Eom Kirsten Y, Dong Weichuan, Hoehn Richard S, Albert Jeffrey M, Kim Uriel, Cooper Gregory, Rose Johnie, Tsui Jennifer, Koroukian Siran M
Center for Health Care Research and Policy at The MetroHealth System, Cleveland, OH, USA.
Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
Cancer Causes Control. 2025 Jun 23. doi: 10.1007/s10552-025-01983-8.
Despite growing research on Medicaid expansion's impact on cancer outcomes, there remains a critical need for a more nuanced understanding of how expansion affects cancer care and survival. This study assesses whether Medicaid expansion was associated with improved receipt of standard treatment, timely treatment initiation, and overall survival among colon cancer patients, while examining the specific factors influencing these outcomes.
Using Ohio's state cancer registry linked with Medicaid records, we analyzed 688 Medicaid-enrolled patients with non-metastatic colon cancer diagnosed between May 2011 and December 2017. We employed multivariable Poisson and Cox proportional hazard regression analyses to evaluate the impact of Medicaid expansion on treatment and survival outcomes, controlling for individual- and area-level factors.
We observed no significant changes in the likelihood of receipt of standard treatment or timely treatment initiation post-expansion vs. pre-expansion, and no significant differences in these outcomes by Medicaid eligibility criteria post-expansion. However, we observed significantly improved survival (hazard ratio, HR 0.49 [0.28, 0.88]) among patients who became newly eligible for Medicaid under the ACA vs. pre-expansion. Patients enrolled emergently (shortly after/upon diagnosis) were more likely to receive standard treatment (risk ratio, RR 1.14 [1.02, 1.27]).
Our findings provide nuanced insights into Medicaid expansion's impact on colon cancer care, showing that while expansion did not affect treatment measures, it improved survival among newly eligible patients. Higher standard treatment likelihood among emergently enrolled patients suggests complex post-expansion care dynamics. Further research should investigate mechanisms underlying improved survival and develop interventions to enhance treatment quality alongside observed survival benefits.
尽管关于医疗补助扩大对癌症结局影响的研究不断增加，但仍迫切需要更细致地了解扩大如何影响癌症护理和生存。本研究评估医疗补助扩大是否与结肠癌患者标准治疗的接受度提高、及时开始治疗以及总体生存改善相关，同时考察影响这些结局的具体因素。
利用俄亥俄州的州癌症登记处与医疗补助记录相链接的数据，我们分析了2011年5月至2017年12月期间确诊的688名参加医疗补助的非转移性结肠癌患者。我们采用多变量泊松和Cox比例风险回归分析来评估医疗补助扩大对治疗和生存结局的影响，并控制个体和地区层面的因素。
我们观察到扩大后与扩大前相比，接受标准治疗或及时开始治疗的可能性没有显著变化，扩大后根据医疗补助资格标准这些结局也没有显著差异。然而，我们观察到根据《平价医疗法案》新符合医疗补助资格的患者与扩大前相比，生存有显著改善（风险比，HR 0.49 [0.28, 0.88]）。紧急登记（诊断后不久/确诊时）的患者更有可能接受标准治疗（风险比，RR 1.14 [1.02, 1.27]）。
我们的研究结果为医疗补助扩大对结肠癌护理的影响提供了细致的见解，表明虽然扩大没有影响治疗措施，但改善了新符合资格患者的生存。紧急登记患者中较高的标准治疗可能性表明扩大后护理动态复杂。进一步的研究应调查生存改善的潜在机制，并制定干预措施以提高治疗质量并同时实现观察到的生存益处。
