The Effect of Medicaid Expansion on Racial/Ethnic Disparities in Receipt of Definitive Treatment and Time to Treatment Initiation: A patient-level and facility-level analysis of breast, colon, lung and prostate cancer

David-Dan Nguyen, MPH
Department of Surgery
Division of Urology
Poster Overview

We sought to determine if Medicaid expansion under the Affordable Care Act was associated with changes in access and time to definitive cancer therapy for treatment-eligible racial/ethnic minorities and at minority-serving hospitals (MSH). We found no significant association between Medicaid expansion and changes in receipt of definitive treatment for breast, colon, lung, and prostate cancer for minorities. Medicaid expansion was associated with improved time to treatment initiation for minorities, but not at MSHs. While Medicaid expansion was associated with improved time to definitive cancer therapy for minorities, coverage expansion did not reduce racial/ethnic disparities in receipt of definitive treatment and disparities between MSHs and non- MSHs.

Scientific Abstract

Background

The effect of Medicaid expansion under the Affordable Care Act on access to definitive cancer therapy for racial/ethnic minorities and at minority-serving hospitals (MSH) is unknown.

Methods:

We conducted a retrospective, difference-in-differences (DID) study including non-metastatic breast, colon, non-small cell lung, and prostate cancer patients under 65 at stages eligible for definitive treatment from the National Cancer DataBase. The outcomes were receipt of stage- appropriate definitive therapy and time to treatment initiation (TTI) within 30 days of diagnosis by state Medicaid expansion status

Results:

In analyses stratified by minority status, receipt of definitive treatment for minorities in expansion states did not change compared to minority patients in non-expansion states. The proportion of minorities in expansion states receiving treatment within 30 days increased (DID: +3.62%, 95% CI: 1.63% to 5.61%, p<0.001) compared to minority patients in non-expansion states. When stratifying by MSH status, there was no change in receipt of definitive therapy and TTI when comparing MSHs in expansion states to MSHs in non-expansion states.

Conclusion:

We found no significant association between Medicaid expansion and changes in receipt of definitive cancer treatment for racial/ethnic minorities. Medicaid expansion was associated with improved TTI at the patient-level for racial/ethnic minorities, but not at the facility-level for MSHs.

Clinical Implications
These findings suggest that Medicaid expansion under the ACA improved timeliness, but not receipt, of definitive cancer treatment for racial/ethnic minorities in our cohort of treatment-eligible cancer patients. Continued investment at the facility level are needed to reduce national disparities in cancer care in addition to coverage expansion.
Research Areas
Authors
David-Dan Nguyen, MPH; Marco Paciotti, MD; Maya Marchese, MSc; Alexander P. Cole, MD; Eugene B. Cone, MD; Stuart R. Lipsitz, ScD; Quoc-Dien Trinh, MD
Principal Investigator
Quoc-Dien Trinh, MD

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