Andrew B Crocker1, Alexander Zeymo2, James McDermott1, David Xiao1, Thomas J Watson3, Thomas DeLeire4, Nawar Shara5, Kitty S Chan2, Waddah B Al-Refaie6. 1. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC. 2. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC. 3. Department of Surgery, MedStar-Georgetown University Hospital Washington, DC. 4. Georgetown McCourt School of Public Policy, Washington, DC. 5. MedStar Health Research Institute, Washington, DC; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC. 6. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital Washington, DC. Electronic address: waddah.b.al-refaie@gunet.georgetown.edu.
Abstract
BACKGROUND: The Affordable Care Act Medicaid expansion demonstrated inconsistent effects on cancer surgery utilization rates among racial and ethnic minorities and low-income Americans. This quasi-experimental study examines whether Medicaid expansion differentially increased the utilization of surgical cancer care for low-income groups and racial minorities in states that expanded their Medicaid programs. METHODS: A cohort of more than 81,000 patients 18 to 64 years of age who underwent cancer surgery were examined in Medicaid expansion versus nonexpansion states. This evaluation utilized merged data from the State Inpatient Database, American Hospital Association, and the Area Resource File for the years 2012 to 2015. Poisson interrupted time series analysis were performed to examine the impact of Medicaid expansion on the utilization of cancer surgery for the uninsured overall, low-income persons, and racial minorities, adjusting for age, sex, Elixhauser comorbidity score, population-level characteristics, and provider-level characteristics. RESULTS: For persons from low-income ZIP codes, Medicaid expansion was associated with an immediate 24% increase in utilization (P = .002) relative to no significant change in nonexpansion states. No significant trends, however, were observed after the Affordable Care Act expansion for racial and ethnic minorities in expansion versus nonexpansion states. CONCLUSION: Medicaid expansion was associated with greater utilization of cancer surgery by low-income Americans but provided no preferential effects for racial minorities in expansion states. Beyond the availability of coverage, these findings highlight the need for additional investigation to uncover other factors that contribute to race-ethnic disparities in surgical cancer care.
BACKGROUND: The Affordable Care Act Medicaid expansion demonstrated inconsistent effects on cancer surgery utilization rates among racial and ethnic minorities and low-income Americans. This quasi-experimental study examines whether Medicaid expansion differentially increased the utilization of surgical cancer care for low-income groups and racial minorities in states that expanded their Medicaid programs. METHODS: A cohort of more than 81,000 patients 18 to 64 years of age who underwent cancer surgery were examined in Medicaid expansion versus nonexpansion states. This evaluation utilized merged data from the State Inpatient Database, American Hospital Association, and the Area Resource File for the years 2012 to 2015. Poisson interrupted time series analysis were performed to examine the impact of Medicaid expansion on the utilization of cancer surgery for the uninsured overall, low-income persons, and racial minorities, adjusting for age, sex, Elixhauser comorbidity score, population-level characteristics, and provider-level characteristics. RESULTS: For persons from low-income ZIP codes, Medicaid expansion was associated with an immediate 24% increase in utilization (P = .002) relative to no significant change in nonexpansion states. No significant trends, however, were observed after the Affordable Care Act expansion for racial and ethnic minorities in expansion versus nonexpansion states. CONCLUSION: Medicaid expansion was associated with greater utilization of cancer surgery by low-income Americans but provided no preferential effects for racial minorities in expansion states. Beyond the availability of coverage, these findings highlight the need for additional investigation to uncover other factors that contribute to race-ethnic disparities in surgical cancer care.
Authors: Gino Cioffi; Kristin A Waite; Jacob L Edelson; Carol Kruchko; Quinn T Ostrom; Jill S Barnholtz-Sloan Journal: J Neurooncol Date: 2022-10-05 Impact factor: 4.506
Authors: Justin M Barnes; Kimberly J Johnson; Eric Adjei Boakye; Lidia Schapira; Tomi Akinyemiju; Eliza M Park; Evan M Graboyes; Nosayaba Osazuwa-Peters Journal: J Natl Cancer Inst Date: 2021-07-14 Impact factor: 11.816
Authors: Michelle C Salazar; Maureen E Canavan; Samantha L Walters; Jeph Herrin; Jason L Schwartz; Michael Leapman; Daniel J Boffa Journal: JAMA Netw Open Date: 2020-09-01