TY - JOUR
T1 - Medicaid expansion and racial disparity in timely multidisciplinary treatment in muscle invasive bladder cancer
AU - Jiang, Changchuan
AU - Perimbeti, Stuthi
AU - Deng, Lei
AU - Xing, Jiazhang
AU - Chatta, Gurkamal S.
AU - Han, Xuesong
AU - Gopalakrishnan, Dharmesh
N1 - Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC. Methods: This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis. Results: The study included 4991 (92.3% White, n ¼ 4605; 7.7% Black, n ¼ 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black–White patient disparity in timely receipt of MIBC treatment (95% confidence interval ¼ 0.5% to 26.8%; P < .01). Conclusions: Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
AB - Background: Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC. Methods: This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis. Results: The study included 4991 (92.3% White, n ¼ 4605; 7.7% Black, n ¼ 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black–White patient disparity in timely receipt of MIBC treatment (95% confidence interval ¼ 0.5% to 26.8%; P < .01). Conclusions: Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
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U2 - 10.1093/jnci/djad112
DO - 10.1093/jnci/djad112
M3 - Article
C2 - 37314971
AN - SCOPUS:85174641518
SN - 0027-8874
VL - 115
SP - 1188
EP - 1193
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 10
ER -