Medicaid expansion is associated with earlier diagnosis of gastric cancer

Abstract

Introduction: The 2014 Medicaid expansion was intended to improve access to care. We hypothesized that Medicaid expansion would be associated with improved gastric cancer (GC) outcomes.

Methods: We selected patients with a new primary diagnosis of GC from the National Cancer Database. We compared states that expanded Medicaid in 2014 to those that did not. We compared pre-and post-expansion intervals 2012-2013 and 2015-2016.

Results: There was an increase in patients diagnosed with stage 0-2 GC from 38% to 41.5% [p < 0.01] in expansion states (ES), but no change at 38.9% in non-expansion states (NES). Uninsured and Medicaid patients diagnosed with stages 0-2 GC increased in ES from 32.4% to 37.8% [p = 0.01] and decreased in NES from 29.7% to 27.3% [p = n.s.]. Uninsured and Medicaid patients receiving treatment rose from 87.0% to 90.3% in ES [p < 0.01] and in NES 83.9%-84.9% [p = n.s.]. Twelve-month survival for ES rose from 68.1% to 70.6% [p = 0.03] and in NES decreased 65.2%-65.1% [p = n.s.].

Conclusion: Increased healthcare access may be related to earlier diagnosis and improved outcomes in GC.

Keywords: Gastric cancer; Health access; Medicaid; Medicaid expansion; Public health.