The expansion of federal Medicaid coverage in 2014 led to improved survival rates for patients with incurable breast cancer who were racial and ethnic minorities, according to a study published April 7 in JAMA Oncology.
Researchers at the University of Texas MD Anderson Cancer Center in Houston examined association between Medicaid expansion and mortality disparity among patients of racial and ethnic minority groups with de novo stage IV breast cancer. In a two-year period after coverage was expanded in 19 states, they found significant increases in overall survival among patients.
"Policies aimed at improving equity and increasing access to health care may reduce racial and ethnic disparities in breast cancer outcomes," wrote corresponding author Dr. Mariana Chavez-MacGregor, a medical oncologist and associate professor of health services research.
Patients who are uninsured and belong to racial and ethnic minority groups or have low socioeconomic status have suboptimal access to healthcare, which likely affects outcomes, the authors wrote.
The Patient Protection and Affordable Care Act (ACA) of 2010 included an expansion of Medicaid eligibility to include nonelderly individuals with income at 138% or less of the federal poverty level, effective January 1, 2014.
Despite reports of positive trends in cancer care since the expansion, reported improved cancer outcomes according to socioeconomic status and race and ethnicity have been mixed, the authors wrote.
In this study, the researchers analyzed data from the U.S. National Cancer Database on 5,077 patients with de novo stage IV breast cancer who were diagnosed four years prior to the expansion in 2014 compared with data gathered on 4,245 patients two years after the expansion. A total of 2,545 patients were included in the group including racial and ethnic minority patients, while 6,777 individuals were in the white patient group.
Results indicated that Medicaid expansion was associated with a significant decrease in the number of uninsured patients: 6.7% for preexpansion versus 3.6% for postexpansion.
The major findings of the study included the following:
- Two-year overall survival for white patients before the expansion was 64% compared with 56% for patients of racial and ethnic minority groups. After the expansion, the difference in overall survival between the two groups was no longer statistically significant (71.0% vs 71.8%).
- Among white patients, two-year mortality rates decreased from 40.6% to 36.3% in the postexpansion period, and for patients of racial and ethnic minority groups, two-year mortality rates decreased from 45.6% to 35.8%.
In addition, among patients in the lowest income quartile, patients in the racial and ethnic minority group had an increased risk of death compared with white patients (hazard ratio [HR], 1.28), but this also decreased in the postexpansion period (HR, 0.75).
"Our findings are particularly novel and relevant because they add to the understanding of how policy-level interventions, particularly regarding the ACA expansion of Medicaid eligibility, are associated with differential breast cancer outcomes among vulnerable populations," the authors wrote.
The researchers noted it is possible that the use of novel therapeutics during the study time was associated with improved outcomes.
"However, the differential improvement among racial and ethnic minority group participants suggests that access to health care likely played an important role," they stated.
Since Medicaid expansion took effect in January 2014, 36 states and the District of Columbia have expanded their programs.
"Survival could be improved if Medicaid expansion is implemented by other states," the authors concluded.