Association of Medicaid expansion and insurance status, cancer stage, treatment and mortality among patients with cervical cancer

Cancer Reports

E. John Orav¹  Paul L. Nguyen²  Miranda B. Lam²  Alexi A. Wright²  Edward Christopher Dee²  Daniel W. Kim³  Grace Lee³ 

[1] Department of Medicine, Division of General Internal Medicine in Boston Brigham and Women's Hospital Boston Massachusetts USA;Harvard Medical School Boston Massachusetts USA;Harvard Radiation Oncology Program Boston Massachusetts USA;

关键词: cervical cancer;    diagnosis;    Medicaid expansion;    national cancer database;    survival;    treatment;   

DOI  :  10.1002/cnr2.1407

来源: DOAJ

【 摘 要 】

Abstract Background Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer. Aim We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer. Methods and results Using the National Cancer Database, we performed a difference‐in‐differences (DID) cross‐sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011–2013) and after (2014–2015) Medicaid expansion. January 1, 2014 was used as the timepoint for Medicaid expansion. The primary outcomes of interest were insurance status, stage at diagnosis, treatment within 30 and 90 days of diagnosis, and overall survival. Fifteen thousand two hundred sixty‐five patients (median age 50) were included: 42% from Medicaid expansion and 58% from nonexpansion states. Medicaid expansion was significantly associated with increased Medicaid coverage (adjusted DID = 11.0%, 95%CI = 8.2, 13.8, p < .01) and decreased rates of uninsured (adjusted DID = −3.0%, 95%CI = −5.2, −0.8, p < .01) among patients in expansion states compared with non‐expansion states. However, Medicaid expansion was not associated with any significant changes in cancer stage at diagnosis or timely treatment. There was no significant change in survival from the pre‐ to post‐expansion period in either expansion or nonexpansion states, and no significant differences between the two (DID‐HR = 0.95, 95%CI = 0.83, 1.09, p = .48). Conclusion Although Medicaid expansion was associated with an increase in Medicaid coverage and decrease in uninsured among patients with cervical cancer, the effects of increased coverage on diagnosis and treatment outcomes may have yet to unfold. Future studies, including longer follow‐up are necessary to understand the effects of Medicaid expansion.

【 授权许可】

Unknown