Influence of Medicaid Expansion on Head and Neck Squamous Cell Carcinoma Presentation and Survival

Objective To compare head and neck squamous cell carcinoma stage at presentation and survival in Medicaid‐expanded states versus nonexpanded states. Study Design Retrospective cohort. Setting Northwestern University Feinberg School of Medicine. Methods The Head and Neck with human papillomavirus Status Database within the Surveillance, Epidemiology, and End Results (SEER) Program was queried for cases of head and neck squamous cell carcinoma (HNSCC) diagnosed in the years 2010 to 2016. Cases were grouped according to their respective state Medicaid expansion status. Multivariable logistic regressions and multivariable Cox proportional hazards models were used to evaluate associations with stage IV disease and survival. Results Compared to nonexpanded states, Medicaid‐expanded states had a significantly larger proportion of Medicaid patients (20.3% vs 16.7%, P = .0009) and a significantly smaller proportion of uninsured patients (1.7% vs 10.1%, P