Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival

Abstract

BACKGROUND: This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN: We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non–early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS: In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (–2.0 ppt). Those who were insured (–0.1 ppt) or uninsured (–2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS: Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.

Health insurance coverage during the COVID‐19 pandemic: The role of Medicaid expansion

“…While most of the growth was observed in expansion states—12 million newly insured—nonexpansion states also saw over 2 million Americans enroll in the program (Uberoi et al, 2016 ). Medicaid expansion is associated with greater access to health care overall, greater access to opioid treatment, lower cardiovascular mortality, a decline in overall mortality rates, and significant increases in preventative care, cancer survival rate, outpatient care utilization, and improved health care quality (Khatana et al, 2019 ; Meinhofer & Witman, 2018 ; Miller et al, 2019 ; Miller & Wherry, 2019 ; Mobley et al, 2022 ; Sommers et al, 2016 ; Wen et al, 2017 ). Multiple studies have found overall improvements in insurance coverage due to the implementation of the ACA, especially in reducing racial and ethnic disparities in access to health insurance (Buchmueller et al, 2016 ; Mazurenko et al, 2018 ).…”

Calling Out Disparities in Pancreatic Cancer Care

“…A recent study demonstrated an increased probability of 1-year survival for patients diagnosed with and treated for pancreatic adenocarcinoma in Medicaid expansion states. 3 However, socioeconomic and racial/ethnic disparities persisted. The present study was not able to capture racial and ethnic disparities given the homogenous demographic of the study population.…”

“…Not surprisingly, uninsured and Medicaid payor status were strong negative predictors for receipt of chemotherapy and/or surgery. A recent study demonstrated an increased probability of 1-year survival for patients diagnosed with and treated for pancreatic adenocarcinoma in Medicaid expansion states . However, socioeconomic and racial/ethnic disparities persisted.…”