Medicaid expansion and overall mortality among women with cervical cancer

To assess the association between Medicaid expansion under the Affordable Care Act (ACA) and overall mortality among women with cervical cancer, specifically evaluating changes in stage at diagnosis and treatment utilization and emphasizing differences in survival between early expansion states (implemented by 2014) and non-expansion states.

Researchers conducted a retrospective cohort study using data from the National Cancer Database for the period 2006-2021, involving individuals aged 18-64 years. Medicaid expansion served as the primary explanatory variable, classifying states that implemented Medicaid expansion before January 2014 as early expansion states and states that did not expand as non-expansion states. The Difference-in-Differences (DID) analytical method assessed the effects of Medicaid expansion on survival, cancer stage at diagnosis, and treatment utilization, adjusting for demographics, cancer stage, treatment modalities, and incorporating state and year fixed effects. Robust standard errors were clustered at the state level.

The analysis included 77 774 women aged 18-64 years diagnosed with cervical cancer, with 37 901 (48.7%) diagnosed pre-ACA and 39 873 (51.3%) diagnosed post-ACA. In early expansion states, Medicaid expansion correlated with a 3.12% increase in early-stage cervical cancer diagnoses (95% confidence interval [CI] 1.74%-4.53%) and a 1.44 percentage point reduction in distant metastatic disease at presentation (95% CI -2.52% to -0.30%). Additionally, there was a 3.24% increase in surgical treatment utilization (95% CI 1.83%-4.62%) compared with non-expansion states. Furthermore, early expansion states demonstrated a 29.12% reduction in overall mortality hazard (95% CI -56.41% to -1.63%), with these survival improvements consistent across racial groups and disease stages.

Medicaid expansion was associated with earlier diagnosis, increased surgical treatment utilization, and significantly reduced overall mortality among women with cervical cancer.