ASPO Abstracts
Association of the Affordable Care Act`s Medicaid expansion on stage at diagnosis and timely treatment for four common cancers
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
The expansion of Medicaid under the Affordable Care Act (ACA) aimed to provide coverage to low-income individuals, a population at greater risk for disparities in access to health care. We evaluated whether Medicaid expansion was associated with changes stage at diagnosis and timely treatment for four common cancers. This quasi-experimental retrospective cohort study was limited to Medicaid and uninsured patients (aged 40-64 years) diagnosed with invasive (female) breast, cervical, colorectal (CRC), or non-small cell lung cancer (NSCLC) within the National Cancer Database. We examined the effect of Medicaid expansion on stage at diagnosis (stage I versus stage IV), and time to treatment initiation within 30 days and 60 days of diagnosis using multivariable difference-in-difference (DID) regression analyses, we compared changes outcomes before (2010-2013) and after (2014-2017) the expansion of Medicaid eligibility between patients living in expansion versus nonexpansion states. Of the 197,360 patients (69.0% women; mean [SD] age, 56.6 [9.1] years; 23.4% black; 4.3% Asian/PI; and 12.7% Hispanic) diagnosed with invasive breast (37.7%), cervical (5.8%), CRC (24.6%), or NSCLC (31.9%); 48.3% resided in expansion states and 54.8% resided in nonexpansion states. Compared with nonexpansion states, the percentage of stage I diagnosis of breast (DID=2.72; p<0.001), cervical (DID=4.37, p=0.013), CRC (DID=3.22; p<0.001), and NSCLC (DID=3.71, p<0.001) increased more in expansion states. During the same time, stage IV diagnosis decreased more in expansion states compared to nonexpansion states, and this was consistent across all four cancers (p<0.05 for all). Among the 177,568 patients who received treatment within 365 days of diagnosis, Medicaid expansion was associated with an increase in the percent of patients treated within 30 days of diagnosis for breast (DID= 2.72, p=0.001) and/or cervical cancer (DID=5.97, p=0.002). Changes in timely treatment of CRC and NSCLC were not statistically different between expansion and nonexpansion states after 2014. Our results highlight the positive effect of the ACA`s Medicaid Expansion on earlier diagnosis stage and timely treatment among groups most targeted by the policy.
Keywords: Diagnosis stage, Time to treatment, Medicaid Expansion