Impact of the affordable care act's medicaid expansion on presentation stage and perioperative outcomes of colorectal cancer

Background and Objectives Medicaid expansion has improved healthcare coverage and preventive health service use. To what extent this has resulted in earlier stage colorectal cancer diagnoses and impacted perioperative outcomes is unclear. Methods This was a retrospective difference‐in‐difference stu...

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Bibliographic Details
Published in:Journal of surgical oncology 2022-12, Vol.126 (8), p.1471-1480
Main Authors: Sharon, Cimarron E., Song, Yun, Straker, Richard J., Kelly, Nicholas, Shannon, Adrienne B., Kelz, Rachel R., Mahmoud, Najjia N., Saur, Nicole M., Miura, John T., Karakousis, Giorgos C.
Format: Article
Language:English
Subjects:
cancer screening
Colorectal cancer
Medicaid
medicaid expansion
Minimally invasive surgery
outcomes
Surgery
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Summary:Background and Objectives Medicaid expansion has improved healthcare coverage and preventive health service use. To what extent this has resulted in earlier stage colorectal cancer diagnoses and impacted perioperative outcomes is unclear. Methods This was a retrospective difference‐in‐difference study using the National Cancer Database on adults (40–64) with Medicaid or no insurance, diagnosed with colorectal adenocarcinomas before (2010–2013) and after (2015–2018) expansion. The primary outcome was early‐stage (American Joint Committee on Cancer Stage 0–1) diagnosis. The secondary outcomes were rate of local excision, emergency surgery, postoperative length of stay, rates of minimally invasive surgery, postoperative mortality, and overall survival (OS). Results Medicaid expansion was associated with an increase in early‐stage diagnoses for patients with colorectal cancers (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.15–1.43), an increase in local excision (OR: 1.39, 95% CI: 1.13–1.69), and a decreased rate of emergent surgery (OR: 0.85, 95% CI: 0.75–0.97) and 90‐day mortality (OR: 0.75, 95% CI: 0.59–0.97). Additionally, patients in expansion states postexpansion had an improved 5‐year OS (hazard ratio: 0.88, 95% CI: 0.83–0.94). Conclusions Insurance coverage expansion may be particularly important for optimizing stage of diagnosis, subsequent survival, and perioperative outcomes for socioeconomically vulnerable patients.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.27070