Association of Medicaid expansion with racial disparities in cancer stage at presentation
BACKGROUND This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC). METHODS A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in...
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| Veröffentlicht in: | Cancer 2022-09, Vol.128 (18), p.3340-3351 |
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| creator | Snyder, Rebecca A. Hu, Chung‐Yuan DiBrito, Sandra R. Chang, George J. |
| description | BACKGROUND
This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC).
METHODS
A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in the National Cancer Database was performed. Difference‐in‐differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non‐expansion states (non‐MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis.
RESULTS
Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p |
| doi_str_mv | 10.1002/cncr.34347 |
| format | Article |
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This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC).
METHODS
A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in the National Cancer Database was performed. Difference‐in‐differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non‐expansion states (non‐MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis.
RESULTS
Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p < 0.001) after expansion. Among Black and White patients, there was a shift towards increased early‐stage diagnosis (DID 3.5% and 3.5%, respectively; p < 0.001) and decreased late‐stage diagnosis (DID White: −3.5%; Black −2.5%; p < 0.001) in MES compared to non‐MES following expansion. Overall stage migration was greater for White compared to Black patients with CRC (10.3% vs. 5.1%) and NSCLC (8.1% vs. 6.7%) after expansion. Stage migration effects in patients with breast cancer were similar by race (White 4.8% vs. Black 4.5%).
CONCLUSION
An increased proportion of Black and White patients residing in Medicaid expansion states presented with earlier stage cancer following Medicaid expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.
Both Black and White patients residing in Medicaid expansion states presented with colorectal, breast, and non‐small cell lung cancer at earlier stages following expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.34347</identifier><language>eng</language><publisher>Atlanta: Wiley Subscription Services, Inc</publisher><subject>Breast cancer ; cancer stage ; Colorectal cancer ; Diagnosis ; Government programs ; Heterogeneity ; Inequality ; Lung cancer ; Medicaid ; Medicaid expansion ; Non-small cell lung carcinoma ; non‐small cell lung cancer ; Oncology ; Race ; Race factors ; Racial differences ; racial disparities ; Small cell lung carcinoma ; Tumors</subject><ispartof>Cancer, 2022-09, Vol.128 (18), p.3340-3351</ispartof><rights>2022 American Cancer Society.</rights><rights>2022 American Cancer Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3347-1b10d847abd3b51501e5b02618606d02d88aff253c2f178dfad3a8eb2576198e3</citedby><cites>FETCH-LOGICAL-c3347-1b10d847abd3b51501e5b02618606d02d88aff253c2f178dfad3a8eb2576198e3</cites><orcidid>0000-0002-9758-5361 ; 0000-0003-4252-7065 ; 0000-0002-2485-2481</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.34347$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.34347$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids></links><search><creatorcontrib>Snyder, Rebecca A.</creatorcontrib><creatorcontrib>Hu, Chung‐Yuan</creatorcontrib><creatorcontrib>DiBrito, Sandra R.</creatorcontrib><creatorcontrib>Chang, George J.</creatorcontrib><title>Association of Medicaid expansion with racial disparities in cancer stage at presentation</title><title>Cancer</title><description>BACKGROUND
This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC).
METHODS
A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in the National Cancer Database was performed. Difference‐in‐differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non‐expansion states (non‐MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis.
RESULTS
Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p < 0.001) after expansion. Among Black and White patients, there was a shift towards increased early‐stage diagnosis (DID 3.5% and 3.5%, respectively; p < 0.001) and decreased late‐stage diagnosis (DID White: −3.5%; Black −2.5%; p < 0.001) in MES compared to non‐MES following expansion. Overall stage migration was greater for White compared to Black patients with CRC (10.3% vs. 5.1%) and NSCLC (8.1% vs. 6.7%) after expansion. Stage migration effects in patients with breast cancer were similar by race (White 4.8% vs. Black 4.5%).
CONCLUSION
An increased proportion of Black and White patients residing in Medicaid expansion states presented with earlier stage cancer following Medicaid expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.
Both Black and White patients residing in Medicaid expansion states presented with colorectal, breast, and non‐small cell lung cancer at earlier stages following expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.</description><subject>Breast cancer</subject><subject>cancer stage</subject><subject>Colorectal cancer</subject><subject>Diagnosis</subject><subject>Government programs</subject><subject>Heterogeneity</subject><subject>Inequality</subject><subject>Lung cancer</subject><subject>Medicaid</subject><subject>Medicaid expansion</subject><subject>Non-small cell lung carcinoma</subject><subject>non‐small cell lung cancer</subject><subject>Oncology</subject><subject>Race</subject><subject>Race factors</subject><subject>Racial differences</subject><subject>racial disparities</subject><subject>Small cell lung carcinoma</subject><subject>Tumors</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp90E9LwzAYBvAgCs7pxU8Q8CJC55u0abKjDP_BVBAFPYU0STWjS2vSMfftzVZPHjy95OWXl4cHoVMCEwJAL7XXYZIXecH30IjAlGdACrqPRgAgMlbkb4foKMZFenLK8hF6v4qx1U71rvW4rfGDNU4rZ7D97pSP2-3a9Z84qIQabFzsVHC9sxE7j7Xy2gYce_VhsepxF2y0vt9dO0YHtWqiPfmdY_R6c_0yu8vmT7f3s6t5pvMUMyMVASMKriqTV4wwIJZVQEsiSigNUCOEquuUVdOacGFqZXIlbEUZL8lU2HyMzoe7XWi_Vjb2cumitk2jvG1XUdJSCEYpLViiZ3_ool0Fn9JJyqHkQEo2TepiUDq0MQZbyy64pQobSUBuW5bbluWu5YTJgNeusZt_pJw9zp6HPz-piX8d</recordid><startdate>20220915</startdate><enddate>20220915</enddate><creator>Snyder, Rebecca A.</creator><creator>Hu, Chung‐Yuan</creator><creator>DiBrito, Sandra R.</creator><creator>Chang, George J.</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9758-5361</orcidid><orcidid>https://orcid.org/0000-0003-4252-7065</orcidid><orcidid>https://orcid.org/0000-0002-2485-2481</orcidid></search><sort><creationdate>20220915</creationdate><title>Association of Medicaid expansion with racial disparities in cancer stage at presentation</title><author>Snyder, Rebecca A. ; Hu, Chung‐Yuan ; DiBrito, Sandra R. ; Chang, George J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3347-1b10d847abd3b51501e5b02618606d02d88aff253c2f178dfad3a8eb2576198e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Breast cancer</topic><topic>cancer stage</topic><topic>Colorectal cancer</topic><topic>Diagnosis</topic><topic>Government programs</topic><topic>Heterogeneity</topic><topic>Inequality</topic><topic>Lung cancer</topic><topic>Medicaid</topic><topic>Medicaid expansion</topic><topic>Non-small cell lung carcinoma</topic><topic>non‐small cell lung cancer</topic><topic>Oncology</topic><topic>Race</topic><topic>Race factors</topic><topic>Racial differences</topic><topic>racial disparities</topic><topic>Small cell lung carcinoma</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Snyder, Rebecca A.</creatorcontrib><creatorcontrib>Hu, Chung‐Yuan</creatorcontrib><creatorcontrib>DiBrito, Sandra R.</creatorcontrib><creatorcontrib>Chang, George J.</creatorcontrib><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Snyder, Rebecca A.</au><au>Hu, Chung‐Yuan</au><au>DiBrito, Sandra R.</au><au>Chang, George J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Medicaid expansion with racial disparities in cancer stage at presentation</atitle><jtitle>Cancer</jtitle><date>2022-09-15</date><risdate>2022</risdate><volume>128</volume><issue>18</issue><spage>3340</spage><epage>3351</epage><pages>3340-3351</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>BACKGROUND
This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC).
METHODS
A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in the National Cancer Database was performed. Difference‐in‐differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non‐expansion states (non‐MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis.
RESULTS
Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p < 0.001) after expansion. Among Black and White patients, there was a shift towards increased early‐stage diagnosis (DID 3.5% and 3.5%, respectively; p < 0.001) and decreased late‐stage diagnosis (DID White: −3.5%; Black −2.5%; p < 0.001) in MES compared to non‐MES following expansion. Overall stage migration was greater for White compared to Black patients with CRC (10.3% vs. 5.1%) and NSCLC (8.1% vs. 6.7%) after expansion. Stage migration effects in patients with breast cancer were similar by race (White 4.8% vs. Black 4.5%).
CONCLUSION
An increased proportion of Black and White patients residing in Medicaid expansion states presented with earlier stage cancer following Medicaid expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.
Both Black and White patients residing in Medicaid expansion states presented with colorectal, breast, and non‐small cell lung cancer at earlier stages following expansion. However, because the proportion of Black patients is higher in non‐expansion states, national racial disparities in cancer stage at presentation appear worse following Medicaid expansion.</abstract><cop>Atlanta</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/cncr.34347</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-9758-5361</orcidid><orcidid>https://orcid.org/0000-0003-4252-7065</orcidid><orcidid>https://orcid.org/0000-0002-2485-2481</orcidid></addata></record> |
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| subjects | Breast cancer cancer stage Colorectal cancer Diagnosis Government programs Heterogeneity Inequality Lung cancer Medicaid Medicaid expansion Non-small cell lung carcinoma non‐small cell lung cancer Oncology Race Race factors Racial differences racial disparities Small cell lung carcinoma Tumors |
| title | Association of Medicaid expansion with racial disparities in cancer stage at presentation |
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