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Impact of the Affordable Care Act on Early Stage Cervical Cancer Diagnoses in Pennsylvania: An Interrupted Time Series Analysis

Duquette, Jennie (2021) Impact of the Affordable Care Act on Early Stage Cervical Cancer Diagnoses in Pennsylvania: An Interrupted Time Series Analysis. Master's Thesis, University of Pittsburgh. (Unpublished)

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Significant advances in cervical cancer screening have led to improved survival rates and reduced cancer burden in the United States but disparities remain. Race, socioeconomic and insurance status and region strongly influence cervical cancer outcomes. The Affordable Care Act (ACA) included multiple provisions that aimed to expand access to coverage and cancer screening and care. The purpose of this study was to investigate the impact of ACA, following Medicaid expansion, on early stage cervical cancer diagnoses for women in Pennsylvania, with a focus on minority women and rurally located women. The study utilized data from the Pennsylvania Cancer Registry, a statewide data system responsible for collecting information on all new cancer cases diagnosed in Pennsylvania, to identify cervical cancer cases in Pennsylvania from 2010 through 2016. The effect of Medicaid expansion in Pennsylvania through implementation of the ACA was assessed on cancer stage at diagnosis using a retrospective natural experiment design and interrupted time series analysis. Multiple logistic regression models utilizing the interrupted time series analysis framework were estimated to assess the relationships between the implementation of the ACA, patient characteristics and the likelihood of an early stage cervical cancer diagnosis. A total of 2,052 cervical cancer cases in women aged 26 to 64 years were included in analysis over the study period between 2010 and 2016. Average age of the sample was 46 years (SD = 10.24). Most women were white (79.74%) and non-Hispanic (90.99%) and were privately insured (52.13%). The study did not find a significant effect of ACA implementation on early stage cervical cancer diagnoses across Pennsylvania, both when examining the full sample and when stratifying to examine effects for specific subpopulations, but results do highlight interesting trends in patterns of cervical cancer diagnosis between 2010 and 2016 motivating further research.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Duquette, Jenniejed118@pitt.edujed118
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSabik, Lindsaylsabik@pitt.edulsabik
Committee MemberDrake, Colemancdrake@pitt.educdrake
Committee MemberRobertson,
Date: 27 August 2021
Date Type: Publication
Defense Date: 26 July 2021
Approval Date: 27 August 2021
Submission Date: 10 August 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 41
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: cervical cancer, Affordable Care Act, Pennsylvania, insurance coverage and cancer prevention
Date Deposited: 27 Aug 2021 19:25
Last Modified: 27 Aug 2021 19:25


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