ASPO Abstracts
Gender Differences in the Impact of Medicaid Expansion on Guideline-Recommended Colorectal Cancer Screening: Evidence from the Affordable Care Act
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose of the study: This study examined overall and gender-specific effect of healthinsurance expansion on guideline-recommended colorectal cancer (CRC) screening rates usingthe natural experiment of the Medicaid Expansion under the Affordable Care Act (ACA) in 2014. Methods: We used data from the Behavioral Risk Factor Surveillance System (2008-2016) foradults from 50 to 64 years in 39 states. We measured self-reported ever use ofguideline-recommended CRC screening and whether the time since their most recent screeningwas concordant with guidelines. We employed difference-in-difference models comparingchanges in CRC screening rates in 20 Medicaid expansion states before and after the ACA tochanges in 19 states which did not adopt the ACA. We divided the post-ACA period into theearly (2014-15) and late (2016-17) to account for possible lagging effect of the ACAMedicaid expansion.Results: We found no significant effect of Medicaid expansion on receipt of any CRCscreening services in the early post-ACA period among adults whose household income was<138% federal poverty level. However, in this Medicaid-eligible population, the proportionof women had any CRC screening services increased by 16.8% points in Medicaid expansionstates in the late post-ACA period whereas no significant effect was reported among males.Stratified analyses by screening modality showed that the proportion of women who hadcolonoscopy increased by 13.6% points in Medicaid expansion states in the late postperiod. No significant effect of Medicaid expansion was observed on receipt of FOBT orsigmoidoscopy in both genders.Conclusion: CRC is the fourth most common cancer among adults and the second leading causeof cancer deaths in the US. Despite increased CRC screening rates over time, disparitiesin screening by insurance status and other socioeconomic factors persist. However, theevidence of gender differences in CRC screening is equivocal. Our findings showed thathealth insurance expansion had a lagged but significant effect on CRC screening inMedicaid expansion states. A significant increase in CRC screening among women providedmore evidence that barriers to CRC screening differ by gender and clinical practice toincrease CRC screening need to be tailored by gender.
Keywords: Colorectal Cancer;Affordable Care Act;Medicaid Expansion;Gender-SpecificEffect; HealthServices Research