Medicaid expansion linked to reduced mortality after lung cancer surgery
Click Here to Manage Email Alerts
Key takeaways:
- Medicaid expansion reduced postoperative mortality rates for patient with NSCLC.
- In-hospital mortality after surgical resection declined in Medicare expansion states.
Postoperative mortality rates in patients who had surgical resection of non-small cell lung cancer dropped significantly with Medicaid expansion under the Patient Protection and Affordable Care Act, per a study in JAMA Network Open.
The decrease occurred in states where Medicaid coverage grew but not in states where it stayed the same.
“Expanding health insurance coverage options facilitates access to care, which seems to contribute to improved cancer outcomes,” Leticia Nogueira, PhD, MPH, scientific director of health services research at American Cancer Society, told Healio.
Background and methods
Currently, 40 states and the District of Columbia have increased Medicaid coverage since the approval of the Patient Protection and Affordable Care Act (ACA) in 2014.
The ACA boosted health care for individuals and families near the poverty line, according to background information provided by researchers.
“We know Medicaid expansion is associated with improved health insurance coverage among cancer patients and earlier stage of diagnosis, but previous studies evaluating the association between Medicaid expansion and cancer outcomes .... weren’t able to figure out whether Medicaid expansion improved access to care or if the survival was due to cancers being diagnosed earlier,” Nogueira said.
“We set out to test whether Medicaid expansion was associated with changes in early mortality following lung cancer surgery among patients who were discharged from the hospital — a setting in which access to care is strongly associated with better survival because patients with health insurance coverage are less likely to delay contacting health care providers with concerns and face fewer barriers navigating the health care system,” she added.
Recommended treatment for patients with NSCLC isolated to the lung and lymph nodes is surgical resection, but 40% of patients experience adverse events within 30 days.
Nogueira and colleagues used the National Cancer Database to find patients diagnosed with stage I to III NSCLC aged between 45 to 64 years, treated with lobectomy or pneumonectomy in 27 states that extended Medicaid eligibility by 2014 and 16 that did not by 2019.
Results and next steps
The study cohort included 14,984 individuals (mean age, 56.3 years; 54.6% women; 69.2% white; 19.1% Black); 62.1% lived in states that expanded Medicaid coverage.
Mortality rates for discharged patients in states that expanded Medicaid decreased drastically at the 30-day postoperative mark (0.97% to .26%; P < .001) and 90-day mark (2.63% to 1.32%; P < .001).
Mortality rates barely changed in states that did not expand coverage (30 days: 0.75% to 0.68%; 90 days: 2.43% to 2.2%).
In-hospital mortality for patients in states that expanded Medicaid also decrease (1.41% to 0.77%; P = .004), but stayed the same in the other states (1.49% to 1.2%). However, “there was no significant difference-in-differences between expansion and non-expansion states,” researchers wrote.
“These results were expected because while access to care is strongly associated with post-discharge survival, in-hospital mortality is more strongly associated with a patient’s age and comorbidity status, which did not change significantly with Medicaid expansion,” Nogueira said.
Nogueira believes future research should explore whether patients with Medicaid act quicker in seeking care than others because of their coverage and if navigating the system comes with fewer hurdles. Furthermore, other government policies concerning insurance eligibility, including income and age, and their impact on cancer care, should be examined.
“The U.S. is the only developed country without universal health care,” she said. “This study contributes to the body of evidence showing health insurance coverage expansion contributes to better health outcomes in the population.”
For more information:
Leticia Nogueira, PhD, MPH, can be reached at leticia.nogueira@cancer.org.
Collapse
Read more about
Click Here to Manage Email Alerts