Akinyemi Oluwasegun, Fasokun Mojisola, Eze Akachukwu, Ugochukwu Nkemdirim, Arshad Sumaiyya, Belie Orimisan, Hughes Kakra, Cornwell Edward, Levy Gal
The Clive O Callender Outcomes Research Center, Howard University College of Medicine, Washington DC, USA.
Department of Epidemiology, University of Alabama at Birmingham, AL, USA.
medRxiv. 2025 Sep 2:2025.08.31.25334804. doi: 10.1101/2025.08.31.25334804.
The Affordable Care Act's Medicaid expansion aimed to enhance healthcare access for low-income individuals and minority groups, promoting early screening and treatment to improve health equity.
This study examines the impact of Medicaid expansion on lung cancer-specific survival (CSM) and overall mortality (OS) by comparing outcomes in Texas (non-expansion of ACA) and California (expansion of ACA).
We conducted a retrospective study using data from SEER cancer registry (2007-2021) to evaluate the impact of Medicaid expansion on lung cancer survival in California (expansion) vs. Texas (non-expansion). The study included adults aged 18-64, with periods split into pre-ACA (2007-2013), one-year washout (2014), and post-ACA (2015-2021). We utilized a DID design and adjusted for important covariates.
Among 119,937 individuals with Lung cancer, 52.1% were in California (62,521), while 47.8% were in Texas (57,416). The pre-ACA period included 60,010 individuals (53.1% in California and 46.9% in Texas), and 59,927 patients were in the post-ACA period (51.2% in California and 48.8% in Texas). Overall, Medicaid expansion was associated with a 1.12-point (-1.12, 95% CI -1.46 to -0.77) reduction in the hazard of cancer-specific mortality. The policy was also associated with a 0.81point reduction in the hazard of overall mortality (-0.81, 95% CI -1.06 to -0.57).
Medicaid expansion was associated with a significant improvement in lung cancer outcomes among individuals with lung cancer in California, which implemented the policy in 2014, compared to Texas, which has not yet implemented the policy.
《平价医疗法案》的医疗补助扩大计划旨在改善低收入人群和少数群体的医疗服务可及性，推动早期筛查和治疗以提高健康公平性。
本研究通过比较得克萨斯州（未扩大《平价医疗法案》）和加利福尼亚州（扩大《平价医疗法案》）的结果，考察医疗补助扩大对肺癌特异性生存（CSM）和总体死亡率（OS）的影响。
我们进行了一项回顾性研究，使用监测、流行病学和最终结果（SEER）癌症登记处（2007 - 2021年）的数据，以评估医疗补助扩大对加利福尼亚州（扩大）与得克萨斯州（未扩大）肺癌生存的影响。该研究纳入了18至64岁的成年人，时间段分为《平价医疗法案》实施前（2007 - 2013年）、一年缓冲期（2014年）和《平价医疗法案》实施后（2015 - 2021年）。我们采用了双重差分设计并对重要协变量进行了调整。
在119,937名肺癌患者中，52.1%在加利福尼亚州（62,521名），而47.8%在得克萨斯州（57,416名）。《平价医疗法案》实施前阶段包括60,010名患者（加利福尼亚州占53.1%，得克萨斯州占46.9%），《平价医疗法案》实施后阶段有59,927名患者（加利福尼亚州占51.2%，得克萨斯州占48.8%）。总体而言，医疗补助扩大与癌症特异性死亡风险降低1.12个百分点（-1.12，95%置信区间 -1.46至 -0.77）相关。该政策还与总体死亡风险降低0.81个百分点（-0.81，95%置信区间 -1.06至 -0.57）相关。
与尚未实施该政策的得克萨斯州相比，2014年实施该政策的加利福尼亚州，医疗补助扩大与肺癌患者的肺癌结局显著改善相关。
