{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T19:19:50Z","timestamp":1770491990738,"version":"3.49.0"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T00:00:00Z","timestamp":1638921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR001860"],"award-info":[{"award-number":["UL1 TR001860"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014807","name":"Cancer Research Coordinating Committee","doi-asserted-by":"publisher","award":["CRR\u201017\u2010420784"],"award-info":[{"award-number":["CRR\u201017\u2010420784"]}],"id":[{"id":"10.13039\/100014807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016953","name":"Comprehensive Cancer Center, University of California, Davis","doi-asserted-by":"publisher","award":["P30CA093373"],"award-info":[{"award-number":["P30CA093373"]}],"id":[{"id":"10.13039\/100016953","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["T32HP30037"],"award-info":[{"award-number":["T32HP30037"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Adolescents and young adults (AYAs, 15\u201039\u2009years) are the largest uninsured population in the Unites\u2009States, increasing the likelihood of late\u2010stage cancer diagnosis and poor survival. We evaluated the associations between the Affordable Care Act (ACA), insurance coverage, stage at diagnosis and survival among AYAs with lymphoma. We used data from the California Cancer Registry linked to Medicaid enrollment files on AYAs diagnosed with a primary non\u2010Hodgkin (NHL; n\u00a0=\u00a05959) or Hodgkin (n\u00a0=\u00a05378) lymphoma pre\u2010ACA and in the early and full ACA eras. Health insurance was categorized as continuous Medicaid, discontinuous Medicaid, Medicaid enrollment at diagnosis\/uninsurance, other public and private. We used multivariable regression models for statistical analyses. The proportion of AYAs uninsured\/Medicaid enrolled at diagnosis decreased from 13.4% pre\u2010ACA to 9.7% with full ACA implementation, while continuous Medicaid increased from 9.3% to 29.6% during this time (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). After full ACA, AYAs with NHL were less likely to be diagnosed with Stage\u2009IV disease (adjusted odds ratio [aOR]\u00a0=\u00a00.84, 95% confidence interval [CI]\u00a0=\u00a00.73\u20100.97). AYAs with lymphoma were more likely to receive care at National Cancer Institute\u2010Designated Cancer Centers (aOR\u00a0=\u00a01.42, 95%\u00a0CI\u00a0=\u00a01.28\u20101.57) and had lower likelihood of death (adjusted hazard ratio\u00a0=\u00a00.54, 95%\u00a0CI\u00a0=\u00a00.46\u20100.63) after full ACA. However, AYAs from the lowest socioeconomic neighborhoods, racial\/ethnic minority groups and those with Medicaid continued to experience worse survival. In summary, AYAs with lymphomas experienced increased access to healthcare and better clinical outcomes following Medicaid expansion under the ACA. Yet, socioeconomic and racial\/ethnic disparities remain, calling for additional efforts to decrease health inequities among underserved AYAs with lymphoma.<\/jats:p>","DOI":"10.1002\/ijc.33880","type":"journal-article","created":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T12:16:26Z","timestamp":1637410586000},"page":"1113-1122","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Stage at diagnosis and survival among adolescents and young adults with lymphomas following the Affordable Care Act implementation in California"],"prefix":"10.1002","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1644-0313","authenticated-orcid":false,"given":"Renata","family":"Abrah\u00e3o","sequence":"first","affiliation":[{"name":"Center for Healthcare Policy &amp; Research University of California Davis  Sacramento California USA"},{"name":"Center for Oncology Hematology Outcomes Research and Training (COHORT) University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julianne J. P.","family":"Cooley","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances B.","family":"Maguire","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arti","family":"Parikh\u2010Patel","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyllene R.","family":"Morris","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonor Bimla","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Center for Healthcare Policy &amp; Research University of California Davis  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ted","family":"Wun","sequence":"additional","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training (COHORT) University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa H. M.","family":"Keegan","sequence":"additional","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training (COHORT) University of California Davis Comprehensive Cancer Center  Sacramento California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21637"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27684"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21438"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32407-2"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21590"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkz031"},{"key":"e_1_2_11_8_1","unstructured":"US Government.The Patient Protection and Affordable Care Act Public Law No: 111\u2013148.https:\/\/www.congress.gov\/111\/plaws\/publ148\/PLAW-111publ148.pdf. 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