Lower Medicaid income limits linked to shorter survival among patients with cancer
Patients with cancer who resided in states with lower Medicaid income eligibility limits had poorer long-term survival rates than patients in states with higher limits, according to a study presented during the virtual ASCO Annual Meeting.
Researchers observed the association across a variety of cancers and among patients both with early- and late-stage disease at diagnosis.
“Income eligibility limits for Medicaid, the health insurance program for low-income populations in the United States, vary substantially by state for nonelderly adults,” Jingxuan Zhao, MPH, associate scientist at American Cancer Society, told Healio. “To date, little is known about the effects of Medicaid income eligibility limits on long-term cancer outcomes.”
Zhao and colleagues used the National Cancer Database to analyze 1,426,657 adults aged 18 to 64 years newly diagnosed with 17 common cancers between 2010 and 2013, before the implementation of Medicaid expansion under the Affordable Care Act. The researchers grouped states according to the following Medicaid income eligibility limits: 50% or less than the federal poverty level (FPL), 51% to 137% of the FPL, and greater than or equal to 138% of the FPL. They measured survival time from date of diagnosis through Dec. 31, 2017.
The investigators assessed associations of income eligibility limits and stage-specific survival — controlling for age group, sex, race/ethnicity, metropolitan statistical area, number of health conditions in addition to cancer, diagnosis year, facility type, and the random effect of state of residence — using multivariable Cox proportional hazard models with age as time scale.
Among the patients, 22% resided in states with Medicaid income eligibility limits of 50% or less than the FPL, 43.5% in states with limits between 51% and 137% of the FPL, and 34.5% in states with limits greater than or equal to 138% of the FPL.
Results showed patients in states with lower income eligibility limits had worse survival outcomes for all cancers combined, including patients with early-stage and late-stage disease.
Multivariable analysis showed the highest HRs among patients living in states with income eligibility limits no greater than 50% of the FPL (P for trend < .05). For instance, when compared with fellow women with early-stage breast cancer who resided in the 11 states with Medicaid income eligibility limits of 138% of the FPL or greater, those living in states with limits of 50% or less had a 31% higher rate of death due to any cause (HR = 1.31; 95% CI, 1.18-1.46), whereas those living in states with limits of 51% to 137% had a 17% higher death rate (HR = 1.17; 95% CI, 1.06-1.3).
Researchers reported similar results among women with late-stage breast cancer and patients with other common cancers, including prostate, colorectal and non-small lung cancers.
Thirty-eight states plus the District of Columbia have expanded Medicaid income limits, supported in part by a federal match included in the ACA, according to an ASCO press release.
“Policies to increase Medicaid income eligibility limits, such as Medicaid expansion, may help improve survival following cancer diagnosis,” Zhao told Healio, adding that further research is planned.
“We plan to explore the association of Medicaid income eligibility limits and access to cancer treatment among newly diagnosed [patients with cancer] and to explore the association of Medicaid income eligibility limits and access to health care and affordability among cancer survivors,” Zhao said. “We also plan to assess the effects of Medicaid expansion under the ACA and survival and mortality among [patients with cancer].”
Perspective
Back to Top
The study suggests that having Medicaid expansion may indirectly indicate more access to cancer screening and therefore early cancer detection. It may also be a proxy for access to better care and more specialized oncologists. All this translates into better survival. However, this is a preliminary analysis of existing data and, as such, doesn't have all the information we would like to study; we don't know what the expansion has brought to the population of that specific state.
The Tisch Cancer Institute at Mount Sinai
Collapse
Zhao J, et al. Abstract 6512. Scheduled for presentation at: ASCO Annual Meeting (virtual meeting); June 4-8, 2021.