TOPLINE

In a study of US patients with non-small cell lung cancer (NSCLC), those in Medicaid-expansion states had greater gains in insurance coverage, early diagnosis, and survival than those in nonexpansion states — especially if they lived outside of metropolitan areas.

METHODOLOGY

• Medicaid expansion, a key provision of the Affordable Care Act, has been tied to improved cancer outcomes. The association between Medicaid expansion and place-based disparities in lung cancer outcomes, including urban-rural gaps, remains unclear.
• Researchers conducted a cohort study with data from the Cancer Incidence in North America database of the North American Association of Central Cancer Registries. They included 303,503 US patients aged 18-64 years diagnosed with NSCLC between 2009 and 2019.
• Outcomes were insurance coverage at diagnosis, localized-stage diagnosis, and 3-year overall survival, adjusted for age, sex, county-level metropolitan status, and social deprivation.
• Analyses of insurance coverage and early-stage diagnosis compared pre-expansion (2009-2013) and post-expansion (2015-2019) periods in 26 Medicaid expansion states and Washington, DC, and 17 nonexpansion states. The survival analysis was based on 178,071 patients diagnosed between 2009 and 2012 (pre-expansion) or 2015 and 2018 (post-expansion) from 26 expansion states and 16 nonexpansion states.

TAKEAWAY

• Over time, health insurance coverage increased by 5.06 percentage points in expansion states and 2.87 percentage points in nonexpansion states, with an adjusted difference-in-differences of 2.22 percentage points (P < .001).
• Localized-stage diagnosis rose by 6.09 percentage points in expansion states and 4.42 percentage points in nonexpansion states, resulting in an adjusted difference-in-differences of 1.76 percentage points (P < .001).
• Similarly, 3-year overall survival improved by 9.39 percentage points vs 7.64 percentage points in expansion vs nonexpansion states, with an adjusted difference-in-differences of 1.89 percentage points (P < .001).
• The survival improvement associated with Medicaid expansion was significantly greater in nonmetropolitan counties (adjusted difference-in-differences, 4.22 percentage points; P < .001) than in metropolitan counties (1.21 percentage points; 95% CI, 0.26-2.17).

IN PRACTICE

“Given the higher burden of NSCLC and persistent health disparities in the Medicaid nonexpansion states, Medicaid expansion may support improved cancer outcomes and health equity in these states,” the study authors wrote. The findings also raise concerns, they noted, about the potential impact of pending federal cuts to Medicaid under the 2025 budget reconciliation bill.

SOURCE

The study, led by Marvin Okon, PhD, of Clemson University in Clemson, South Carolina, was published online in JAMA Network Open.

LIMITATIONS

Most place-based disparities were examined at the county level, limiting the granularity of geographic analysis. Limited treatment data precluded assessment of guideline-concordant treatment as a mechanism linking Medicaid expansion to improved survival. The analysis ended follow-up prior to the COVID pandemic to avoid pandemic-related disruptions, potentially limiting generalizability to current policy and clinical contexts.

DISCLOSURES

The study received support from the American Cancer Society. A co-author disclosed receiving honoraria from the American Society of Clinical Oncology. No other conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.