Impact of Medicaid Expansion on the Surgical Treatment of Early Stage Lung Cancer
Jeremiah T. Martin, MD1, Aitua Salami, MD2, Abbas E. Abbas, MD3, Roman V. Petrov, MD3, Charles T. Bakhos, MD3.
1Southern Ohio Medical Center, Portsmouth, OH, USA, 2Albert Einstein Healthcare, Philadelphia, PA, USA, 3Temple University, Philadelphia, PA, USA.
OBJECTIVE: Surgical resection confers optimal outcomes in early stage lung cancer. This is often limited by comorbidities and other barriers including access to care and insurance status. We sought to investigate the impact of Medicaid expansion on the access to lung cancer surgery.
METHODS: The National Cancer Database was queried. Trends were examined in clinical Stage I and II lung cancer cases diagnosed between 2014 and 2016 in states which sought Medicaid expansion versus not. Cases were stratified based on receipt of surgery. A multivariable model was constructed to investigate potential association between residence in an expansion state and receipt of surgery, while controlling for the available demographic, socioeconomic, and clinical variables.
RESULTS: Of the 143038 patients treated since 2014, the proportion undergoing surgery was 60% in expansion states vs 56% in non-expansion states. The proportion of uninsured patients was 0.6% in expansion states vs 2% in non-expansion states. Multivariable regression confirmed a negative association between non-expansion states and receipt of surgery (OR 0.94, 95%CI 0.92-0.97) while controlling for and confirming positive association with treatment at academic programs (OR 1.6), private insurance (OR 2.0), less comorbidities (OR 1.2), and better socio-economic status (OR 1.6).
CONCLUSIONS: Socioeconomic factors are strongly linked to rates of surgery in early-stage lung cancer. Medicaid expansion seems to be associated with access to surgical care. Continued monitoring of these programs and long-term studies are needed to demonstrate a clear impact on survival in this patient population.
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