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The Affordable Care Act and suicide incidence among adults with cancer.

Publication ,  Journal Article
Barnes, JM; Graboyes, EM; Adjei Boakye, E; Kent, EE; Scherrer, JF; Park, EM; Rosenstein, DL; Mowery, YM; Chino, JP; Brizel, DM; Osazuwa-Peters, N
Published in: J Cancer Surviv
April 2023

BACKGROUND: Patients with cancer are at an increased suicide risk, and socioeconomic deprivation may further exacerbate that risk. The Affordable Care Act (ACA) expanded insurance coverage options for low-income individuals and mandated coverage of mental health care. Our objective was to quantify associations of the ACA with suicide incidence among patients with cancer. METHODS: We identified US patients with cancer aged 18-74 years diagnosed with cancer from 2011 to 2016 from the Surveillance, Epidemiology, and End Results database. The primary outcome was the 1-year incidence of suicide based on cumulative incidence analyses. Difference-in-differences (DID) analyses compared changes in suicide incidence from 2011-2013 (pre-ACA) to 2014-2016 (post-ACA) in Medicaid expansion relative to non-expansion states. We conducted falsification tests with 65-74-year-old patients with cancer, who are Medicare-eligible and not expected to benefit from ACA provisions. RESULTS: We identified 1,263,717 patients with cancer, 812 of whom died by suicide. In DID analyses, there was no change in suicide incidence after 2014 in Medicaid expansion vs. non-expansion states for nonelderly (18-64 years) patients with cancer (p = .41), but there was a decrease in suicide incidence among young adults (18-39 years) (- 64.36 per 100,000, 95% CI =  - 125.96 to - 2.76, p = .041). There were no ACA-associated changes in suicide incidence among 65-74-year-old patients with cancer. CONCLUSIONS: We found an ACA-associated decrease in the incidence of suicide for some nonelderly patients with cancer, particularly young adults in Medicaid expansion vs. non-expansion states. Expanding access to health care may decrease the risk of suicide among cancer survivors.

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Published In

J Cancer Surviv

DOI

EISSN

1932-2267

Publication Date

April 2023

Volume

17

Issue

2

Start / End Page

449 / 459

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Suicide
  • Patient Protection and Affordable Care Act
  • Oncology & Carcinogenesis
  • Neoplasms
  • Medicare
  • Medicaid
  • Insurance, Health
  • Insurance Coverage
 

Citation

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Barnes, J. M., Graboyes, E. M., Adjei Boakye, E., Kent, E. E., Scherrer, J. F., Park, E. M., … Osazuwa-Peters, N. (2023). The Affordable Care Act and suicide incidence among adults with cancer. J Cancer Surviv, 17(2), 449–459. https://doi.org/10.1007/s11764-022-01205-z
Barnes, Justin M., Evan M. Graboyes, Eric Adjei Boakye, Erin E. Kent, Jeffrey F. Scherrer, Eliza M. Park, Donald L. Rosenstein, et al. “The Affordable Care Act and suicide incidence among adults with cancer.J Cancer Surviv 17, no. 2 (April 2023): 449–59. https://doi.org/10.1007/s11764-022-01205-z.
Barnes JM, Graboyes EM, Adjei Boakye E, Kent EE, Scherrer JF, Park EM, et al. The Affordable Care Act and suicide incidence among adults with cancer. J Cancer Surviv. 2023 Apr;17(2):449–59.
Barnes, Justin M., et al. “The Affordable Care Act and suicide incidence among adults with cancer.J Cancer Surviv, vol. 17, no. 2, Apr. 2023, pp. 449–59. Pubmed, doi:10.1007/s11764-022-01205-z.
Barnes JM, Graboyes EM, Adjei Boakye E, Kent EE, Scherrer JF, Park EM, Rosenstein DL, Mowery YM, Chino JP, Brizel DM, Osazuwa-Peters N. The Affordable Care Act and suicide incidence among adults with cancer. J Cancer Surviv. 2023 Apr;17(2):449–459.
Journal cover image

Published In

J Cancer Surviv

DOI

EISSN

1932-2267

Publication Date

April 2023

Volume

17

Issue

2

Start / End Page

449 / 459

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Suicide
  • Patient Protection and Affordable Care Act
  • Oncology & Carcinogenesis
  • Neoplasms
  • Medicare
  • Medicaid
  • Insurance, Health
  • Insurance Coverage