The Effect of Medicaid Expansion Among Adults from Low-Income Communities on Stage at Diagnosis in Screening-Amenable Cancers

Details

• Alternative Title:
  Cancer
• Personal Author:
  Kim, Uriel ; Koroukian, Siran ; Statler, Abby ; Rose, Johnie
• Description:
  Background:
  
  Several states opted to expand Medicaid under the Affordable Care Act (ACA), which offers insurance coverage to low-income individuals up to 138% of the federal poverty level. This expansion of Medicaid to a medically vulnerable population can potentially reduce cancer outcome disparities, especially in screening-amenable cancers. The study objective was to estimate the effect of Medicaid expansion on the proportion of adults from low-income communities with screening-amenable cancers who present with metastatic disease.
  
  Methods:
  
  Using state cancer registry data linked with block group-level income data, 12,760 individuals aged 30–64 years who were diagnosed with incident invasive breast (female), cervical, colorectal, or lung cancer in 2011 – 2016, and were uninsured or had Medicaid insurance at diagnosis were identified. This sample was probability weighted based on income to reflect potential Medicaid eligibility under the ACA’s Medicaid expansion. Then, a multivariable logistic model was fitted to examine the independent association between the exposure (pre-expansion, years 2011–2013 versus post-expansion, years 2014–2016) and the outcome (metastatic versus non-metastatic disease at diagnosis).
  
  Results:
  
  After adjusting for potential confounders, individuals diagnosed post-expansion had 15% lower odds of having metastatic disease compared to pre-expansion (Adjusted Odds Ratio: 0.85, 95% Confidence Interval: 0.77 – 0.93). As a control, a separate analysis that focused on individuals with private insurance from high-income communities found nonsignificant pre/post-expansion changes in the outcome (Adjusted Odds Ratio: 1.02, 95% Confidence Interval: 0.96 – 1.09).
  
  Conclusions:
  
  Medicaid expansion is associated with a narrowing of a critical cancer outcome disparity in adults from low-income communities.
  
  
• Subjects:
  Adult Early Detection Of Cancer Female Humans Male Medicaid Middle Aged Neoplasms Neoplasm Staging Poverty United States

  More +
• Keywords:
  Breast Neoplasms Cancer Staging Chlorination Colorectal Neoplasms Household Water Treatment Lung Neoplasms Patient Protection And Affordable Care Act Safe Water Storage Uterine Cervical Neoplasms
• Source:
  Cancer. 126(18):4209-4219
• Pubmed ID:
  32627180
• Pubmed Central ID:
  PMC8571714
• Document Type:
  Journal Article
• Funding:
  TL1 TR002549/TR/NCATS NIH HHSUnited States/ ; UL1TR000439/TR/NCATS NIH HHSUnited States/ ; PDHO18/Pharmaceutical Research and Manufacturers of America Foundation/ ; P30 CA043703/CA/NCI NIH HHSUnited States/ ; UL1 TR000439/TR/NCATS NIH HHSUnited States/ ; GM007250/GM/NIGMS NIH HHSUnited States/ ; 1TL1TR002549/TR/NCATS NIH HHSUnited States/ ; U48DP005013/ACL/ACL HHSUnited States/ ; T32 GM007250/GM/NIGMS NIH HHSUnited States/ ; 1U48DP005013/CC/CDC HHSUnited States/
• Volume:
  126
• Issue:
  18
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5ed1c7e0395d0ff7591a2a4c6ca885a62f8249d6b66dea365fb6a6aa7dc4ddf2
• Download URL:
  https://stacks.cdc.gov/view/cdc/111346/cdc_111346_DS1.pdf
• File Type:
  [PDF - 754.74 KB ]