Changes in Cancer Mortality after Medicaid Expansion and the Role of Stage at Diagnosis

Autor: Justin M Barnes, Kimberly J Johnson, Nosayaba Osazuwa-Peters, K Robin Yabroff, Fumiko Chino
Rok vydání: 2023
Předmět:
Zdroj: JNCI: Journal of the National Cancer Institute.
ISSN: 1460-2105
0027-8874
DOI: 10.1093/jnci/djad094
Popis: Background Medicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates. Methods Nationwide state-level cancer data from 2001-2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results/National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs. non-expansion states using generalized estimating equations with robust standard errors. Mediation analyses were utilized to assess whether distant stage cancer incidence mediated changes in cancer mortality. Results There were 17,370 state-level observations. For all cancers combined, there were Medicaid expansion-associated decreases in distant stage cancer incidence (adjusted odds ratio [aOR] 0.967, 95%CI = 0.943-0.992, P = 0.01) and cancer mortality (aOR 0.965, 95%CI = 0.936-0.995, P = 0.022). This translates to 2,591 averted distant stage cancer diagnoses and 1,616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P = 0.008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality. Conclusions Medicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses.
Databáze: OpenAIRE
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