Erin M Mobley1, Ian Tfirn2, Christina Guerrier2, Michael S Gutter3, Kim Vigal2, Keouna Pather1, Brett Baskovich4, Ziad T Awad1, Alexander S Parker5. 1. From the Department of Surgery (Mobley, Pather, Awad), University of Florida, Jacksonville, FL. 2. Center for Data Solutions (Tfirn, Guerrier, Vigal), University of Florida, Jacksonville, FL. 3. Institute for Food and Agricultural Sciences (Gutter), University of Florida, Gainesville, FL. 4. Department of Pathology (Baskovich), University of Florida, Jacksonville, FL. 5. College of Medicine (Parker), University of Florida, Jacksonville, FL.
Abstract
BACKGROUND: This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN: We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS: In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS: Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
BACKGROUND: This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN: We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS: In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS: Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
Authors: John N Bliton; Michael Parides; Peter Muscarella; Katia T Papalezova; Haejin In Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-12-10 Impact factor: 4.254
Authors: Andrew P Loehrer; David C Chang; Matthew M Hutter; Zirui Song; Keith D Lillemoe; Andrew L Warshaw; Cristina R Ferrone Journal: J Am Coll Surg Date: 2015-10-09 Impact factor: 6.113
Authors: Anasooya Abraham; Waddah B Al-Refaie; Helen M Parsons; Vikas Dudeja; Selwyn M Vickers; Elizabeth B Habermann Journal: Ann Surg Oncol Date: 2013-04-12 Impact factor: 5.344
Authors: Whitney E Zahnd; Cathryn Murphy; Marie Knoll; Gabriel A Benavidez; Kelsey R Day; Radhika Ranganathan; Parthenia Luke; Anja Zgodic; Kewei Shi; Melinda A Merrell; Elizabeth L Crouch; Heather M Brandt; Jan M Eberth Journal: Int J Environ Res Public Health Date: 2021-02-03 Impact factor: 3.390