Nosayaba Osazuwa-Peters1, Justin M Barnes2, Uchechukwu Megwalu3, Eric Adjei Boakye4, Kenton J Johnston5, Matthew E Gaubatz2, Kimberly J Johnson6, Neelima Panth7, Rosh K V Sethi8, Mark A Varvares9. 1. Saint Louis University Cancer Center, St. Louis, MO, USA; Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St. Louis, MO, USA. Electronic address: nosa.peters@duke.edu. 2. Saint Louis University School of Medicine, St. Louis, MO, USA. 3. Stanford University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Stanford, CA, USA. 4. Southern Illinois University School of Medicine, Department of Population Science and Policy, Springfield, IL, USA. 5. Saint Louis University College for Public Health and Social Justice, Department of Health Management and Policy, St. Louis, MO, USA; Saint Louis University Center for Health Outcomes Research (SLUCOR), St. Louis, MO, USA. 6. Washington University in St. Louis, Brown School, St. Louis, MO, USA. 7. Yale School of Medicine, Department of Surgery, Division of Otolaryngology, New Haven, CT, USA. 8. University of Michigan Health System, Department of Otolaryngology Head and Neck Surgery, Ann Arbor, MI, USA. 9. Harvard Medical School, Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA.
Abstract
OBJECTIVES: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC. METHODS: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011-2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP). RESULTS: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18-34 years (17.2 PP, 95% CI - 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30-7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67-24.3, p = 0.015). CONCLUSIONS: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.
OBJECTIVES: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC. METHODS: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011-2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP). RESULTS: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18-34 years (17.2 PP, 95% CI - 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30-7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67-24.3, p = 0.015). CONCLUSIONS: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.
Keywords:
Access to care; Affordable Care Act (ACA); Head and neck cancer (HNC); Health disparities; Health insurance; Medicaid expansion; SEER; Stage at diagnosis
Authors: Sarah P Huepenbecker; Shuangshuang Fu; Charlotte C Sun; Hui Zhao; Kristin M Primm; Sharon H Giordano; Larissa A Meyer Journal: Am J Obstet Gynecol Date: 2022-04-29 Impact factor: 10.693