Impact of Medicaid expansion on racial disparities among patients with gastrointestinal cancer

Background

Racial minority groups experience disparities in cancer treatment and mortality. This study aimed to investigate the effect of Medicaid expansion on the existing racial disparities in all-cause mortality among patients with gastrointestinal malignancies.

Methods

A cross-sectional cohort study of patients with pancreatic ductal adenocarcinoma (PDAC), colorectal cancer (CRC), and gastric adenocarcinoma (GC) of any stage was conducted using data from the National Cancer Database (2009–2019). Using difference-in-difference (DID) analysis, the authors compared adjusted 2-year mortality rates among Black and White patients residing in states with expanded Medicaid benefits (MES) and non-MES before (2009–2013) and after (2014–2019) Medicaid expansion.

Results

A total of 86,052 patients were included in this analysis, including 19,188 patients with PDAC, 60,404 with CRC, and 6460 with GC. Two-year mortality rates decreased among Black patients with PDAC residing in MES but not those residing in non-MES following Medicaid expansion (DID, –9.4%; 95% confidence interval [CI], –14.4% to –4.4%; p < .001). Mortality decreased more among Black and White patients with CRC in MES compared to those in non-MES following Medicaid expansion (DID, –2.9%; 95% CI, –5.7 to –0.04; p = .047 and DID, –4.2%; 95% CI, –5.8 to –2.5; p < .001, respectively). Black patients with GC in MES experienced a marked reduction in mortality compared to those in non-MES (DID, –7.7%, 95% CI, –16.1 to 0.56; p = .07).

Conclusion

Medicaid expansion was associated with a greater reduction in 2-year mortality rates among Black patients residing in MES compared to those residing in non-MES. Existing racial disparities in mortality remained the same or worsened in non-MES but were mitigated in MES following Medicaid expansion in almost all comparisons.