LATEBREAKER
Cancer
The impact of Medicaid expansion on non-small cell lung cancer diagnosis, survival, and disparities Lu Zhang* Lu Zhang Marvin Okon Jingxuan Zhao K. Robin Yabroff Rachel Mayo Khoa Truong Xuesong Han
Background
Medicaid Expansion (ME) under the Affordable Care Act increased insurance coverage among low-income populations. We examined the associations of ME with changes in early stage at diagnosis and 3-year overall survival among individuals with non-small cell lung cancer (NSCLC), by race/ethnicity and residential segregation status.
Methods
Patients aged 18-64 newly diagnosed with NSCLC in 2010-2013 (pre-expansion) and 2015-2019 (post-expansion) from 22 states that expanded Medicaid eligibility before 12/31/2014 and 16 states that had not expanded Medicaid by 12/31/2019 were identified from the North American Association of Central Cancer Registries CiNA database. Outcomes included diagnosis at localized stage and 3-year overall survival. Residential racial and economic segregation was measured by the Index of Concentration at Extremes (ICE) at the county level. The Difference-in-differences (DD) approach was used. Linear probability regressions were fitted for early-stage diagnosis and flexible parametric survival models were fitted for survival, , and stratified by race and ethnicity and ICE tertile.
Results
A total of 215,854 patients from expansion and 167,180 patients from non-expansion states were included. ME was associated with significant increases in local stage diagnosis (aDD=1.55ppt, P<.0001) and 3-year survival (aDD=2.28ppt, P<.0001). The pattern was consistent across racial/ethnic groups and ICE tertiles, though the net increase in early-stage diagnosis associated with ME was most prominent among non-Hispanic White patients (aDD=1.82ppt, P<.0001).
Conclusion
ME was associated with an increase in early diagnosis and 3-year overall survival of NSCLC in a nationwide population-based database. The improvements were seen in all segments of populations in terms of race/ethnicity and residential segregation status.