16: Association of Medicaid Expansion with reduction in racial disparities in the timely delivery of up-front surgical care for patients with early stage breast cancer

Saturday, March 25, 2023

8:42 AM – 8:52 AM

Location: Veterans Memorial Auditorium

Abstract Presenter(s)

Nina Tamirisa, MD

Assistant Professor
MD Anderson Cancer Center, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Nina Tamirisa, MD

Assistant Professor
MD Anderson Cancer Center, United States

Disclosure(s): No financial relationships to disclose

Author(s)

XL

Xiudong Lei, PhD

Director of Biostatistics
American Society of Clinical Oncology Center for Research and Analytics, United States

Disclosure information not submitted.
CM

Catalina Malinowski, BA

Research Data Coordinator
MD Anderson Cancer Center, United States

Disclosure information not submitted.
ML

Meng Li, PhD

Assistant Professor
MD Anderson Cancer Center, United States

Disclosure information not submitted.
IB

Isabelle Bedrosian, MD

Professor, Department of Breast Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston, TX, United States

Disclosure information not submitted.
MC

Mariana Chavez-MacGregor, MD

Associate Professor
MD Anderson Cancer Center, United States

Disclosure information not submitted.

Disclosure(s):

Nina Tamirisa, MD: No financial relationships to disclose

Introduction: Minority groups are disproportionately affected by lack of access to care. Understanding the impact of Medicaid expansion on reducing racial and ethnic disparities in healthcare delivery is critical. Treatment delay in breast cancer is associated with worse outcomes. We sought to evaluate the association of Medicaid expansion with time to surgery among patients with early-stage breast cancer in Medicaid expansion and non-expansion states.

Methods: Women 40-64 with stage I-II breast cancer who underwent up front surgery were identified in the National Cancer database (2010-2017). We compared rates of delayed surgery ( >90 days) in patients residing in Medicaid expansion and non-expansion states and divided patients in both cohorts by time period: pre-expansion (2010-2012) and post-expansion (2014-2017). We evaluated difference-in-difference (DID) estimates by multivariable linear regression models, as well as logistic regression and Cox proportional hazards models.

Results: Among the Medicaid expansion states, 98,719 patients were included. Post expansion, racial and ethnic minority patients with Medicaid insurance experienced a decrease in delay to surgery with an adjusted DID of -1.8% points (95% CI -3.7% to 0, p=0.05) using the linear regression models. Similarly, the adjusted DID odds ratio for risk of delayed surgery was 0.74 (95% CI 0.53-10.2, p=0.07) using logistic regression; and a reduced time to surgery was observed using the Cox models (adjusted DID hazard ratio=1.15, 95% CI 1.06-1.24, P< 0.001). The reductions in delay to surgery among racial and ethnic minority groups were present only in Medicaid expansion states.

Conclusions: Our study demonstrates a positive association between Medicaid expansion and a reduction in racial disparities in the delivery of upfront surgical care for early stage breast cancer patients.

Learning Objectives:

Upon completion, participant will be able to describe the impact of Medicaid expansion on time to surgery in early stage breast cancer patients.
Upon completion, participant will be able to describe the importance of mitigating delays to treatment to improve cancer care outcomes.
Upon completion, participant will be able to demonstrate understanding the impact of Medicaid expansion on reducing ethnic and racial disparities in breast cancer care.