Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion

• Published in: Preventive medicine 2019-07, Vol.124, p.91-97
• Main Authors: Huguet, Nathalie, Angier, Heather, Rdesinski, Rebecca, Hoopes, Megan, Marino, Miguel, Holderness, Heather, DeVoe, Jennifer E.
• Format: Article
• Language: English
• Subjects: Adult; Affordable Care Act; Cancer screening; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - prevention & control; Community Health Centers; Early Detection of Cancer; Female; Humans; Insurance Coverage - economics; Insurance, Health - economics; Male; Medicaid; Medicaid - statistics & numerical data; Middle Aged; Patient Protection and Affordable Care Act - legislation & jurisprudence; Prevalence; Primary healthcare; Socioeconomic status; United States - epidemiology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - prevention & control; Young Adult
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2019.05.003

Community health centers (CHCs), which serve socioeconomically disadvantaged patients, experienced an increase in insured visits after the 2014 Affordable Care Act (ACA) coverage options began. Yet, little is known about how cancer screening rates changed post-ACA. Therefore, this study assessed changes in the prevalence of cervical and colorectal cancer screening from pre- to post-ACA in expansion and non-expansion states among patients seen in CHCs. Electronic health record data on 624,601 non-pregnant patients aged 21–64 eligible for cervical or colorectal cancer screening between 1/1/2012 and 12/31/2015 from 203 CHCs were analyzed. We assessed changes in prevalence and screening likelihood among patients, by insurance type and race/ethnicity and compared Medicaid expansion and non-expansion states using difference-in-difference methodology. Female patients had 19% increased odds of receiving cervical cancer screening post- relative to pre-ACA in expansion states [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.09–1.31] and 23% increased odds in non-expansion states (aOR = 1.23, 95% CI = 1.05–1.46): the greatest increase was among uninsured patients in expansion states (aOR = 1.36, 95% CI = 1.16–1.59) and privately-insured patients in non-expansion states (aOR = 1.43, 95% CI = 1.11–1.84). Colorectal cancer screening prevalence increased from 11% to 18% pre- to post-ACA in expansion states and from 13% to 21% in non-expansion states. For most outcomes, the observed changes were not significantly different between expansion and non-expansion states. Despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients. •Colorectal and cervical cancer screening prevalences increased post-ACA.•Cancer screening rates increased in both Medicaid expansion and non-expansion states.•All racial and ethnic groups had improved cancer screening rates following the ACA.•Uninsured, Medicaid-, and privately-insured patients had improved cancer screening.•Despite improvement, colorectal and cervical cancer screening rates remained low.