Evidence map›Paper›PMID 31709523›Full record

ArticleCancer2020

The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer-directed treatment in HIV-infected patients with cancer in the United States.

Kelsey L Corrigan, Leticia Nogueira, K Robin Yabroff, Chun Chieh Lin, Xuesong Han, Junzo P Chino, Anna E Coghill, Meredith Shiels, Ahmedin Jemal, Gita Suneja

Open access · bronzeAbstract read
In one paragraph

Article in Cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Kelsey L CorriganDuke University School of Medicine, Durham, North Carolina.ORCID 0000-0003-0314-6972
Leticia NogueiraSurveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.ORCID 0000-0001-6990-3660
K Robin YabroffSurveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
Chun Chieh LinSurveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
Xuesong HanSurveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
Junzo P ChinoDuke University School of Medicine, Durham, North Carolina.ORCID 0000-0002-3633-9685
Anna E CoghillCancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.ORCID 0000-0001-7142-7499
Meredith ShielsDivision of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, Maryland.ORCID 0000-0001-8390-6091
Ahmedin JemalSurveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.ORCID 0000-0002-0000-4111
Gita SunejaDuke University School of Medicine, Durham, North Carolina.
American Cancer Society · USDuke University · USMoffitt Cancer Center · USNational Cancer Institute · US

Funding

Women's Cancer Research ProgramP30CA014236 · NCI · DUKE UNIVERSITY · PI JOHN N. NORTON · 1985 to 2026
$174.8M
Social and Behavioral Sciences CoreP30AI064518 · NIAID · DUKE UNIVERSITY · PI GEORGIA Doris TOMARAS · 2005 to 2026
$50.5M
Infections, immunity, and inflammation in cancerZIACP010150 · NCI · DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS · PI ENGELS, ERIC A · 2009 to 2025
$24.0M
Cancer Treatment Disparities in the HIV Population: Exploring the Impact of HIV on Physician and Patient Decision-MakingK08CA228631 · NCI · UNIVERSITY OF UTAH · PI SUNEJA, GITA · 2018 to 2022
$1.2M
NCI NIH HHS K08 CA228631NCI NIH HHS P30 CA014236NIAID NIH HHS P30 AI064518
6 · The paper itself

Abstract

backgroundTo the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States.

methodsHIV-infected individuals aged 18 to 64 years old with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non-Medicaid expansion and Medicaid expansion states using difference-in-differences analysis.

resultsOf the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; P = .01) and nonexpansion states (from 17.6% to 14.6%; P = .06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% [P < .0001]; difference-in-differences analysis: 7.2 percentage points [P = .02]).

conclusionsThe implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non-Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion.

Indexed as

Insurance CoveragePatient Protection and Affordable Care ActAdolescentAdultFemaleHIV InfectionsHumansMaleMedicaidMiddle AgedNeoplasmsUnited StatesYoung Adulthealth care disparitiesHIVinsurance coverageneoplasmsPatient Protection and Affordable Care Act

Identifiers

PMID31709523
PMCPMC6980281
OpenAlexW2985342232

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.