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Welcome

Attend this session at the
2019 ASCO Annual Meeting!


Session: Plenary Session Including the Distinguished Achievement Award and Science of Oncology Award Lecture

Type: Plenary Session

Time: Sunday June 2, 1:00 PM to 4:00 PM

Location: Hall B1

Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

Sub-category:
Disparities/Access to Care

Category:
Health Services Research, Clinical Informatics, and Quality of Care

Meeting:
2019 ASCO Annual Meeting

Abstract No:
LBA1

Citation:
J Clin Oncol 37, 2019 (suppl; abstr LBA1)

Author(s): Blythe J.S. Adamson, Aaron B. Cohen, Melissa Estevez, Kelly Magee, Erin Williams, Cary Philip Gross, Neal J. Meropol, Amy J. Davidoff; Flatiron Health, New York, NY; Yale School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT

Abstract Disclosures

Abstract:

Background: Racial disparities in cancer outcomes remain a societal challenge. The ACA sought to improve equity in healthcare access and outcomes by permitting states to expand Medicaid and providing subsidies for purchase of private insurance. We assessed the impact of Medicaid expansions on racial disparities in time to treatment among patients (pts) with advanced cancer. Methods: We selected pts ages 18-64 years with advanced or metastatic cancer (NSCLC, breast, urothelial, gastric, colorectal, renal cell, prostate, and melanoma), diagnosed between Jan 1, 2011 and Dec 31, 2018, from the nationwide Flatiron Health electronic health record-derived database. We assigned expansion status based on whether the pts’ state of residence had expanded Medicaid as of the diagnosis date. We estimated Medicaid expansion-related changes in the rate of “timely treatment,” an outcome defined as first-line treatment start within 30 days of advanced or metastatic diagnosis. Regression model covariates included race (White, African American, Asian, and Other race), age, sex, practice type, cancer type, stage, and unemployment rate, using time and state fixed-effects. Regression results present predictive margins. Results: The study included 34,067 pts (median age 57 years; 12% African American). Racial disparities were observed pre-expansion: African American pts were 4.9 percentage points (%pt) less likely to receive timely treatment (Table). Regardless of race, Medicaid expansion trended toward an increase in timely treatment overall (p = 0.05). Expansion was associated with a differential benefit for African American vs white pts (6.9 %pt and 1.8 %pt). Prior racial disparities were no longer observed after Medicaid expansion. Conclusions: Implementation of Medicaid expansions as part of the ACA differentially improved African American cancer pts’ receipt of timely treatment, reducing racial disparities in access to care.

Predictive margins of timely treatment (%).

Pre-ExpansionPost-ExpansionPre-Post Change
White41.843.11.8
African American39.144.36.9**
Adjusted disparity (African American vs whites)-4.9**0.25.1**

** p < 0.05

 
Other Abstracts in this Sub-Category:

 

1. The Affordable Care Act and cost-related medication non-compliance in cancer survivors.

Meeting: 2019 ASCO Annual Meeting Abstract No: 106 First Author: Justin Barnes
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

2. Impact of broadening clinical trial eligibility criteria for advanced non-small cell lung cancer patients: Real-world analysis.

Meeting: 2019 ASCO Annual Meeting Abstract No: LBA108 First Author: R. Donald Harvey
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

3. Quality of end-of-life cancer care at minority-serving US cancer centers: A retrospective study of Medicare claims data.

Meeting: 2019 ASCO Annual Meeting Abstract No: 6507 First Author: Garrett Wasp
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

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