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Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms.
- Source :
-
JAMA network open [JAMA Netw Open] 2021 May 03; Vol. 4 (5), pp. e217051. Date of Electronic Publication: 2021 May 03. - Publication Year :
- 2021
-
Abstract
- Importance: Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer.<br />Objective: To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer.<br />Design, Setting, and Participants: This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021.<br />Exposures: State Medicaid expansion status.<br />Main Outcomes and Measures: Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses.<br />Results: Among a total of 340 552 patients with newly diagnosed genitourinary cancers, 94 033 (27.6%) had kidney cancer, 25 770 (7.6%) had bladder cancer, and 220 749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas.<br />Conclusions and Relevance: These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.
- Subjects :
- Adolescent
Adult
Case-Control Studies
Early Detection of Cancer
Healthcare Disparities
Humans
Kidney Neoplasms diagnosis
Kidney Neoplasms pathology
Kidney Neoplasms therapy
Male
Middle Aged
Neoplasm Staging
Poverty
Prostatic Neoplasms diagnosis
Prostatic Neoplasms pathology
Prostatic Neoplasms therapy
United States
Urinary Bladder Neoplasms diagnosis
Urinary Bladder Neoplasms pathology
Urinary Bladder Neoplasms therapy
Urogenital Neoplasms pathology
Young Adult
Insurance Coverage
Medicaid economics
Patient Protection and Affordable Care Act economics
Urogenital Neoplasms diagnosis
Urogenital Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2574-3805
- Volume :
- 4
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- JAMA network open
- Publication Type :
- Academic Journal
- Accession number :
- 34009349
- Full Text :
- https://doi.org/10.1001/jamanetworkopen.2021.7051