Oral cancer screening prevalence in low-income adults before and after the ACA

Semprini, Jason

doi:10.1016/j.oraloncology.2022.106055

Cited by 8 publications

(13 citation statements)

References 36 publications

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“…Because dentists provide the bulk of oral cancer screenings, access to dental services promotes earlier oral cancer detection. 5 However, our findings suggest that access to dental insurance benefits without good access to providers who are willing to accept these insurance benefits may not be sufficient. The results of interactions between dropping dental coverage and dentist supply support this premise; the effect of dropping coverage was larger in areas with more dentists, indicating that patients in these areas stood to lose the most from dropping coverage, likely due to better access (before dropping the coverage) than areas without enough providers.…”

Section: Discussionmentioning

confidence: 69%

“…28 Among the services most responsive to changing dental benefits are comprehensive exams: the service where most oral cancer screenings are performed. 5,29 By hindering access to comprehensive exams, dropping Medicaid dental benefits may have slowed the detection of oral cancer among low-income adults. However, low-income adults have among the lowest rates of self-reported oral cancer screening.…”

Section: Medicaid Dental Benefits and Oral Cancer Detectionmentioning

confidence: 99%

“…However, low-income adults have among the lowest rates of self-reported oral cancer screening. 5 Therefore, it is not clear if and by how much reduced access to comprehensive dental exams would negatively impact oral cancer detection among Medicaid enrollees. Our objective was to examine the effect of dropping Medicaid dental benefits on stage at diagnosis for oral cancers.…”

Section: Medicaid Dental Benefits and Oral Cancer Detectionmentioning

confidence: 99%

“…[2][3][4] Dental professionals conduct over 75% of all oral cancer screenings. 5 They are also the only health care provider in the United States to systematically screen for oral cancers during routine examinations. 6,7 However, less than 30% of oral cancers were diagnosed early in 2019.…”

Section: Introductionmentioning

confidence: 99%

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Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Semprini,

Reynolds,

Zahnd

et al. 2024

Cancer Medicine

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BackgroundDespite the importance of regular dental visits for detecting oral cancer, millions of low‐income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees.MethodsWe analyzed Surveillance, Epidemiology, and End Results‐Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference‐in‐differences model. Our design compares the change in early‐stage (Stages 0–II) diagnoses before and after dropping dental benefits in California with the change in early‐stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non‐OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita.ResultsDropping Medicaid dental benefits was associated with a 6.5%‐point decline in early‐stage diagnoses of non‐OPC (95% CI = −14.5, −3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%‐point decline in the probability of early‐stage non‐OPC diagnoses for every additional dentist per 5000 population (p = 0.006).ConclusionsEliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.

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Section: Discussionmentioning

confidence: 69%

Section: Medicaid Dental Benefits and Oral Cancer Detectionmentioning

confidence: 99%

Section: Medicaid Dental Benefits and Oral Cancer Detectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Semprini,

Reynolds,

Zahnd

et al. 2024

Cancer Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Left untreated, chronic oral health conditions may eventually result in tooth loss and low functional dental status [7][8][9]. Emerging evidence continues to highlight the critical importance of regular dental visits for preventing late-stage oral cancer diagnoses [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Semprini

2023

International Journal of Dentistry

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Background. American adults delay dental care more than any other healthcare service. Unfortunately, the COVID-19 pandemic may have stalled efforts to address dental service delays. Early evidence has suggested substantial declines in dental service visits in the early phase of the pandemic; however, our study is among the first to measure within-person changes from 2019 to 2020 and conduct subgroup analyses to examine if changing dental patterns were mediated by exposure to the pandemic, risk of adverse COVID-19 outcomes, or dental insurance. Methods. We analyzed a National Health Interview Survey panel of individuals initially surveyed in 2019, with subsequent follow-up in 2020. The outcomes included dental service access measures and the interval of a most recent dental visit. By constructing a probability-weighted linear regression model with fixed-effects, we estimated the average within-person change from 2019 to 2020. Robust standard errors were clustered within each respondent. Results. From 2019 to 2020, adults reported a 4.6%-point reduction in the probability of visiting the dentist ( p < 0.001 ). Significantly higher declines were found in Northeast and West regions compared to Midwest and South regions. We find no evidence that declining dental services in 2020 were associated with more chronic diseases, older age, or lack of dental insurance coverage. Adults did not report more financial or nonfinancial access barriers to dental care in 2020 compared to 2019. Conclusions. The long-term effects of the COVID-19 pandemic on delayed dental care warrant continued monitoring as policymakers aim to mitigate the pandemic’s negative consequences on oral health equity.

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Late‐Stage Oral Cancer Detection After California and Illinois Restored Medicaid Dental Benefits

Semprini

2024

OTO Open

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ObjectivePrevious research found an association between California's Medicaid dental coverage and oral cancer detection. However, this relationship has yet to be explored in other states or by subgroup populations.Study DesignIn addition to controlling for sociodemographic and tumor characteristics, this study implemented a traditional difference‐in‐differences design to compare distant‐stage diagnosis trends in states restoring Medicaid dental benefits (California [CA] and Illinois [IL]) with trends in states with constant Medicaid dental benefits.SettingThis retrospective, observational study analyzed oral cavity and pharynx cancer case data from The Surveillance, Epidemiology, and End Results program (2004‐2017).MethodsThe outcome was a binary variable indicating whether a patient was diagnosed at a distant stage. Subgroup analyses were conducted by state, race/ethnic group, sex, age, and county‐level household income.ResultsThe sample included 109,997 adults diagnosed with cancer of the oral cavity and pharynx. Restoring Medicaid dental benefits was associated with a statistically significant 2.7%‐point decline in the probability of a distant‐stage oral cancer diagnosis. This estimate represented a 14% relative change from baseline rates. Results were consistent for CA and IL and by county‐level median income. Estimates were significantly larger for adults under age 65, males, and adults identifying as Hispanic; non‐Hispanic Black; American Indian; or Asian American or Pacific Islander.ConclusionRestoring Medicaid dental coverage improved early detection in both CA and IL, with the greatest reductions in distant‐stage diagnoses occurring in younger adults, males, and minoritized racial/ethnic groups. Future research should investigate whether earlier detection reduces oral cancer mortality disparities.

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Oral cancer screening prevalence in low-income adults before and after the ACA

Cited by 8 publications

References 36 publications

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Late‐Stage Oral Cancer Detection After California and Illinois Restored Medicaid Dental Benefits

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