Top

Published in:

15-02-2024 | Pancreatic Tumors

Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States

Authors: Hemanth Venkatesh, MD, Tingting Li, PhD, Qingzhao Yu, PhD, Xiao-Cheng Wu, MD, MPH, Yong Yi, PhD, Mei-Chin Hsieh, PhD, Quyen D. Chu, MD, MBA, FACS

Published in: Annals of Surgical Oncology | Issue 5/2024

Abstract

Introduction

Medicaid expansion (ME) impacted patients when assessed at a national level. However, of the 32 states in which Medicaid expansion occurred, only 3 were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of ME on pancreatic ductal adenocarcinoma (PDAC) treatment in eight Southern states in the USA.

Patients and Methods

We identified uninsured or Medicaid patients (age 40–64 years) diagnosed with PDAC between 2011 and 2018 in Southern states from the North American Association of Central Cancer Registries–Cancer in North America (NAACCR–CiNA) research dataset. Medicaid-expanded states (MES; Louisiana, Kentucky, and Arkansas) were compared with non-MES (NMES; Tennessee, Alabama, Mississippi, Texas, and Oklahoma) using multivariate logistic regression. P < 0.05 was considered statistically significant.

Results

Among 3036 patients, MES significantly increased odds of Medicaid insurance by 36%, and increased proportions of insured Black patients by 3.7%, rural patients by 3.8%, and impoverished patients by 18.4%. After adjusting for age, race, rural–urban status, poverty status, and summary stage, the odds of receiving radiation therapy decreased by 26% for each year of expansion in expanded states (P = 0.01). Last, ME did not result in a significant difference between MES and NMES in diagnosing early stage disease (P = 0.98) nor in receipt of chemotherapy or surgery (P = 0.23 and P = 0.63, respectively).

Conclusions

ME in Southern states increased insurance access to traditionally underserved groups. Interestingly, ME decreased the odds of receiving radiation therapy yearly and had no significant impact on receipt of chemotherapy or surgery.

Neiman PU, Tsai TC, Bergmark RW, Ibrahim A, Nathan H, Scott JW. The affordable care act at 10 years: evaluating the evidence and navigating an uncertain future. J Surg Res. 2021;263:102–9. https://doi.org/10.1016/j.jss.2020.12.056.CrossRefPubMed

Rudowitz R, Drake P, Tolbert J. How many uninsured are in the coverage gap and how many could be eligible if all states adopted the medicaid expansion? San Francisco: KFF; 2023.

Laughlin AI, Li T, Yu Q, Wu XC, Yi Y, Hsieh M-C, et al. Impact of medicaid expansion on breast cancer diagnosis and treatment in southern states. J Am Coll Surg. 2023;236(4):838–45. https://doi.org/10.1097/XCS.0000000000000550.CrossRefPubMed

Samaan JS, Abboud Y, Oh J, Jiang Y, Watson R, Park K, Liu Q, Atkins K, Hendifar A, Gong J, Osipov A, Li D, Nissen NN, Pandol SJ, Lo SK, Gaddam S. Pancreatic cancer incidence trends by race, ethnicity, age and sex in the United States: a population-based study, 2000–2018. Cancers (Basel). 2023;15(3):870. https://doi.org/10.3390/cancers15030870.CrossRefPubMed

Boevers E, McDowell BD, Mott SL, Button AM, Lynch CF. Insurance status is related to receipt of therapy and survival in patients with early-stage pancreatic exocrine carcinoma. J Cancer Epidemiol. 2017;2017:4354592. https://doi.org/10.1155/2017/4354592.CrossRefPubMedPubMedCentral

Maas CJM, Hox JJ. Sufficient sample sizes for multilevel modeling. Methodology. 2005;1(3):86–92.CrossRef

American Cancer Society. Survival rates for pancreatic cancer. https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html.

SEER* Stat Database: North American Association of Central Cancer Registries (NAACCR). Incidence Data‐CiNA analytic file, 1995‐2018, for NHIAv2 origin, standard file (which includes data from CDC’s national program).

Mass S. Administrative burdens lead some doctors to avoid medicaid patients. NBER. https://www.nber.org/digest/202112/administrative-burdens-lead-some-doctors-avoid-medicaid-patients..

10.

Neprash HT, Zink A, Sheridan B, Hempstead K, et al. The effect of Medicaid expansion on medicaid participation, payer mix, and labor supply in primary care. J Health Econ. 2021;80:102541. https://doi.org/10.1016/j.jhealeco.2021.102541.CrossRefPubMed

11.

Allen L, Gian CT, Simon K, et al. The impact of medicaid expansion on emergency department wait times. Health Serv Res. 2021. https://doi.org/10.1111/1475-6773.13892.CrossRefPubMedPubMedCentral

12.

Hsiang WR, Lukasiewicz A, Gentry M, Kim CY, Leslie MP, Pelker R, et al. Medicaid patients have greater difficulty scheduling health care appointments compared with private insurance patients: a meta-analysis. Inquiry. 2019. https://doi.org/10.1177/0046958019838118.CrossRefPubMedPubMedCentral

13.

Nguyen DD, Paciotti M, Marchese M, Cole AP, Cone EB, Kibel AS, Ortega G, Lipsitz SR, Weissman JS, Trinh QD. Effect of Medicaid expansion on receipt of definitive treatment and time to treatment initiation by racial and ethnic minorities and at minority-serving hospitals: a patient-level and facility-level analysis of breast, colon, lung, and prostate cancer. JCO Oncol Pract. 2021;17(5):e654–65. https://doi.org/10.1200/OP.21.00010.CrossRefPubMed

14.

Eisenberg JM, Power EJ. Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality. JAMA. 2000;284(16):2100–7. https://doi.org/10.1001/jama.284.16.2100.CrossRefPubMed

15.

Ahn DH, Bekaii-Saab T. The continued struggle for defining a role for radiotherapy in pancreas cancer. JAMA Oncol. 2022;8(9):1257–9. https://doi.org/10.1001/jamaoncol.2022.2309.CrossRefPubMed

16.

Hoehn R, Rieser C, Phelos H, Sabik L, et al. Medicaid expansion and the management of pancreatic cancer. J Surg Oncol. 2021;124:324–33.CrossRefPubMedPubMedCentral

17.

Cross-Call J. Medicaid expansion has helped narrow racial disparities in health coverage and access to care. New York: Center on Budget and Policy Priorities; 2020.

18.

Auty SG, Aswani MS, Wahbi RN, Griffith KN, et al. Changes in health care access by race, income, and Medicaid expansion during the COVID-19 pandemic. Med Care. 2022;61(1):45–9. https://doi.org/10.1097/mlr.0000000000001788.CrossRefPubMedPubMedCentral

Title: Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States
Authors: Hemanth Venkatesh, MD
Tingting Li, PhD
Qingzhao Yu, PhD
Xiao-Cheng Wu, MD, MPH
Yong Yi, PhD
Mei-Chin Hsieh, PhD
Quyen D. Chu, MD, MBA, FACS
Publication date: 15-02-2024
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-15039-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States

Abstract

Introduction

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2024

ASO Visual Abstract: Determination of Factors Associated with Upstage in Atypical Ductal Hyperplasia to Identify Low-Risk Patients Where Active Surveillance May be an Alternative

ASO Visual Abstract: Access, Outcomes, and Costs Associated with Surgery for Malignancy Among People Experiencing Homelessness

ASO Visual Abstract: Postoperative Complications After Neoadjuvant Chemotherapy Compared with Upfront Surgery in Gastric Adenocarcinoma—A Population-Based, Nationwide Study in Finland

Differences in DVT Rates in Patients Treated With and Without Preoperative Chemotherapy Prior to Distal Pancreatectomy: Is it the Therapy or Disease Burden?

ASO Author Reflections: Early-Onset Intrahepatic Cholangiocarcinoma—Poor Oncological Outcomes and Distinct Molecular Features

ASO Author Reflections: A Novel Combination Index of Sialyl-Lewis Antigen-Related Tumor Markers Enhances Predictive Significance in Patients with a Modest Radiological Response to Neoadjuvant Treatment for Pancreatic Cancer