Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival.
Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival.
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DOI：
10.1097/xcs.0000000000000018
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发表时间：
2022-01-01
影响因子：
5.2
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中科院分区：
文献类型：
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This study examined the effect of Medicaid expansion on one-year survival of pancreatic cancer for non-elderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and one-year survival. We obtained data from the Surveillance Epidemiology and End-Results (SEER-18) dataset on individuals diagnosed with pancreatic cancer from 2007-2015. A Difference-in-Differences (DD) model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on one-year survival. In the univariable DD model, the probability of one-year survival for pancreatic cancer increased by 4.8ppt for those from Medicaid expansion states post-expansion (n=35,347). After adjustment for covariates, the probability of one-year survival was reduced to 0.8ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on one-year survival was similar for men and women (0.6ppt for men versus 1.2ppt for women), and was also similar for whites (2.6ppt) and was higher those of other races (5.9ppt) but decreased for blacks (−2.0ppt). Those who were insured (−0.1ppt) or uninsured (−2.2ppt) experienced a decrease in the probability of one-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of one-year survival (7.4ppt). Medicaid expansion during or after 2014 is associated with an increase in the probability of one-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups. Medicaid expansion during or after 2014 is associated with an increase in the probability of one-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
