Background Many uninsured patients do not receive Medicaid coverage until a cancer diagnosis, potentially delaying access to care for early cancer detection and treatment. We examine the association of Medicaid enrollment timing and patterns with survival among children and adolescents/young adults (AYAs) diagnosed with blood cancers, where disease onset can be acute and early detection is critical. Methods We identified 28,750 children and AYAs (0-39 years) newly diagnosed with blood cancers from the 2006-2013 SEER-Medicaid data. Enrollment patterns included continuous Medicaid (preceding through diagnosis), newly gained Medicaid (at/shortly after diagnosis), other noncontinuous Medicaid enrollment, and private/other insurance. We assessed cumulative incidence of death from diagnosis, censoring at last follow-up, five years post-diagnosis, or December 2018, whichever occurred first. Multivariable survival models estimated the association of insurance enrollment patterns with risk of death. Results One-fourth (26.1%) of the cohort were insured by Medicaid; of these, 41.1% had continuous Medicaid, 34.9% had newly gained Medicaid, and 24.0% had other noncontinuous enrollment. The cumulative incidence of all-cause death five-year post-diagnosis was highest in patients with newly gained Medicaid (30.2%, 95%CI = 28.4-31.9%), followed by other noncontinuous enrollment (23.2%, 95%CI = 21.3-25.2%), continuous Medicaid (20.5%, 95%CI = 19.1-21.9%), and private/other insurance (11.2%; 95%CI = 10.7-11.7%). In multivariable models, newly gained Medicaid was associated with a higher risk of all-cause (hazard ratio = 1.39, 95%CI = 1.27-1.53) and cancer-specific death (hazard ratio = 1.50, 95%CI = 1.35-1.68), compared to continuous Medicaid. Conclusions Continuous Medicaid coverage is associated with survival benefits among pediatric and AYA patients diagnosed with blood cancers; however, less than half of Medicaid-insured patients have continuous coverage before diagnosis.

中文翻译：

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患有血癌的儿童和青少年/年轻人的健康保险连续性和死亡率


背景 许多未投保的患者直到癌症诊断后才获得医疗补助，这可能会延迟获得早期癌症检测和治疗的护理。我们研究了医疗补助登记时间和模式与被诊断患有血癌的儿童和青少年/年轻人 (AYA) 的生存率之间的关系，这些人的疾病发病可能很严重，早期发现至关重要。方法 我们从 2006 年至 2013 年 SEER-Medicaid 数据中确定了 28,750 名新诊断患有血癌的儿童和 AYA（0-39 岁）。登记模式包括连续医疗补助（诊断之前）、新获得的医疗补助（诊断时/诊断后不久）、其他非连续医疗补助登记以及私人/其他保险。我们评估了诊断后的累积死亡发生率、最后一次随访时的审查、诊断后五年或 2018 年 12 月（以先发生者为准）。多变量生存模型估计了保险登记模式与死亡风险的关联。结果 四分之一（26.1%）的人群有医疗补助保险；其中，41.1%的人有持续的医疗补助，34.9%的人新获得了医疗补助，24.0%的人有其他非连续的参保。诊断后五年全因死亡的累积发生率在新获得医疗补助的患者中最高（30.2%，95%CI = 28.4-31.9%），其次是其他非连续入组患者（23.2%，95%CI = 21.3） -25.2%）、持续医疗补助（20.5%，95%CI = 19.1-21.9%）和私人/其他保险（11.2%；95%CI = 10.7-11.7%）。在多变量模型中，新获得的医疗补助与较高的全因风险（风险比 = 1.39，95% CI = 1.27-1.53​​）和癌症特异性死亡（风险比 = 1.50，95% CI = 1.35-1.68）相关。 ，与连续医疗补助相比。 结论 持续医疗补助覆盖与诊断为血癌的儿科和 AYA 患者的生存获益相关；然而，只有不到一半的医疗补助患者在诊断前有持续的保险。