Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey

Tsui, Jennifer; DeLia, Derek; Stroup, Antoinette M.; Nova, José Luis Muñoz de; Kulkarni, Aishwarya; Ferrante, Joan M.; Cantor, Joel C.

doi:10.1002/cncr.31824

Cited by 21 publications

(32 citation statements)

References 40 publications

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“…Among the 13 studies that examined coverage disruptions and stage of disease at diagnosis, details for study populations, settings, measures of coverage disruptions and outcomes, comparison groups, and key findings are listed in Table 3 (33,34,40,41,(43)(44)(45)(46)(47)(48)(49)(50)(51). Each of these studies examined timing of Medicaid enrollment in a single state, including California, Michigan, New Jersey, North Carolina, Ohio, or Washington.…”

Section: Stage Of Disease At Diagnosismentioning

confidence: 99%

“…Four studies evaluated the effects of Medicaid coverage disruptions on receipt of treatment (44,(51)(52)(53), and 7 studies evaluated the effects of disruptions on survival (34,35,40,42,44,45,51). Details of study populations, settings, measures of coverage disruptions and outcomes, comparison groups, and key findings are listed in Table 4.…”

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

“…Among newly diagnosed patients with Medicaid coverage, between 22.1% and 59.5% enrolled in Medicaid at or after diagnosis. In 3 of 4 studies evaluating treatment, coverage disruptions were associated with treatment delay (51) and lower likelihood of receiving treatment (44,52). Treatment delay and lack of definitive surgery were reported for multiple cancer sites, including breast, colon, lung, and gastric cancers (44,51,52).…”

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

“…In 3 of 4 studies evaluating treatment, coverage disruptions were associated with treatment delay (51) and lower likelihood of receiving treatment (44,52). Treatment delay and lack of definitive surgery were reported for multiple cancer sites, including breast, colon, lung, and gastric cancers (44,51,52). Two relatively small studies reported null findings for the association between coverage disruption and receipt of treatment (52,53); however, they measured both coverage disruptions and treatment with Medicaid claims after diagnosis, limiting interpretation of findings because treatment could not be measured among those without Medicaid coverage.…”

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

“…All 7 studies reported that survival following diagnosis was statistically significantly worse for patients who gained Medicaid coverage at or after diagnosis. Worse survival was reported for multiple cancer types, including, breast, cervical, colon, lung, and gastric cancers, with odds ratios or hazard ratios ranging from 1.28 to 2.43 (40,42,51). Several studies reported that disparities in survival for those with coverage disruptions were mediated by differences in stage at diagnosis (40,45).…”

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

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Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Yabroff

Reeder‐Hayes

Zhao

et al. 2020

JNCI: Journal of the National Cancer Institute

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Abstract Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.

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Section: Stage Of Disease At Diagnosismentioning

confidence: 99%

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

Section: Cancer Treatment and Survivalmentioning

confidence: 99%

See 3 more Smart Citations

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Yabroff

Reeder‐Hayes

Zhao

et al. 2020

JNCI: Journal of the National Cancer Institute

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Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

et al. 2023

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ImportancePrior research has reported undertreatment among patients with cancer who are insured by Medicaid, but this finding may be due, in part, to incomplete data in cancer registries.ObjectiveTo compare disparities in radiation and hormone therapy between women with breast cancer covered by Medicaid and those with private insurance using the Colorado Central Cancer Registry (CCCR) and CCCR data supplemented with All Payer Claims Data (APCD).Design, Setting, and ParticipantsThis observational cohort study included women aged 21 to 63 years who received breast cancer surgery. We linked the CCCR and Colorado APCD to identify Medicaid and privately insured women who were newly diagnosed with invasive, nonmetastatic breast cancer between January 1, 2012, and December 31, 2017. In the radiation treatment analysis, we narrowed the sample to women who received breast-conserving surgery (Medicaid, n = 1408; private, n = 1984) and in the hormone therapy analysis, we selected women who were hormone-receptor positive (Medicaid, n = 1156; private, n = 1667).Main Outcomes and MeasuresWe used logistic regression to estimate the likelihood of treatment within 12 months to assess whether the results varied between data sources.ResultsThere were 3392 and 2823 participants in the radiation and hormone therapy cohorts, respectively. The mean (SD) age was 51.71 (8.30) years in the radiation therapy cohort, and 52.00 (8.16) years in the hormone therapy cohort. Among the participants, there were 140 (4%) and 105 (4%) who were Black non-Hispanic, 499 (15%) and 406 (14%) who were Hispanic, 2602 (77%) and 2190 (78%) were White, and 151 (4%) and 122 (4%) were other/unknown in the radiation and hormone therapy cohorts, respectively. A higher percentage of women were aged 50 years or younger in the Medicaid samples (40% vs 34% in the privately insured sample) and identified as non-Hispanic Black (about 7%) or Hispanic (approximately 24%). Treatment was underreported in both sources, but to a lesser extent in the APCD (2.5% and 2.0% for Medicaid and private insurance, respectively) compared with CCCR (19.5% and 13.3% for Medicaid and private insurance, respectively). Using CCCR data, Women with Medicaid insurance were 4 (95% CI, −8 to −1; P = .02) and 10 (95% CI, −14 to −6; P &lt; .001) percentage points less likely to have a record of radiation and hormone therapy compared with privately insured women, respectively. Using combined CCCR and APCD, no statistically significant disparity was observed in radiation or hormone therapy between Medicaid-insured and privately insured women.Conclusions and RelevanceAmong women with breast cancer covered by Medicaid vs private insurance, cancer treatment disparities may be overestimated if based solely on cancer registry data.

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Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

et al. 2020

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IMPORTANCE Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC. OBJECTIVE To determine the association of Medicaid coverage with survival compared with other insurance statuses. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients with limitedstage (LS) and extensive-stage (ES) SCLC in the US National Cancer Database from 2004 to 2013. Data were analyzed in January 2019. MAIN OUTCOMES AND MEASURES Patients were analyzed with respect to insurance status. Associations of insurance status with survival were interrogated with univariate analyses, multivariable analyses, and propensity score matching. RESULTS A total of 181 784 patients with SCLC (93 131 [51.2%] female; median [interquartile range] age; 67 [60-75] years for patients with LS-SCLC and 68 [60-75] years for patients with ES-SCLC) were identified, of whom 70 247 (38.6%) had LS-SCLC and 109 479 (60.2%) had ES-SCLC. On univariate analyses of patients with LS-SCLC, Medicaid coverage was not associated with a survival advantage compared with being uninsured (hazard ratio, 1.02; 95% CI, 0.96-1.08; P = .49). Likewise, on multivariable analyses of patients with ES-SCLC, compared with being uninsured, Medicaid coverage was not associated with a survival advantage (hazard ratio, 1.00; 95% CI, 0.96-1.03; P = .78). After propensity score matching, median survival was similar between the uninsured and Medicaid groups both among patients with LS-SCLC (14.4 vs 14.1 months; hazard ratio, 1.05; 95% CI, 0.98-1.12; P = .17) and those with ES-SCLC (6.3 vs 6.4 months; hazard ratio, 1.00; 95% CI, 0.96-1.04; P = .92). CONCLUSIONS AND RELEVANCE Despite of billions of dollars in annual federal and state spending, Medicaid was not associated with improved survival in patients with SCLC compared with being uninsured in the US National Cancer Database. These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act.

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Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey

Cited by 21 publications

References 40 publications

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

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