Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis.

Autor: Bergstein A; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America., Huang Y; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America., Hershman DL; Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA., Xu X; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America., Wright J; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA. Electronic address: jw2459@columbia.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2024 Oct; Vol. 189, pp. 49-55. Date of Electronic Publication: 2024 Jul 15.
DOI: 10.1016/j.ygyno.2024.06.028
Abstrakt: Objective: In 2014 the Affordable Care Act expanded Medicaid coverage in states that opted to participate. Limited data are available describing the effect of Medicaid expansion on cancer screening. The objective of our study was to evaluate trends in cervical cancer screening associated with Medicaid expansion.
Methods: Using data from the Behavioral Risk Factor Surveillance System, we identified female respondents ages 30-64 years with a household income below $35,000. The outcome measure was guideline-adherent cervical cancer screening. The years 2010 and 2012 constituted the pre-expansion period while 2016 and 2018 were used to capture the post-expansion period. A difference-in-difference (DID) analysis was performed to assess changes in cervical cancer screening in Medicaid expansion states compared to non-expansion states, for the overall sample and for each expansion state individually.
Results: The overall DID analysis showed a greater increase in cervical cancer screening by 1.1 percentage points (95% CI: 0.1 to 2.0%, P = 0.03) in expansion states compared to non-expansion states. The analysis comparing individual expansion states to non-expansion states showed that 6 expansion states had a significantly higher increase in screening relative to non-expansion states: Oregon (8.5%, P < 0.001), Kentucky (4.5%, P = 0.001), Washington (4.2%, P = 0.002), Colorado (4.3%, P = 0.008), Nevada (4.7%, P = 0.048), and Ohio (2.8%, P = 0.03). Of these states, 5 ranked among the states with the lowest baseline screening rates.
Conclusions: Medicaid expansion states experienced a greater increase in cervical cancer screening relative to non-expansion states. Expansion states with lower baseline screening rates experienced greater increases in screening after expanding Medicaid.
Competing Interests: Declaration of competing interest Jason D. Wright has received royalties from UpToDate, honoraria from the American College of Obstetricians and Gynecologists and received research funding from Merck. Xiao Xu has received honoraria from the American Association of Gynecologic Laparoscopists The other authors have no conflict of interest to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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