until age 26 years. The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE-eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more. During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer. Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults.