Abstract Background Medicaid expansion under the Affordable Care Act (ACA) is associated with increased insurance coverage among patients with cancer. Whether these gains translate to improved survival is largely unknown. This study examines changes in 2-year survival among patients newly diagnosed with cancer following the ACA Medicaid expansion. Methods Patients aged 18-62 years from 42 states’ population-based cancer registries diagnosed pre (2010-2012) and post (2014-2016) ACA Medicaid expansion were followed through September 30, 2013, and December 31, 2017, respectively. Difference-in-differences (DD) analysis of 2-year overall survival was stratified by sex, race and ethnicity, census tract–level poverty, and rurality. Results A total of 2 555 302 patients diagnosed with cancer were included from Medicaid expansion (n = 1 523 585) and nonexpansion (n = 1 031 717) states. The 2-year overall survival increased from 80.58% pre-ACA to 82.23% post-ACA in expansion states and from 78.71% to 80.04% in nonexpansion states, resulting in a net increase of 0.44 percentage points (ppt) (95% confidence interval [CI] = 0.24ppt to 0.64ppt) in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer (DD = 0.90ppt, 95% CI = 0.19ppt to 1.60ppt), lung cancer (DD = 1.29ppt, 95% CI = 0.50ppt to 2.08ppt), non-Hodgkin lymphoma (DD = 1.07ppt, 95% CI = 0.14ppt to 1.99ppt), pancreatic cancer (DD = 1.80ppt, 95% CI = 0.40ppt to 3.21ppt), and liver cancer (DD = 2.57ppt, 95% CI = 1.00ppt to 4.15ppt). The improvement in 2-year overall survival was larger among non-Hispanic Black patients (DD = 0.72ppt, 95% CI = 0.12ppt to 1.31ppt) and patients residing in rural areas (DD = 1.48ppt, 95% CI= -0.26ppt to 3.23ppt), leading to narrowing survival disparities by race and rurality. Conclusions Medicaid expansion was associated with greater increase in 2-year overall survival, and the increase was prominent among non-Hispanic Blacks and in rural areas, highlighting the role of Medicaid expansion in reducing health disparities. Future studies should monitor changes in longer-term health outcomes following the ACA.

中文翻译：

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《平价医疗法案》下的医疗补助扩张与新诊断癌症患者的生存率之间的关系

摘要 背景《平价医疗法案》(ACA) 下医疗补助的扩大与癌症患者保险覆盖范围的增加有关。这些成果是否会转化为生存率的提高目前还不得而知。本研究调查了 ACA 医疗补助计划扩展后新诊断出癌症的患者 2 年生存率的变化。 方法来自 42 个州基于人口的癌症登记处的年龄在 18-62 岁的患者在 ACA 医疗补助计划扩展之前（2010-2012 年）和之后（2014-2016 年）被诊断出，分别随访至 2013 年 9 月 30 日和 2017 年 12 月 31 日。对 2 年总体生存率进行双重差分 (DD) 分析，按性别、种族和族裔、人口普查区贫困程度和农村地区进行分层。 结果医疗补助扩展州 (n = 1 523 585) 和非扩展州 (n = 1 031 717) 共有 2 555 302 名被诊断患有癌症的患者纳入其中。扩张州的 2 年总体生存率从 ACA 前的 80.58% 提高到 ACA 后的 82.23%，非扩张州的 2 年总体生存率从 78.71% 提高到 80.04%，净增加 0.44 个百分点 (ppt)（95% 置信区间）调整社会人口因素后，处于扩张状态的 [CI] = 0.24ppt 至 0.64ppt）。按癌症部位划分，结直肠癌（DD = 0.90ppt，95% CI = 0.19ppt 至 1.60ppt）、肺癌（DD = 1.29ppt，95% CI = 0.50ppt 至 2.08ppt）、非癌症的净增加更大。霍奇金淋巴瘤（DD = 1.07ppt，95% CI = 0.14ppt 至 1.99ppt）、胰腺癌（DD = 1.80ppt，95% CI = 0.40ppt 至 3.21ppt）和肝癌（DD = 2.57ppt，95% CI） = 1.00ppt 至 4.15ppt)。非西班牙裔黑人患者（DD = 0.72ppt，95% CI = 0.12ppt 至 1.31ppt）和居住在农村地区的患者（DD = 1.48ppt，95% CI= -0.26）的 2 年总生存率改善更大ppt 到 3.23ppt），导致种族和农村地区的生存差距缩小。 结论医疗补助的扩张与两年总体生存率的更大提高相关，这种增长在非西班牙裔黑人和农村地区尤为突出，凸显了医疗补助的扩张在缩小健康差距方面的作用。未来的研究应监测 ACA 后长期健康结果的变化。