Two-year mortality and racial disparities in survival among patients with gastrointestinal (GI) cancers have declined in the period following the 2014 Medicaid expansion, according to research presented at the American Society of Clinical Oncology (ASCO) annual meeting. ) of 2023.
Overall, Medicaid expansion was associated with decreased 2-year mortality for patients with gastrointestinal cancers in expanding states and an even greater reduction in mortality for black patients residing in expanding states compared with those in expanding states. non-expansion, the researchers found. In the study, existing racial disparities in mortality remained the same or worsened in non-expansion states, but were narrowed in expansion states. An increase in treatment (surgery or chemotherapy) has also been observed.
Our study provides compelling data showing that Medicaid expansion was associated with improved survival for both black and white patients with gastrointestinal cancers. It also suggests that expanding Medicaid is a potential avenue to mitigate the racial survival disparities that exist among these patients, said Naveen Manisundaram, MD, a research scientist at the University of Texas MD Anderson Cancer Center, in a statement.
Using a difference-in-difference (DID) analysis, the researchers compared changes in 2-year mortality for black and white patients in the time periods before the Medicaid expansion (2009-13) and after the expansion. (2014-19) expanding and non-expanding states. The 2-year mortality rate was adjusted for age, sex, income level, insurance status, area of residence, comorbidity index (an estimate of the risk of dying from a comorbid disease), and type of care facility.
After expansion, there was a greater absolute reduction in 2-year mortality among black patients with pancreatic cancer in the expansion states (-11.8%) than in the non-expansion states (-2.4%) ( DID -9.4%). Additionally, in the expansion states there was a greater absolute increase in chemotherapy treatment in patients with stage 3-4 pancreatic cancer (4.5 percent for blacks and 3.2 percent for whites) than in the expansion states non-expansion (0.8 percent for blacks and 0.4% for whites), (DID 3.7% for black patients and DID 2.7% for whites).
In the expansion states, there was a greater absolute decrease in 2-year post-expansion mortality for patients with colorectal cancer (-4.9% for black patients and -6% for whites) than in the expansion states. non-expansion (-2% for black patients and -1.8% for whites), (DID 2.9% for black patients and 4.2% for whites). Among black patients with stage 4 colorectal cancer, there was a marked increase in rates of surgery in expansion states compared with non-expansion states (DID 5.7%), but not in treatment with chemotherapy (DID 1%, p = 0.66).
Among black patients with stomach cancer in the expansion, post-expansion states there was a greater absolute decrease in mortality in the expansion states (-13%) than in the non-expansion states (-5.2%) (DID – 7.7%, p = 0.07) and an absolute increase in chemotherapy treatment among those with stage 4 stomach cancer in the expanding states (8.6%) versus an absolute decrease in the non-expanding states (- 2.4%) (DID 11%, p = 0.06), however, these results were not statistically significant.
The study included 86,052 National Cancer Database patients between 2009 and 2019 with pancreatic, colorectal or stomach cancer. This year in the United States, approximately 241,610 adults will be diagnosed with at least one of these cancers and approximately 113,470 will die.
The researchers plan to look at other types of cancer and analyze whether Medicaid Expansion had a similar effect on cancer survival or treatment.
This study was funded by the National Institutes of Health.
Everyone, everywhere should have access to the best care possible, yet, in the United States, people in minorities continue to experience disparities in cancer treatment and survival,” said Julie R. Gralow, MD, chief medical officer and executive vice president of ASCO, in a statement.\”The results of this study provide a solid step forward in closing the gap, demonstrating that the opportunity for Medicaid expansion presented by the Affordable Care Act, which allows participating states to improve access to \’health care for underprivileged populations, results in better cancer outcomes and mitigation of racial disparities in cancer survival,
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