GI cancer death rates, survival disparities decrease after Medicaid expansion
Click Here to Manage Email Alerts
Key takeaways:
- Medicaid expansion correlated with overall reductions in 2-year mortality rates among patients with GI cancers.
- Expansion could reduce survival disparities between Black patients and white patients.
Racial disparities in gastrointestinal cancer mortality decreased in states that expanded Medicaid coverage under the Affordable Care Act while staying the same or increasing in states that did not, study results showed.
Medicaid expansion — which several states adopted in 2014 — correlated with overall reductions in 2-year mortality rates among patients with GI cancers, according to the findings, scheduled for presentation at ASCO Annual Meeting. In addition, researchers observed consistently larger reductions in mortality among Black patients in expansion vs. nonexpansion states.
“Thus, expanding Medicaid is one attainable and concrete solution that has been found to be associated with improved survival outcomes,” Naveen Manisundaram, MD, MPH, research fellow at The University of Texas MD Anderson Cancer Center, said during a press conference.
Background and methods
Medicaid expansion has resulted in better access to cancer screenings and receipt of treatment for patients with cancer, according to Manisundaram.
“However, there are still a number of states that have not expanded Medicaid, [and] these patients have a large number of minority patients,” he said. “Our study aimed to investigate the impact of expansion on survival disparities between white and Black patients with gastrointestinal malignancies.”
Manisundaram and colleagues used data from the National Cancer Database to compare mortality rates by race before expansion (2009-2013) and after expansion (2014-2019) among 86,052 patients (74.3% white, 25.7% Black) with GI cancers, including 60,404 with colorectal cancer, 19,188 with pancreatic ductal adenocarcinoma and 6,460 with gastric adenocarcinoma. The researchers conducted a difference-in-difference (DID) analysis, with a negative figure indicating a larger decrease in mortality in expansion states compared with nonexpansion states.
Results
Among patients with pancreatic ductal adenocarcinoma, results showed a significantly greater decrease in 2-year mortality rates after Medicaid expansion among Black patients who lived in expansion vs. nonexpansion states (11.8% vs. 2.4%; DID = 9.4%), as well as increases in chemotherapy for patients with stage III to stage IV disease in expansion states (Black patients, DID = 3.7%; white patients, DID = 2.7%).
Researchers also observed greater reductions in 2-year mortality rates in expansion vs. nonexpansion states among patients with colorectal cancer (Black patients, 4.9% vs. 2%; DID = 2.9%; white patients, 6% vs. 1.8%; DID = 4.2%), primarily among Black patients with late-stage disease (12.6% vs. 6.1%; DID = 6.4%). Rates of surgery increased among Black patients with stage IV disease in expansion states (DID = 5.7%), but rates of chemotherapy receipt did not (DID = 1%).
Results showed larger 2-year mortality-rate declines among Black patients with gastric adenocarcinoma in expansion vs. nonexpansion states (13% vs. 5.2%; DID = 7.7%). One possible reason for the “profound improvement” may be that Black patients with late-stage disease in expansion states had higher rates of chemotherapy receipt after expansion, Manisundaram said.
Next steps, implications
Researchers now intend to examine the potential impact of Medicaid expansion on survival and treatment of other cancer types.
“We’ve seen many analyses looking at Medicaid expansion and its impact,” Julie R. Gralow, MD, FACP, FASCO, chief medical officer and executive vice president of ASCO, said during the press conference. “I think the strength of this one is that we have pre- and post-expansion, and we have the expanded states and those that didn’t.”
Gralow noted that 10 states have yet to expand Medicaid.
“Hopefully with solid data like this, we’ll be able to provide evidence that Medicaid expansion and the resultant improved access to care can really help overcome the inequities in access,” she said.
References:
- ASCO. Medicaid expansion linked to decrease in mortality and racial disparities for people with GI cancers (press release). Published May 25, 2023. Accessed May 25, 2023.
- Manisundaram N, et al. Abstract 6546. Scheduled for presentation at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
Collapse
Manisundaram N, et al. Abstract 6546. Scheduled for presentation at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
Click Here to Manage Email Alerts