Mortality Down for Cancer Patients With Medicaid Expansion

FRIDAY, Nov. 6, 2020 — Medicaid expansion is associated with reduced mortality in patients with newly diagnosed breast, colorectal, and lung cancer, according to a study published online Nov. 5 in JAMA Network Open.

Miranda B. Lam, M.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues examined whether Medicaid expansion is associated with improved mortality in a difference-in-difference (DID) cross-sectional study involving 523,802 patients with breast, lung, or colorectal cancer newly diagnosed from Jan. 1, 2012, to Dec. 31, 2015: 289,330 lived in Medicaid expansion states and 234,472 lived in nonexpansion states.

The researchers found a significant decrease in mortality in expansion states after Medicaid expansion (hazard ratio [HR], 0.98; 95 percent confidence interval [CI], 0.97 to 0.99; P = 0.008), but not in nonexpansion states (HR, 1.01; 95 percent CI, 0.99 to 1.02; P = 0.43); this resulted in a significant DID (HR, 1.03; 95 percent CI, 1.01 to 1.05; P = 0.01). The difference was mainly observed in patients with stages I to III nonmetastatic cancer. The mortality improvement in expansion states from the periods before and after expansion was no longer evident after adjustment for cancer stage (HR, 1.00; 95 percent CI, 0.98 to 1.02; P = 0.94), nor was the difference between expansion and nonexpansion states (DID HR, 1.00; 95 percent CI, 0.98 to 1.02; P = 0.84).

“This association appeared to be mediated by earlier stage of cancer diagnosis and did not differ by race or area-level income,” the authors write.

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