P66: Medicaid Expansion Increases Early Lung Cancer Diagnosis in Urban Blacks

Thursday, March 23, 2023

9:21 AM – 9:26 AM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

Tommy D. Kim (he/him/his)

Medical Student
University of Massachusetts Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.

Author(s)

BM

Boniface Mensah, MBChB, MPH

Postdoctoral Fellow
Houston Methodist Hospital
Houston, Texas, United States

Disclosure information not submitted.
Tommy D. Kim (he/him/his)

Medical Student
University of Massachusetts Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.
CY

Chi-Fu J. Yang, MD

Thoracic Surgeon
Massachusetts General Hospital, Massachusetts, United States

Disclosure information not submitted.
DC

David C. Chang, MD, PhD, MPH, MBA

Associate Professor of Surgery
Harvard Medical School, Massachusetts General Hospital, Massachusetts, United States

Disclosure information not submitted.
TO

Tawakalitu Oseni, MD, FACS, MPH

Assistant Professor of Surgery
Harvard Medical School, Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.

Introduction:

The Patient Protection and Affordable Care Act (ACA) expanded the Medicaid program to adults below 65 years with income below 133% of the federal poverty level. After the Supreme Court ruling made expansion optional, only some states proceeded with expansion resulting in a varying access to health insurance. The aim of this study is to determine the effect of the ACA implementation on early lung cancer diagnosis in states that expanded Medicaid compared to states that did not.

Methods:

The study population consisted of patients aged 55-64 years diagnosed with lung cancer from 2009 to 2019 using the Surveillance, Epidemiology and End Results (SEER) database (n=219,778). A difference-in-difference analysis, comparing non-Medicaid expansion states with Medicaid expansion states before and after 2014, was performed to determine the odds ratio of early lung cancer (Stage 1 and 2) diagnosis, adjusting for age at diagnosis, sex, race, marital status, median household income and rural urban continuum. California, Connecticut, and Massachusetts were excluded due to their insurance coverage expansion policies prior to 2010.

Results:

Overall, there was an increase in early lung cancer diagnosis across all states (relative increase of 32.2% for Medicaid expansion states vs 20% for non-expansion states). However, the odds of early lung cancer diagnosis were significantly larger in Medicaid expansion states (Adjusted OR 1.52, 95% Cl: 1.43-1.62) than non-expansion states (Adjusted OR 1.27, 95% Cl: 1.18 -1.37). Subgroup analysis showed the impact of the expansion policy was primarily among Blacks and male patients who lived in counties with metropolitan areas of more than 1 million people (as shown in the figure).

Conclusions:

The odds of early lung cancer diagnosis in Medicaid expansion and non-expansion states were similar before the implementation of the ACA. After the policy, there was an increase in the odds of early lung cancer diagnosis in both groups of states; however, this increase was larger in Medicaid expansion states. ACA increased access for millions of Americans, with the greatest gains in lung cancer screening among Blacks and male patients living in urban areas. The policy improved lung cancer screening in minority groups.

Learning Objectives:

Upon completion, participant will be able to establish the effect of Medicaid expansion on early lung cancer diagnosis in expansion states compared to non-expansion states.
Upon completion, participant will be able to identify the impact of Medicaid expansion in minority groups like Blacks.
Upon completion, participant will be able to discuss how Medicaid expansion in currently non-expansion states will improve health outcomes in minority groups.