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- W4313005507 abstract "Introduction: Pancreatic cancer (PC) remains highly lethal despite advances in care. This study evaluates the impact of insurance and Affordable Care Act (ACA) Medicaid expansion on access, utilization, and survival. Method: NCDB was queried for patients (age<65) with PC from 2004-16, grouped by state Medicaid expansion status. Expansion and non-expansion states were compared pre-and post-2014. Chi-squared tests assessed associations between patient characteristics and insurance. Kaplan-Meier methods estimated overall survival (OS) from disease diagnosis. Results: Of 94942 patients, 63.5% had private insurance (PI), 12.6% Medicaid, 7.3% uninsured, 16.4% other. Patients with PI were more likely to present with stage I-II disease (37.5% vs Medicaid:31.2% vs uninsured:29%) and receive multimodal curative treatment. Median time to treatment was 22-days (IQR:10-36), with no clinical difference between insurance types. Patients with PI were more likely to enroll in clinical trials (PI:0.7% vs Medicaid:0.4% vs uninsured:0.1%; p<.001). Medicaid expansion policies did not appear to affect stage at diagnosis, utilization or time-to-treatment. OS was better for PI patients across all stages, most striking in stage 0/I with 1-Y OS PI:76% (95%CI:75-78%), Medicaid:63% (95%CI:59-67%) and uninsured:62% (95%CI:57-67%). Among a subset diagnosed between 2014-16, Medicaid expansion was associated with improved 1-Y OS for stage I disease (74% (95%CI:70-78%) vs non-expansion:67% (95%CI:64-71%)). Conclusions: PI is associated with better access, utilization, and survival. The impact of Medicaid expansion policies may be less pronounced in PC, given high disease lethality and lack of effective screening. Efforts to understand differences in access and utilization between Medicaid and PI may inform ongoing healthcare reform." @default.
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- W4313005507 date "2022-01-01" @default.
- W4313005507 modified "2023-09-26" @default.
- W4313005507 title "Persistent Disparities in Treatment and Survival for Patients with Pancreatic Cancer Despite Insurance Expansion Policies" @default.
- W4313005507 doi "https://doi.org/10.1016/j.hpb.2022.05.818" @default.
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