Table 4:
Relation of ACA implementation period and sociodemographic and clinical factors to hazard of death, 2005–2017
| All patients N=11,221 | Non-Hodgkin lymphoma N=5,878 | Hodgkin lymphoma N=5,343 | |
|---|---|---|---|
|
| |||
| Characteristics | aHR (95% CI)§ | aHR (95% CI) | aHR (95% CI) |
| Age at diagnosis, years | |||
| 15–20 | Reference | Reference | Reference |
| 21–25 | 1.43 (1.16–1.78) | 1.43 (1.09–1.88) | 1.46 (1.02–2.10) |
| 26–39 | 1.91 (1.59–2.31) | 1.85 (1.47–2.33) | 2.06 (1.48–2.86) |
| Sex | |||
| Females | Reference | Reference | Reference |
| Males | 1.39 (1.24–1.56) | 1.43 (1.24–1.64) | 1.28 (1.02–1.61) |
| Period of diagnosis | |||
| Pre-ACA (Mar 2005–Sep 2010) | Reference | Reference | Reference |
| Early ACA (Oct 2010–Dec 2013) | 0.76 (0.66–0.88) | 0.80 (0.68–0.93) | 0.67 (0.51–0.89) |
| Full ACA (Jan 2014–Dec 2017) | 0.54 (0.46–0.63) | 0.56 (0.47–0.67) | 0.48 (0.34–0.70) |
| Stage at diagnosis& | |||
| I | Reference | Reference | Reference |
| II | 1.45 (1.19–1.76) | 1.35 (1.08–1.69) | 2.04 (1.15–3.62) |
| III | 2.07 (1.69–2.54) | 1.94 (1.53–2.45) | 3.00 (1.67–5.39) |
| IV | 3.03 (2.56–3.60) | 2.93 (2.45–3.50) | 4.13 (2.31–7.39) |
| Race/ethnicity& | |||
| Non-Hispanic White | Reference | Reference | Reference |
| Non-Hispanic Black | 1.29 (1.07–1.57) | 1.28 (1.03–1.60) | 1.31 (0.90–1.92) |
| Hispanic | 1.26 (1.10–1.45) | 1.23 (1.05–1.44) | 1.37 (1.05–1.80) |
| Asian/Pacific Islander | 1.22 (1.01–1.48) | 1.20 (0.96–1.48) | 1.26 (0.85–1.85) |
| American Indian/Alaska Native | 2.16 (1.21–3.85) | 1.75 (0.86–3.54) | 3.43 (1.25–9.40) |
| Neighborhood SES | |||
| Highest | Reference | Reference | Reference |
| Medium | 1.09 (0.94–1.26) | 1.10 (0.92–1.31) | 1.07 (0.81–1.41) |
| Lowest | 1.26 (1.08–1.47) | 1.40 (1.17–1.68) | 0.91 (0.67–1.24) |
| Insurance type& | |||
| Private | Reference | Reference | Reference |
| Continuous Medicaid | 1.93 (1.63–2.29) | 1.84 (1.52–2.23) | 2.18 (1.55–3.08) |
| Discontinuous Medicaid | 2.17 (1.83–2.58) | 2.06 (1.69–2.52) | 2.52 (1.81–3.50) |
| Medicaid at diagnosis/uninsured | 2.14 (1.83–2.49) | 2.10 (1.76–2.51) | 2.25 (1.64–3.08) |
| Other public* | 1.13 (0.66–1.93) | 1.25 (0.66–2.36) | 0.93 (0.34–2.54) |
| Charlson Comorbidity Index& | |||
| None | Reference | Reference | Reference |
| One | 1.26 (1.06–1.50) | 1.18 (0.97–1.45) | 1.51 (1.08–2.12) |
| More than one | 3.09 (2.55–3.74) | 2.88 (2.33–3.56) | 4.24 (2.70–6.65) |
| Treatment facility | |||
| NCI-DCC | Reference | Reference | Reference |
| Non-NCI-DCC | 1.04 (0.92–1.17) | 1.04 (0.91–1.20) | 0.98 (0.75–1.27) |
| Marital status& | |||
| Married | Reference | Reference | Reference |
| Unmarried | 1.24 (1.09–1.42) | 1.24 (1.07–1.44) | 1.23 (0.93–1.62) |
Abbreviations: SES, socioeconomic status; NCI-DCC, National Cancer Institute-Designated Cancer Center; ACA, Affordable Care Act; aHR, adjusted hazard ratios, CI, confidence interval; Jan, January; Mar, March; Sep September; Oct, October; Dec, December.
*
Other public includes Indian/Public Health Service, County Funded, not-otherwise specified (NOS), Medicare without supplement, Medicare, NOS.
§
Model stratified by cancer site (Hodgkin and non-Hodgkin lymphomas) due to violation of the Cox proportional hazards assumption.
&
Not included patients with unknown insurance, race/ethnicity, marital status, stage at diagnosis, and comorbidity.