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The Effect of Medicaid Expansion Among Adults from Low-Income Communities on Stage at Diagnosis in Screening-Amenable Cancers
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9 15 2020
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Source: Cancer. 126(18):4209-4219
[PDF-754.74 KB]
Details:
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Alternative Title:Cancer
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Personal Author:
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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.
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Source:
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Pubmed ID:32627180
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Pubmed Central ID:PMC8571714
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Volume:126
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Issue:18
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