State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients.

Journal Article (Journal Article)

OBJECTIVES: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC. METHODS: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011-2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP). RESULTS: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18-34 years (17.2 PP, 95% CI - 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30-7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67-24.3, p = 0.015). CONCLUSIONS: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.

Full Text

Duke Authors

Cited Authors

  • Osazuwa-Peters, N; Barnes, JM; Megwalu, U; Adjei Boakye, E; Johnston, KJ; Gaubatz, ME; Johnson, KJ; Panth, N; Sethi, RKV; Varvares, MA

Published Date

  • November 2020

Published In

Volume / Issue

  • 110 /

Start / End Page

  • 104870 -

PubMed ID

  • 32629408

Electronic International Standard Serial Number (EISSN)

  • 1879-0593

Digital Object Identifier (DOI)

  • 10.1016/j.oraloncology.2020.104870


  • eng

Conference Location

  • England