Medicaid expansion linked to decreased cancer incidence, mortality
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Medicaid expansion appeared associated with reductions in metastatic cancer incidence and overall cancer mortality, according to study results scheduled for presentation at ASCO Quality Care Symposium.
Researchers attributed approximately 12% of the improvements in cancer mortality to declines in metastatic diagnoses, which may reflect increased rates of curative-intent treatment, as well as other factors.
Background and methodology
Medicaid expansion after adoption of the Affordable Care Act in 2014 has been associated with earlier cancer diagnoses and improved cancer survival, but less is known about whether the expansion-associated survival benefits are primarily driven by early cancer detection that leads to improved prognosis, increased access to appropriate cancer care or both.
“Information on the impact of Medicaid expansion on population-level cancer mortality rates is limited,” Justin Michael Barnes, MD, resident in the department of radiation oncology at Washington University School of Medicine in St. Louis, told Healio. “This project was prompted by wanting to assess whether Medicaid expansion is associated with population-level mortality rates, and to what extent changes in distant-stage cancer incidence rates affect the potential expansion-associated changes in mortality.”
The study included state-level data on cancer incidence and mortality between 2001 and 2019 among individuals aged 20 to 64 years. Researchers conducted overall analyses of 16,470 state-year observations and analyses by cancer site subtype. They also used mediation analyses to assess whether local and/or distant stage diagnosis rates were mediators of the changes in cancer mortality rates.
Key findings
Researchers reported an approximately 3.3% decline in the rate of distant-stage cancer incidence and approximately 3.5% decline in the rate of cancer mortality in Medicaid expansion states compared with nonexpansion states. This indicated 2,612 distant-stage cancer diagnoses and 1,031 cancer deaths had been averted per year in the states with Medicaid expansion, according to a press release. Conversely, researchers observed no Medicaid expansion-associated changes in localized cancer incidence rates.
Reductions in metastatic cancer diagnoses accounted for about 12% of the improvement in mortality.
“Medicaid expansion by race subgroups was similarly associated with decreased distant-stage cancer diagnoses and cancer deaths for white individuals,” Barnes told Healio. “Distant-stage cancer incidence was a stronger driver in the changes, mediating 75% of the changes in cancer mortality rates associated with Medicaid expansion. However, there were minimal expansion-associated changes in cancer incidence or mortality for Black individuals.”
Researchers observed Medicaid expansion-associated decreases in cancer mortality by cancer site, with rate declines of about 3.6% for breast cancer and about 6% for cervical cancer.
“These data additionally provide evidence supporting the hypothesized mechanism that Medicaid expansion, through improved access to care, decreased new distant-stage cancer diagnoses or is causing a shift toward earlier-stage cancers and ultimately decreasing cancer deaths,” he said. “Additionally, our data raise concerns that providing insurance coverage alone may not be sufficient to improve outcomes among marginalized populations, specifically the Black population, where additional interventions may be needed to overcome structural barriers to care.”
Looking ahead
Five additional states expanded Medicaid after the end of the study period in late 2019; therefore, researchers anticipate additional averted distant-stage cancer diagnoses and cancer deaths. Future research that incorporates data after 2019 will have another challenge of interpreting changes in the context of the COVID-19 pandemic, they added.
“There are increasing data demonstrating that investing in Medicaid expansion improves the health of a state's population, and it would be great if additional states took action,” Barnes told Healio. “In fact, there are a couple of states where potentially enacting Medicaid expansion is an active issue. I think it is important for all of us clinicians, researchers, patients and advocates to actively promote policies that improve access to care for patients with cancer and exercise our democratic right to vote.”
References :
- Barnes JM, et al. Abstract 74. Presented at: ASCO Quality Care Symposium; Sept. 30-Oct. 1, 2022; Chicago.
- Research finds Medicaid expansion led to decreases in cancer incidence and mortality rates (press release). Available at: www.asco.org/about-asco/press-center/news-releases/medicaid-expansion-led-decreases-cancer-incidence-and. Published Sept. 27, 2022. Accessed Sept. 29, 2022.
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Barnes JM, et al. Abstract 74. Presented at: ASCO Quality Care Symposium; Sept. 30-Oct.-1, 2022; Chicago.
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