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Pract Radiat Oncol. 2019 Oct 18. pii: S1879-8500(19)30309-1. doi: 10.1016/j.prro.2019.10.003. [Epub ahead of print]

Associations of early Medicaid expansion with insurance status and stage at diagnosis among cancer patients receiving radiation therapy.

Author information

1
Saint Louis University School of Medicine, St. Louis, Missouri.
2
Washington University School of Medicine, Department of Radiation Oncology, St. Louis, Missouri.
3
Washington University School of Medicine, Department of Radiation Oncology, St. Louis, Missouri. Electronic address: sperkins@wustl.edu.

Abstract

PURPOSE:

Medicaid expansion in 2014 is associated with improved insurance coverage and stage at diagnosis in cancer patients. However, little is known about the impact of early Medicaid expansions in 2010-2011 on outcomes in radiotherapy recipients. The objective of this study was to estimate the impact of early Medicaid expansion on insurance status and stage at diagnosis among radiotherapy recipients.

METHODS AND MATERIALS:

The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases aged 18-64 diagnosed in 2007-2013 with a first primary malignancy treated with radiotherapy. Difference-in-differences analyses were used to compare changes in insurance coverage and stage at diagnosis from 2007-2009 to 2011-2013 in expansion relative to non-expansion states.

RESULTS:

There was a -0.48 (95% CI = -0.84 to -0.13, p=0.007) percentage point (PP) reduction in uninsured in expansion relative to non-expansion states, primarily among counties with lower educational attainment (-1.73 PP, 95% CI = -2.72 to -0.75). Increases in early stage diagnoses in expansion relative to non-expansion states were found overall and in breast (1.56 PP, 95% CI = 0.45 to 2.68, p=0.006), colorectal (3.72 PP, 95% CI = 0.33 to 7.12, p=0.032), and lung (1.49 PP, 95% CI = 0.25 to 2.72, p=0.018) cancers. Decreases in late stage diagnoses were found in cervical (-5.91 PP, 95% CI = -9.58 to -2.25, p=0.002), colorectal (-2.72 PP, 95% CI = -5.43 to -0.01, p=0.05), and lung (-3.28 PP, 95% CI = -5.47 to -1.1, p=0.003) cancers.

CONCLUSIONS:

For radiotherapy recipients, early Medicaid expansion was associated with decreased percent uninsured, particularly among low education counties, and earlier stage diagnoses for screenable cancers. Thus, early Medicaid expansion may improve access to care and decrease disparities for radiotherapy recipients.

PMID:
31634633
DOI:
10.1016/j.prro.2019.10.003

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