BackgroundColorectal cancer screening rates remain suboptimal, particularly among low‐income populations. Our objective was to evaluate the long‐term effects of Medicaid expansion on colorectal cancer screening.Design, Setting, and ParticipantsThis cross‐sectional study analyzed data from 354,384 individuals aged 50–64 with an income below 400% of the federal poverty level (FPL), who participated in the Behavioral Risk Factors Surveillance System from 2010 to 2018. A difference‐in‐difference analysis was employed to estimate the effect of Medicaid expansion on colorectal cancer screening. Subgroup analyses were conducted for individuals with income up to 138% of the FPL and those with income between 139% and 400% of the FPL. The effect of Medicaid expansion on colorectal cancer screening was examined during the early, mid, and late expansion periods.Main Outcomes and MeasuresThe primary outcome was the likelihood of receiving colorectal cancer screening for low‐income adults aged 50–64.ResultsMedicaid expansion was associated with a significant 1.7 percentage point increase in colorectal cancer screening rates among adults aged 50–64 with income below 400% of the FPL (p < 0.05). A significant 2.9 percentage point increase in colorectal cancer screening was observed for those with income up to 138% the FPL (p < 0.05), while a 1.5 percentage point increase occurred for individuals with income between 139% and 400% of the FPL. The impact of Medicaid expansion on colorectal cancer screening varied based on income levels and displayed a time lag for newly eligible beneficiaries.ConclusionsMedicaid expansion was found to be associated with increased colorectal cancer screening rates among low‐income individuals aged 50–64. The observed variations in impact based on income levels and the time lag for newly eligible beneficiaries receiving colorectal cancer screening highlight the need for further research and precision public health strategies to maximize the benefits of Medicaid expansion on colorectal cancer screening rates.

中文翻译：

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《平价医疗法案》和医疗补助扩大对结直肠癌筛查的影响：医疗补助扩大第五年的证据

背景结直肠癌筛查率仍然不理想，特别是在低收入人群中。我们的目标是评估医疗补助扩展对结直肠癌筛查的长期影响。设计、设置和参与者这项横断面研究分析了 354,384 名 50-64 岁、收入低于联邦贫困线 (FPL) 400% 的个人的数据。 ），从 2010 年至 2018 年参加了行为风险因素监测系统。采用双重差分分析来估计医疗补助扩大对结直肠癌筛查的影响。对收入高达 FPL 138% 和收入在 FPL 139% 至 400% 之间的个人进行了亚组分析。在早期、中期和晚期扩展期间检查了医疗补助扩展对结直肠癌筛查的影响。主要结果和措施主要结果是 50-64 岁低收入成年人接受结直肠癌筛查的可能性。结果医疗补助扩展与收入低于 FPL 400% 的 50-64 岁成年人的结直肠癌筛查率显着提高 1.7 个百分点（p< 0.05）。对于那些收入高达 FPL 138% 的人来说，结直肠癌筛查显着增加了 2.9 个百分点（p< 0.05），而收入在 FPL 139% 至 400% 之间的个人则增加了 1.5 个百分点。医疗补助扩大对结直肠癌筛查的影响因收入水平而异，并且对于新符合资格的受益人显示出时间滞后。结论发现医疗补助扩大与 50-64 岁低收入个人结直肠癌筛查率的增加有关。根据收入水平和接受结直肠癌筛查的新合格受益人的时间滞后观察到的影响差异突出表明需要进一步研究和精确的公共卫生策略，以最大限度地发挥医疗补助扩大对结直肠癌筛查率的好处。