Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 13:12:916167.
doi: 10.3389/fonc.2022.916167. eCollection 2022.

Changes in Cancer Mortality by Race and Ethnicity Following the Implementation of the Affordable Care Act in California

Maria Elena Martinez  1   2 , Scarlett L Gomez  3   4 , Alison J Canchola  3 , Debora L Oh  3 , James D Murphy  2   5 , Winta Mehtsun  2   6 , K Robin Yabroff  7 , Matthew P Banegas  2   5
Affiliations

Changes in Cancer Mortality by Race and Ethnicity Following the Implementation of the Affordable Care Act in California

Maria Elena Martinez et al. Front Oncol. .

Abstract

Although Affordable Care Act (ACA) implementation has improved cancer outcomes, less is known about how much the improvement applies to different racial and ethnic populations. We examined changes in health insurance coverage and cancer-specific mortality rates by race/ethnicity pre- and post-ACA. We identified newly diagnosed breast (n = 117,738), colorectal (n = 38,334), and cervical cancer (n = 11,109) patients < 65 years in California 2007-2017. Hazard rate ratios (HRR) and 95% confidence intervals (CI) were calculated using multivariable Cox regression to estimate risk of cancer-specific death pre- (2007-2010) and post-ACA (2014-2017) and by race/ethnicity [American Indian/Alaska Natives (AIAN); Asian American; Hispanic; Native Hawaiian or Pacific Islander (NHPI); non-Hispanic Black (NHB); non-Hispanic white (NHW)]. Cancer-specific mortality from colorectal cancer was lower post-ACA among Hispanic (HRR = 0.82, 95% CI = 0.74 to 0.92), NHB (HRR = 0.69, 95% CI = 0.58 to 0.82), and NHW (HRR = 0.90; 95% CI = 0.84 to 0.97) but not Asian American (HRR = 0.95, 95% CI = 0.82 to 1.10) patients. We observed a lower risk of death from cervical cancer post-ACA among NHB women (HRR = 0.68, 95% CI = 0.47 to 0.99). No statistically significant differences in breast cancer-specific mortality were observed for any racial or ethnic group. Cancer-specific mortality decreased following ACA implementation for colorectal and cervical cancers for some racial and ethnic groups in California, suggesting Medicaid expansion is associated with reductions in health inequity.

Keywords: Affordable Care Act; breast cancer; cervix cancer; colorectal cancer; disparities; race and ethnicity.

PubMed Disclaimer

Conflict of interest statement

WM: Flatiron Health - honorarium for a talk in disparities in healthcare. KRY: Serves on the Flatiron Health Equity Advisory Board. All honoraria are donated to her employer, the American Cancer Society. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hazard Ratio (95% coinfedence interval) for cancer-specific death by time period for younger (<65 years) and older (65 years and older) patienets. P-value indicates interaction for difference in mortality between 2014-2017 compared to 2007-2010 between older and younger patients. Note. NHB, non-Hispanic Black; NHW. Non-Hispanic white.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Institute of Medicine (US) Committee on Health Insurance Status and Its Consequences. In: America’s Uninsured Crisis: Consequences for Health and Health Care. Washington (DC: National Academies Press (US) (2009). - PubMed
    1. American Cancer Society Cancer Action Network . Cancer Disparities: Chartbook National Academies Press; (2018). Available at: https://www.fightcancer.org/sites/default/files/National%20Documents/Dis... (Accessed February 15, 2022).
    1. Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, et al. Association of Insurance With Cancer Care Utilization and Outcomes. CA Cancer J Clin (2008) 58:9–31. doi: 10.3322/CA.2007.0011 - DOI - PubMed
    1. Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of Insurance Status and Ethnicity With Cancer Stage at Diagnosis for 12 Cancer Sites: A Retrospective Analysis. Lancet Oncol (2008) 9:222–31. doi: 10.1016/S1470-2045(08)70032-9 - DOI - PubMed
    1. Bleyer A, Ulrich C, Martin S. Young Adults, Cancer, Health Insurance, Socioeconomic Status, and the Patient Protection and Affordable Care Act. Cancer (2012) 118:6018–21. doi: 10.1002/cncr.27685 - DOI - PubMed