Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities
Purpose To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California. Methods We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010–2017. Censu...
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| Veröffentlicht in: | Cancer causes & control 2024-10, Vol.35 (10), p.1343-1353 |
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| creator | Li, Lihua Yang, Chen Huang, Yuanhui Zhan, Serena Hu, Liangyuan Zou, Joe Yu, Mandi Mazumdar, Madhu Liu, Bian |
| description | Purpose
To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California.
Methods
We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010–2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010–2013) and post-expansion periods (2014–2017), and the relative IRR (DID estimates) across three groups of neighborhoods.
Results
Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06,
p
= 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative
IRR
= 1.05; 95% CI, 1.01 to 1.09,
p
= 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage.
Conclusions
The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods. |
| doi_str_mv | 10.1007/s10552-024-01893-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3068750135</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3114264123</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-f9c2c4d8c18a1ce9d3efd03b664ba1ce3d1e37dc35d0a85bfea4c955e2f6e65f3</originalsourceid><addsrcrecordid>eNp9kclOwzAQhi0EomV5AQ7IEhcuAS9xliOq2CQQFzhbjj1pXaV2sROWt8c0LBIHTrY83_zj0YfQESVnlJDyPFIiBMsIyzNCq5pndAtNqSh5VjImttGU1KLMBMv5BO3FuCSEiIKRXTThVVXmFRVTNNyDsVpZg-FtrVy03mHr8Ex1tvXBWYWVM7gJoGKPtXIaQqprayBdsdLBx4gd2Pmi8WHhvYn41fYL_KLCu3VzHL22qsMvQ-cgqMZ2trcQD9BOq7oIh1_nPnq6unyc3WR3D9e3s4u7TDNR9Flba6ZzU2laKaqhNhxaQ3hTFHnz-cANBV4azYUhqhJNCyrXtRDA2gIK0fJ9dDrmroN_HiD2cmWjhq5TDvwQJSdFVQpCuUjoyR906Yfg0u8kpzRnRU4ZTxQbqc3iAVq5DnaVdpWUyE8pcpQikxS5kSJpajr-ih6aFZiflm8LCeAjEFPJzSH8zv4n9gOqwZpe</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3114264123</pqid></control><display><type>article</type><title>Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities</title><source>MEDLINE</source><source>SpringerLink (Online service)</source><creator>Li, Lihua ; Yang, Chen ; Huang, Yuanhui ; Zhan, Serena ; Hu, Liangyuan ; Zou, Joe ; Yu, Mandi ; Mazumdar, Madhu ; Liu, Bian</creator><creatorcontrib>Li, Lihua ; Yang, Chen ; Huang, Yuanhui ; Zhan, Serena ; Hu, Liangyuan ; Zou, Joe ; Yu, Mandi ; Mazumdar, Madhu ; Liu, Bian</creatorcontrib><description>Purpose
To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California.
Methods
We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010–2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010–2013) and post-expansion periods (2014–2017), and the relative IRR (DID estimates) across three groups of neighborhoods.
Results
Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06,
p
= 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative
IRR
= 1.05; 95% CI, 1.01 to 1.09,
p
= 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage.
Conclusions
The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.</description><identifier>ISSN: 0957-5243</identifier><identifier>ISSN: 1573-7225</identifier><identifier>EISSN: 1573-7225</identifier><identifier>DOI: 10.1007/s10552-024-01893-1</identifier><identifier>PMID: 38874815</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Biomedical and Life Sciences ; Biomedicine ; Breast cancer ; Breast Neoplasms - epidemiology ; California - epidemiology ; Cancer Research ; Census ; Epidemiology ; Female ; Health insurance ; Hematology ; Humans ; Incidence ; Medicaid ; Medicaid - statistics & numerical data ; Middle Aged ; Neighborhood Characteristics - statistics & numerical data ; Neighborhoods ; Oncology ; Original Paper ; Public Health ; Regression analysis ; Residence Characteristics - statistics & numerical data ; Social Vulnerability ; United States - epidemiology ; Womens health ; Young Adult</subject><ispartof>Cancer causes & control, 2024-10, Vol.35 (10), p.1343-1353</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-f9c2c4d8c18a1ce9d3efd03b664ba1ce3d1e37dc35d0a85bfea4c955e2f6e65f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10552-024-01893-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10552-024-01893-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38874815$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Lihua</creatorcontrib><creatorcontrib>Yang, Chen</creatorcontrib><creatorcontrib>Huang, Yuanhui</creatorcontrib><creatorcontrib>Zhan, Serena</creatorcontrib><creatorcontrib>Hu, Liangyuan</creatorcontrib><creatorcontrib>Zou, Joe</creatorcontrib><creatorcontrib>Yu, Mandi</creatorcontrib><creatorcontrib>Mazumdar, Madhu</creatorcontrib><creatorcontrib>Liu, Bian</creatorcontrib><title>Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities</title><title>Cancer causes & control</title><addtitle>Cancer Causes Control</addtitle><addtitle>Cancer Causes Control</addtitle><description>Purpose
To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California.
Methods
We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010–2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010–2013) and post-expansion periods (2014–2017), and the relative IRR (DID estimates) across three groups of neighborhoods.
Results
Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06,
p
= 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative
IRR
= 1.05; 95% CI, 1.01 to 1.09,
p
= 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage.
Conclusions
The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.</description><subject>Adult</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - epidemiology</subject><subject>California - epidemiology</subject><subject>Cancer Research</subject><subject>Census</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health insurance</subject><subject>Hematology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Medicaid</subject><subject>Medicaid - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Neighborhood Characteristics - statistics & numerical data</subject><subject>Neighborhoods</subject><subject>Oncology</subject><subject>Original Paper</subject><subject>Public Health</subject><subject>Regression analysis</subject><subject>Residence Characteristics - statistics & numerical data</subject><subject>Social Vulnerability</subject><subject>United States - epidemiology</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>0957-5243</issn><issn>1573-7225</issn><issn>1573-7225</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kclOwzAQhi0EomV5AQ7IEhcuAS9xliOq2CQQFzhbjj1pXaV2sROWt8c0LBIHTrY83_zj0YfQESVnlJDyPFIiBMsIyzNCq5pndAtNqSh5VjImttGU1KLMBMv5BO3FuCSEiIKRXTThVVXmFRVTNNyDsVpZg-FtrVy03mHr8Ex1tvXBWYWVM7gJoGKPtXIaQqprayBdsdLBx4gd2Pmi8WHhvYn41fYL_KLCu3VzHL22qsMvQ-cgqMZ2trcQD9BOq7oIh1_nPnq6unyc3WR3D9e3s4u7TDNR9Flba6ZzU2laKaqhNhxaQ3hTFHnz-cANBV4azYUhqhJNCyrXtRDA2gIK0fJ9dDrmroN_HiD2cmWjhq5TDvwQJSdFVQpCuUjoyR906Yfg0u8kpzRnRU4ZTxQbqc3iAVq5DnaVdpWUyE8pcpQikxS5kSJpajr-ih6aFZiflm8LCeAjEFPJzSH8zv4n9gOqwZpe</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Li, Lihua</creator><creator>Yang, Chen</creator><creator>Huang, Yuanhui</creator><creator>Zhan, Serena</creator><creator>Hu, Liangyuan</creator><creator>Zou, Joe</creator><creator>Yu, Mandi</creator><creator>Mazumdar, Madhu</creator><creator>Liu, Bian</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20241001</creationdate><title>Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities</title><author>Li, Lihua ; Yang, Chen ; Huang, Yuanhui ; Zhan, Serena ; Hu, Liangyuan ; Zou, Joe ; Yu, Mandi ; Mazumdar, Madhu ; Liu, Bian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-f9c2c4d8c18a1ce9d3efd03b664ba1ce3d1e37dc35d0a85bfea4c955e2f6e65f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - epidemiology</topic><topic>California - epidemiology</topic><topic>Cancer Research</topic><topic>Census</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health insurance</topic><topic>Hematology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Medicaid</topic><topic>Medicaid - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Neighborhood Characteristics - statistics & numerical data</topic><topic>Neighborhoods</topic><topic>Oncology</topic><topic>Original Paper</topic><topic>Public Health</topic><topic>Regression analysis</topic><topic>Residence Characteristics - statistics & numerical data</topic><topic>Social Vulnerability</topic><topic>United States - epidemiology</topic><topic>Womens health</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Lihua</creatorcontrib><creatorcontrib>Yang, Chen</creatorcontrib><creatorcontrib>Huang, Yuanhui</creatorcontrib><creatorcontrib>Zhan, Serena</creatorcontrib><creatorcontrib>Hu, Liangyuan</creatorcontrib><creatorcontrib>Zou, Joe</creatorcontrib><creatorcontrib>Yu, Mandi</creatorcontrib><creatorcontrib>Mazumdar, Madhu</creatorcontrib><creatorcontrib>Liu, Bian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</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 causes & control</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Lihua</au><au>Yang, Chen</au><au>Huang, Yuanhui</au><au>Zhan, Serena</au><au>Hu, Liangyuan</au><au>Zou, Joe</au><au>Yu, Mandi</au><au>Mazumdar, Madhu</au><au>Liu, Bian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities</atitle><jtitle>Cancer causes & control</jtitle><stitle>Cancer Causes Control</stitle><addtitle>Cancer Causes Control</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>35</volume><issue>10</issue><spage>1343</spage><epage>1353</epage><pages>1343-1353</pages><issn>0957-5243</issn><issn>1573-7225</issn><eissn>1573-7225</eissn><abstract>Purpose
To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California.
Methods
We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010–2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010–2013) and post-expansion periods (2014–2017), and the relative IRR (DID estimates) across three groups of neighborhoods.
Results
Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06,
p
= 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative
IRR
= 1.05; 95% CI, 1.01 to 1.09,
p
= 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage.
Conclusions
The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38874815</pmid><doi>10.1007/s10552-024-01893-1</doi><tpages>11</tpages></addata></record> |
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| subjects | Adult Biomedical and Life Sciences Biomedicine Breast cancer Breast Neoplasms - epidemiology California - epidemiology Cancer Research Census Epidemiology Female Health insurance Hematology Humans Incidence Medicaid Medicaid - statistics & numerical data Middle Aged Neighborhood Characteristics - statistics & numerical data Neighborhoods Oncology Original Paper Public Health Regression analysis Residence Characteristics - statistics & numerical data Social Vulnerability United States - epidemiology Womens health Young Adult |
| title | Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities |
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