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. 2023 May;89(5):1764-1773.
doi: 10.1177/00031348211050816. Epub 2022 Feb 25.

Is Medicaid Expansion Associated with Improved Nonmetastatic Colon Cancer Survival? An Analysis of the National Cancer Database

Alexandra C W Reitz  1 , Jeffrey M Switchenko  2 , Theresa W Gillespie  1   3
Affiliations

Is Medicaid Expansion Associated with Improved Nonmetastatic Colon Cancer Survival? An Analysis of the National Cancer Database

Alexandra C W Reitz et al. Am Surg. 2023 May.

Abstract

Methods: This retrospective study of 86 413 patients (40-64 years old) undergoing surgical resection for a new diagnosis of invasive, nonmetastatic colon cancer included in the National Cancer Database (NCDB) from 2010 to 2015 compared overall survival (OS) in MES to NES. Cox proportional hazard models, fit for OS, and propensity score-matching (PSM) analysis were performed.

Results: In this sample, 51 297 cases (59.2%) lived in MES and 35 116 (40.8%) in NES. Medicaid expansion states had earlier pathological stage compared to NES (stage I 25.38% vs 24.17%, stage II 32.93 vs 33.4%, and stage III 41.69 vs 42.43%; P < .001). 5-year OS in MES was higher than NES (79.1% vs 77.3%; P < .001); however, on both multivariable analysis (MVA) and PSM analysis, MES did not have significantly different OS from NES (hazard ratio (HR), .99, 95% confidence interval (CI), .95-1.03; P = .570; HR, .99, 95% CI, .95-1.03; P = .68).

Conclusion: Among NCDB patients with invasive, nonmetastatic colon cancer residing in MES at time of diagnosis was associated with earlier pathological stage. However, on both MVA and PSM analysis, OS was not significantly different in MES vs NES. Research on patient outcomes, such as receipt of guideline concordant care, can further inform the impact of insurance coverage expansion efforts on cancer outcomes.

Keywords: colorectal; socioeconomic.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study population.
Figure 2.
Figure 2.
Unadjusted Kaplan-Meier curve of overall survival of colon cancer patients by resident state’s Medicaid expansion status. Blue solid line = non-expansion state and red dotted line = Medicaid expansion state.
Figure 3.
Figure 3.
Unadjusted Kaplan-Meier curve of overall survival of colon cancer patients by resident state’s time of Medicaid expansion. Blue solid line = early expansion state, red dotted line = January 2014 expansion state, green dashed line = late expansion state, and gray dashed line = non-expansion state.
See this image and copyright information in PMC

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