Where you live matters: A National Cancer Database study of Medicaid expansion and endometrial cancer outcomes

Barrington, David A. Mix; Sinnott, Jennifer A.; Calo, Corinne; Cohn, David E.; Cosgrove, Casey; Felix, Ashley S.

doi:10.1016/j.ygyno.2020.05.018

Cited by 19 publications

(22 citation statements)

References 32 publications

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“…Moreover, while studies on other cancers including lung, colon, breast, and other gynecological cancer observed positive effects of Medicaid expansion on cancer diagnosis, treatment, and outcomes, 1,7,8,43 our study may have not detected significant effects for cervical cancer given underlying differences in cervical cancer and its management compared to other malignancies. For instance, cervical cancer has relatively low incidence (8 out of 100 000 per year) in the United States.…”

Section: Overall Survivalmentioning

confidence: 58%

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

et al. 2021

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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)(2012)(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.

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Section: Overall Survivalmentioning

confidence: 58%

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

et al. 2021

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“…Percentage point reductions in un-insurance disparities were shown under Medicaid expansion [ 19 , 34 , 36 , 38 , 40 ], but several studies reported that disparity reductions were not statistically significant [ 29 , 34 , 35 , 37 , 38 ]. Several failed to report statistical testing of disparity reduction itself [ 17 , 19 , 20 , 23 , 28 , 32 , 33 , 36 , 39 ]. Three studies documented reversed expectations, showing greater coverage gains for African Americans than whites in non-Medicaid expansion states [ 30 , 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…Though not studied widely in the general population—only seven general population studies examined outcomes beyond coverage—disparities in indicators of healthcare access (usual source of care, having a personal doctor, delaying care due to cost) and treatment (having a wellness exam, flu shot) appear to be unchanged by Medicaid expansion [ 18 , 19 , 21 , 29 , 34 – 36 ]. In studies focusing on populations with specific illnesses, access to treatment for specific conditions either showed no significant disparity reductions due to Medicaid expansion [ 31 ] or failed to test the significance in either disparity changes or differences between Medicaid expansion and non-expansion states [ 15 – 17 , 23 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…Reductions in Medicaid expansion states were largest for Black mothers, but the size of Black-white disparities before or after expansions or the significance of any changes in disparities were not measured or tested [ 24 ]. No significant disparity reductions were found in survival rates in patients with specific life-threatening health conditions [ 23 , 26 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

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Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review

et al. 2022

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Objectives To investigate the impact of the Affordable Care Act’s (ACA) Medicaid expansion on African American-white disparities in health coverage, access to healthcare, receipt of treatment, and health outcomes. Design A search of research reports, following the PRISMA-ScR guidelines, identified twenty-six national studies investigating changes in health care disparities between African American and white non-disabled, non-elderly adults before and after ACA Medicaid expansion, comparing states that did and did not expand Medicaid. Analysis examined research design and findings. Results Whether Medicaid eligibility expansion reduced African American-white health coverage disparities remains an open question: Absolute disparities in coverage appear to have declined in expansion states, although exceptions have been reported. African American disparities in health access, treatment, or health outcomes showed little evidence of change for the general population. Conclusions Future research addressing key weaknesses in existing research may help to uncover sources of continuing disparities and clarify the impact of future Medicaid expansion on African American health care disparities.

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“…Currently, 12 states have not adopted the ACA’s Medicaid expansion, and two states have adopted but not yet implemented the expansion. There is evidence that Medicaid expansion has improved rates of early stage diagnosis and overall survival in other gynecologic malignancies 21. While most of the current study’s cohort was diagnosed prior to this broad implementation, this is a useful context in which to consider the data and suggest regional solutions.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic characteristics and cervical cancer survival in different regions of the United States: a National Cancer Database study

Toboni

Cohen

Gentry

et al. 2022

International Journal of Gynecological Cancer

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ObjectiveTo determine how sociodemographic factors impact cervical cancer survival in different geographic locations in the USA.MethodsA retrospective cohort of patients with cervical cancer from January 1, 2004 to December 31, 2015 in the National Cancer Database (NCDB) was identified. Tumor characteristics as well as race, income, insurance type, and treating facility types were compared among nine geographic regions. χ2 tests and Cox regression were used to compare differences between regions; p values <0.05 were considered significant.ResultsA total of 48 787 patients were included. Survival was inferior in seven of nine regions for underinsured patients. In six regions survival was inferior for Medicaid and Medicare patients, respectively: Middle Atlantic: hazard ratio (HR) 1.25 and 1.22; South Atlantic: HR 1.41 and HR 1.22; East North Central: HR 1.36 and HR 1.25; East South Central: HR 1.37 and HR 1.25; West North Central: HR 1.67 and HR 1.42; West South Central: HR 1.44 and HR 1.46. In the Pacific region survival was inferior for Medicare patients (HR 1.35) but not inferior for Medicaid patients. Being uninsured was associated with worse survival in the South Atlantic (HR 1.23), East North Central (HR 1.23), East South Central (HR 1.56), and West South Central (HR 1.31) regions. Annual income level under $38 000 was associated with worse survival in the Middle Atlantic (HR 1.24), South Atlantic (HR 1.35), and East North Central (HR 1.49) regions. Lastly, when compared with academic research institutions, comprehensive community cancer centers had significantly worse survival in four of the nine regions.ConclusionsCervical cancer mortality is higher for women with a low income, underinsured (Medicaid or Medicare) or uninsured status, and decreased access to academic institutions in most US regions. An increase in cervical cancer mortality was associated with underinsured or uninsured populations in regions mainly located in the South and Midwest.

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Where you live matters: A National Cancer Database study of Medicaid expansion and endometrial cancer outcomes

Cited by 19 publications

References 32 publications

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

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

Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review

Sociodemographic characteristics and cervical cancer survival in different regions of the United States: a National Cancer Database study

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