Adam B Weiner1, Amanda X Vo1, Anuj S Desai1, Jim C Hu2, Daniel E Spratt3, Edward M Schaeffer1. 1. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 2. Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York, USA. 3. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
BACKGROUND: The objective of this study was to determine the effect of Medicaid expansion under the Patient Protection and Affordable Care Act (January 1, 2014) on the epidemiology of high-risk prostate-specific antigen (PSA) levels (≥20 ng/mL) at the time of prostate cancer (PCa) diagnosis. The authors hypothesized that better access to care would result in a reduction of high-risk features at diagnosis. METHODS: A retrospective cohort study was performed of 122,324 men aged <65 years who were diagnosed with PCa within the National Cancer Database. Difference-in-difference (DID) analyses adjusting for sociodemographic variables using linear regression compared PSA levels at diagnosis before expansion (2012-2013) and after expansion (2015-2016) between men residing in states that did or did not expand Medicaid. RESULTS: From 2012 to 2016, the proportion of men with PSA levels ≥20 ng/mL increased (from 18.9% to 19.8%) in nonexpansion states and decreased (from 19.9% to 18.2%) in expansion states. Compared with men in nonexpansion states, men in expansion states experienced a decline in PSA ≥20 ng/mL (DID, -2.33%; 95% CI, -3.21% to -1.44%; P < .001). Accordingly, the proportion of men presenting with high-risk disease decreased in expansion states relative to nonexpansion states (DID, -1.25%; 95% CI, -2.26% to 0.25%; P = .015). A similar statistically significant decrease in PSA levels ≥20 ng/mL was noted among black men (DID, -3.11%; 95% CI, -5.25% to 0.96%; P = .005). CONCLUSIONS: In Medicaid expansion states, there was an associated decrease in the proportion of young men presenting with PSA ≥20 ng/mL at the time of PCa diagnosis. These results suggest that Medicaid expansion improved access to PCa screening. Longer term data should assess oncologic outcomes.
BACKGROUND: The objective of this study was to determine the effect of Medicaid expansion under the Patient Protection and Affordable Care Act (January 1, 2014) on the epidemiology of high-risk prostate-specific antigen (PSA) levels (≥20 ng/mL) at the time of prostate cancer (PCa) diagnosis. The authors hypothesized that better access to care would result in a reduction of high-risk features at diagnosis. METHODS: A retrospective cohort study was performed of 122,324 men aged <65 years who were diagnosed with PCa within the National Cancer Database. Difference-in-difference (DID) analyses adjusting for sociodemographic variables using linear regression compared PSA levels at diagnosis before expansion (2012-2013) and after expansion (2015-2016) between men residing in states that did or did not expand Medicaid. RESULTS: From 2012 to 2016, the proportion of men with PSA levels ≥20 ng/mL increased (from 18.9% to 19.8%) in nonexpansion states and decreased (from 19.9% to 18.2%) in expansion states. Compared with men in nonexpansion states, men in expansion states experienced a decline in PSA ≥20 ng/mL (DID, -2.33%; 95% CI, -3.21% to -1.44%; P < .001). Accordingly, the proportion of men presenting with high-risk disease decreased in expansion states relative to nonexpansion states (DID, -1.25%; 95% CI, -2.26% to 0.25%; P = .015). A similar statistically significant decrease in PSA levels ≥20 ng/mL was noted among black men (DID, -3.11%; 95% CI, -5.25% to 0.96%; P = .005). CONCLUSIONS: In Medicaid expansion states, there was an associated decrease in the proportion of young men presenting with PSA ≥20 ng/mL at the time of PCa diagnosis. These results suggest that Medicaid expansion improved access to PCa screening. Longer term data should assess oncologic outcomes.
Authors: Hari T Vigneswaran; Jyotsna S Jagai; David T Greenwald; Achal P Patel; Megh Kumar; Ryan W Dobbs; Daniel M Moreira; Michael R Abern Journal: Prostate Cancer Prostatic Dis Date: 2021-05-04 Impact factor: 5.554
Authors: Adam B Weiner; Stephen Jan; Ketan Jain-Poster; Oliver S Ko; Anuj S Desai; Shilajit D Kundu Journal: PLoS One Date: 2020-09-16 Impact factor: 3.240
Authors: Juan F Javier-DesLoges; Julia Yuan; Shady Soliman; Kevin Hakimi; Margaret F Meagher; Fady Ghali; Walter Hsiang; Devin N Patel; Simon P Kim; James D Murphy; J Kellogg Parsons; Ithaar H Derweesh Journal: JAMA Netw Open Date: 2021-07-01