Niroomand Elaheh, Kumar Smriti Rajita, Goldberg David, Kumar Shria
Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA.
Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA.
Dig Dis Sci. 2023 Apr;68(4):1178-1186. doi: 10.1007/s10620-022-07659-6. Epub 2022 Aug 16.
Individuals in Medicaid expanded states have increased access to treatment for medical conditions and other health care resources. Esophageal and gastric cancer are associated with several modifiable risk factors (e.g. smoking, drinking, Helicobacter pylori infection). The impact of Medicaid expansion on these cancers incidence and mortality remains uninvestigated.
We evaluated the association between Medicaid expansion and gastric and esophageal cancer incidence and mortality in adults aged 25-64. We employed an observational design using a difference-in-differences method with state level data, from 2010 to 2017. Annual, age-adjusted gastric and esophageal cancer incidence and mortality rates, from the CDC Wonder Database, were analyzed. Rates were adjusted for by several socio-demographic factors.
Expansion and non-expansion states were similar in percent Hispanic ethnicity and female gender. The non-expansion states had significantly higher proportion of Black race, diabetics, obese persons, smokers, and those living below the federal poverty line. Adjusted analyses demonstrate that expansion states had significantly fewer new cases of gastric cancer: - 1.6 (95% CI 0.2-3.5; P = 0.08) per 1,000,000 persons per year. No significant association was seen between Medicaid expansion and gastric cancer mortality (0.46 [95% CI - 0.08 to 0.17; P = 0.46]) and esophageal cancer incidence (0.8 [95% CI - 0.08 to 0.24; P = 0.33]) and mortality (1.0 [95% CI - 0.06 to 0.26; P = 0.21]) in multivariable analyses.
States that adopted Medicaid expansion saw a decrease in gastric cancer incidence when compared to states that did not expand Medicaid. Though several factors may influence gastric cancer incidence, this association is important to consider during health policy negotiations.
医疗补助扩大计划覆盖州的居民获得医疗疾病治疗及其他医疗保健资源的机会有所增加。食管癌和胃癌与多种可改变的风险因素相关（如吸烟、饮酒、幽门螺杆菌感染）。医疗补助扩大计划对这些癌症发病率和死亡率的影响仍未得到研究。
我们评估了医疗补助扩大计划与25至64岁成年人胃癌和食管癌发病率及死亡率之间的关联。我们采用了一种观察性设计，运用差异中的差异方法，利用2010年至2017年的州级数据。分析了美国疾病控制与预防中心（CDC）Wonder数据库中按年龄调整的胃癌和食管癌年度发病率及死亡率。发病率经多种社会人口学因素调整。
扩大计划覆盖州和未扩大计划覆盖州在西班牙裔种族百分比和女性性别方面相似。未扩大计划覆盖州的黑人种族、糖尿病患者、肥胖者、吸烟者以及生活在联邦贫困线以下人群的比例显著更高。校正分析表明，扩大计划覆盖州的胃癌新发病例显著减少：每年每100万人中减少1.6例（95%置信区间0.2 - 3.5；P = 0.08）。在多变量分析中，未发现医疗补助扩大计划与胃癌死亡率（0.46 [95%置信区间 - 0.08至0.17；P = 0.46]）、食管癌发病率（0.8 [95%置信区间 - 0.08至0.24；P = 0.33]）和死亡率（1.0 [95%置信区间 - 0.06至0.26；P = 0.21]）之间存在显著关联。
与未扩大医疗补助计划的州相比，实施医疗补助扩大计划的州胃癌发病率有所下降。尽管有几个因素可能影响胃癌发病率，但在卫生政策谈判中考虑这种关联很重要。
