Medicaid expansion caused a decrease in uninsured patients and led to an earlier diagnosis of gastric cancer with an associated increase in 1-year survival, according to research presented by Zhu et al at the Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care (Abstract 95).
The 2014 Medicaid expansion was intended to improve patient access to care. Some states elected to expand Medicaid, while others opted not to. Researchers hypothesized that Medicaid expansion was associated with earlier diagnosis and improved outcomes in gastric cancer.
Study Methods
The research team selected patients with a new primary diagnosis of gastric cancer from the National Cancer Database between 2006 and 2016. They compared states that expanded Medicaid in 2014 to those that did not, excluding states that expanded earlier or later than 2014 and patients older than 64 years.
The research compared the pre- and postexpansion intervals of 2012 to 2013 and 2015 to 2016. A total of 20,639 patients were included in the analysis.
Effect of Expansion
Expansion states demonstrated a significant reduction in uninsured patients—from 7.0% to 2.7% (P < .01)—compared to nonexpansion states (14.2% to 10.9%).
There was an increase in patients diagnosed with stage 0 to II gastric cancer from 38% to 41.5% (P < .01) in expansion states, but no change at 38.9% in nonexpansion states. Patients aged 50 and older diagnosed with stage 0 to II gastric cancer increased in expansion states from 38.2% to 42.5% (P < .01) and in nonexpansion states from 39.3% to 39.9%. Uninsured and Medicaid patients diagnosed with stage 0 to II gastric cancer increased in expansion states from 32.4% to 37.8% (P = .01) and decreased in nonexpansion states from 29.7% to 27.3%.
Patients receiving treatment rose from 91.6% to 92.2% in expansion states (P = .01) and in nonexpansion states 89.6% to 89.7%. Rates of treatment for uninsured and Medicaid patients rose in 87.0% to 90.3% in expansion states (P = .01) and 83.9% to 84.9% in nonexpansion states. Twelve-month survival for patients in expansion states rose from 68.1% to 70.6% (P = .03) and in nonexpansion states, it decreased 65.2% to 65.1%.
“Increased health-care access may be associated with a shift toward earlier diagnosis with improved outcomes in gastric cancer,” concluded the study authors.
