ASCO 2020 – Medicaid expansion linked with fewer cancer deaths


  • Jim Kling
  • Oncology Conference reports
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Takeaway

  • States that adopted Medicaid expansion following the passage of the Affordable Care Act experienced a larger decrease in cancer mortality than states that did not.

Why this matters

  • The study is the first to show a cancer benefit associated with adoption of Medicaid expansion.

Study design

  • Analysis of age-adjusted mortality rates taken from the National Center for Health Statistics, from 1999 to 2017.
  • Only mortality in patients below 65 years of age was considered.
  • Funding: None disclosed.

Key results

  • As of 2015, 27 states and Washington, DC had expanded Medicaid coverage.
  • In 2017, there were 785 fewer cancer deaths in states that adopted Medicaid expansion. An estimated 589 deaths could have been prevented if all states had adopted Medicaid expansion.
  • Age-adjusted cancer mortality declined from 66.9 to 48.8 per 100,000 people between 1999 and 2017. In states that adopted Medicaid expansion, the decline was 64.7 to 46.0 per 100,000 (29%), compared to a reduction of 69.0 to 51.9 per 100,000 (25%) in states that did not adopt Medicaid expansion (both trends, P<.001 p>
  • Medicaid expansion states experienced a mortality change of −1.1 per 100,000 (P=.006), compared to −0.6 (P=.14) in non-Medicaid states.  
  • A previous study showed that Medicaid expansion nearly eliminated the disparities in timely cancer treatment often seen between black and white patients.
  • Black patients did not experience an additional mortality benefit after Medicaid expansion, but those in states without expansion had worse cancer mortality compared to those in states with Medicaid expansion (58.5 vs 63.4 per 100,000 in 2017). However, lead author Anna Lee, MD, MPH, a radiation oncology fellow at Memorial Sloan Kettering Cancer Center in New York City, noted that cancer mortality in black patients had been improving faster than in white and Hispanic patients, which may explain the lack of an observed benefit.
  • Hispanics in expansion states had the highest differential cancer mortality benefit among all subpopulations (−2.1 per 100,000; P=.07). Hispanic populations are larger in states that adopted Medicaid expansion, and Hispanic patients are much more likely than whites to have no insurance or be underinsured.

Limitations

  • Retrospective analysis.

Expert Commentary

  • The improvement in cancer mortality “was probably the result of improved screening as well as improvements in treatments that occurred during this period, and improved access to treatment,” according to Ernest Hawk, MD, MPH, who is the vice president and division head for Cancer Prevention and Population Sciences at the University of Texas MD Anderson Cancer Center in Houston.