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Mortality Down for Cancer Patients With Medicaid Expansion

Mortality reduced for patients with newly diagnosed breast, colorectal, lung cancers, mediated by earlier stage of diagnosis

FRIDAY, Nov. 6, 2020 (HealthDay News) — 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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