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Medicaid expansion has led to earlier cancer detection among individuals with low income

Wed, 07/08/2020 - 14:59
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The likelihood of being diagnosed with advanced cancer decreased among individuals with low income after expansion of Medicaid coverage, according to researchers from the Case Western Reserve University School of Medicine's Center for Community Health Integration in Cleveland, OH.

The findings were reported in the study, 'The effect of Medicaid expansion among adults from low-income communities on stage at diagnosis in those with screening-amenable cancers', published in Cancer, which sought to estimate the effect of Medicaid expansion on the percentage of adults from low‐income communities with screening‐amenable cancers who present with metastatic disease.

In the study, Dr Uriel Kim, a medical student and researcher at Case Western and his colleagues analysed information pertaining to 12,760 individuals in Ohio aged 30 to 64 years who were diagnosed with invasive breast, cervical, colorectal or lung cancer in 2011 to 2016 and were uninsured or had Medicaid insurance at the time of diagnosis. The investigators compared data before Medicaid expansion (2011 to 2013) and after Medicaid expansion (2014 to 2016), noting whether patients were diagnosed with early (non-metastatic) or advanced (metastatic) cancer.

After adjusting for potential confounders, individuals who were diagnosed postexpansion were found to have 15% lower odds of having metastatic disease compared with those who were diagnosed pre‐expansion (adjusted odds ratio, 0.85; 95% confidence interval, 0.77‐0.93). As a control, a separate analysis that focused on individuals with private insurance who resided in high‐income communities found nonsignificant postexpansion (vs pre‐expansion) changes in the outcome (adjusted odds ratio, 1.02; 95% confidence interval, 0.96‐1.09).

"Cancer stage is the strongest predictor of survival for patients. Long-standing disparities in mortality from screening-amenable cancers between high-income and low-income adults have been driven in large part by differences in metastatic cancer rates," said Kim. "Medicaid expansion under the Affordable Care Act was associated with a significant reduction in the likelihood of being diagnosed with deadly metastatic cancer among Americans with low income. These improvements represent substantial progress in closing a persistent gap in cancer survival between Americans with high and low income."

The study's senior author, Dr Johnie Rose, assistant professor at Case Western Reserve University School of Medicine's Center for Community Health Integration, added that the study highlights the important role that Medicaid expansion has played in increasing access to preventive services, which impact health beyond cancer. "This fact is particularly relevant in the era of the COVID-19 pandemic as tens of millions of people have lost their jobs, and record numbers are expected to rely on safety net programs like Medicaid.”

An accompanying editorial notes that the findings are consistent with those from other studies that have examined the impact of Medicaid expansion on cancer outcomes. "The totality of these findings suggests that health coverage through Medicaid is an important predictor of cancer burden, and – critically – of early cancer identification," the authors wrote.