Medicaid Expansion Improved Early Diagnosis of Colon Cancer

The adoption of Medicaid expansion led to earlier diagnoses of colon cancer for Medicaid patients, lessening one key cancer disparity between insured and uninsured Americans, according to a new study.

The finding comes from an analysis of the American College of Surgeons’ National Cancer Database for the years 2010 to 2017. Midway through the study period, on Jan. 1, 2014, states had the option to expand Medicaid by increasing eligibility to residents with household incomes up to 138% of the federal poverty level.

During the eight years studied, 162,805 patients between the ages of 18 to 65 years who had private or Medicaid insurance were diagnosed with colon cancer and registered with the database.

Investigators ranked hospitals into low-, medium- or high-adoption categories based on the percentage of states in each U.S. Census Bureau division that adopted Medicaid expansion.

In areas with a high-adoption rate of Medicaid expansion, the percentage of late-stage colon cancer diagnoses declined, while there was no change in late-stage diagnosis in areas with low rates of Medicaid expansion. The low-adoption rate category consistently showed the highest percentage of late-stage diagnoses, averaging over 60%.

Over the same period, people with private insurance were increasingly likely to have a late-stage colon cancer diagnosis, rising from 47% in 2010 to 52% in 2017.

Analysis was performed to compare Medicaid patients with those with private insurance by eight factors: age, sex, Medicaid expansion, Medicaid adoption rate by division, race, income quartile, facility type and facility setting.

Multivariate analysis showed insurance type was the most significant factor affecting late-stage diagnosis, with an almost 30% increased odds of late-stage colon cancer diagnosis for patients with Medicaid insurance.

“We identified race, socioeconomic status and the rural setting to be factors that lead to disparities in patient care, despite adjusting for Medicaid expansion,” said study author Mayin Lin, DO, MPH, a colon and rectal surgeon at MercyOne Des Moines Surgical Group, in Iowa.

She called on physicians and surgeons to promote access to care and preventive services for patients. “We can improve colon cancer stage diagnosis by promoting cancer screenings and surveillance,” she said.

The study received the Southern California Society of Colon & Rectal Surgeons Award.

This article is from the July 2021 print issue.