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Effect of Medicaid Expansion in Reducing Racial Disparities in Early Onset Colorectal Cancer

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Abstract

Background

The burden of early onset colorectal cancer (EOCRC) falls disproportionately on minorities and individuals in specific geographic regions. While these disparities are likely multi-factorial, access to high-quality health care plays a significant role. We sought to determine if Medicaid expansion is associated with reducing racial disparities in EOCRC detection in Hispanics and non-Hispanic Blacks (NHB), compared to non-Hispanic Whites (NHW).

Methods

Analysis of data from National Cancer Database was undertaken to compare incidence of EOCRC among those aged 40–49 between Medicaid expansion states (ES) and non-expansion states (NES) by racial/ethnic groups. Data was classified by race (NHW, NHB, or Hispanic), state of residence (ES or NES), and time (pre- or post-expansion). The primary outcome was change in incidence rate of EOCRC among racial/ethnic groups, according to whether patients resided in Medicaid expansion or non-expansion states.

Results

Among Hispanics, the ES showed a significant increase in EOCRC incidence post expansion as compared to NES (p = 0.03). The rate of increase in annual incidence of EOCRC among Hispanics was 4.3% per year (pre-expansion) and 9.8% (post-expansion) for ES; and 6.4% (pre-expansion) and 1% (post-expansion) in NES. However, no difference was noted among NHB (p = 0.33) and NHW (p = 0.94).

Conclusions

Medicaid expansion has improved detection rates of EOCRC in ES especially in Hispanic population. This is the first study to demonstrate the effect of Medicaid expansion on the incidence of EOCRC. Based on our study findings we suggest that racial and ethnic disparities should be considered in the earlier CRC screening debates.

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References

  1. Siegel RL, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48.

    Article  PubMed  Google Scholar 

  2. Siegel RL, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233–54.

    Article  PubMed  Google Scholar 

  3. Murphy CC, et al. Decrease in incidence of colorectal cancer among individuals 50 years or older after recommendations for population-based screening. Clin Gastroenterol Hepatol. 2017;15(6):903-909.e6.

    Article  PubMed  Google Scholar 

  4. Brown JJ, et al. Decreased colorectal cancer incidence and mortality in a diverse urban population with increased colonoscopy screening. BMC Public Health. 2021;21(1):1280.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cronin KA, et al. Evaluating the impact of population changes in diet, physical activity, and weight status on population risk for colon cancer (United States). Cancer Causes Control. 2001;12(4):305–16.

    Article  CAS  PubMed  Google Scholar 

  6. Abualkhair WH, et al. Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age. JAMA Netw Open. 2020;3(1):e1920407–e1920407.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nimptsch K, Wu K. Is Timing important? The role of diet and lifestyle during early life on colorectal neoplasia. Curr Colorectal Cancer Rep. 2018;14(1):1–11.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bailey CE, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg. 2015;150(1):17–22.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Abualkhair WH, et al. Geographic and intra-racial disparities in early-onset colorectal cancer in the SEER 18 registries of the United States. Cancer Med. 2020;9(23):9150–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kamath SD, et al. Racial disparities negatively impact outcomes in early-onset colorectal cancer independent of socioeconomic status. Cancer Med. 2021;10(21):7542–50.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Koblinski J, Jandova J, Nfonsam V. Disparities in incidence of early- and late-onset colorectal cancer between Hispanics and Whites: A 10-year SEER database study. Am J Surg. 2018;215(4):581–5.

    Article  PubMed  Google Scholar 

  12. Murphy CC, et al. Racial disparities in incidence of young-onset colorectal cancer and patient survival. Gastroenterology. 2019;156(4):958–65.

    Article  PubMed  Google Scholar 

  13. Acuna-Villaorduna AR, et al. Racial/ethnic disparities in early-onset colorectal cancer: implications for a racial/ethnic-specific screening strategy. Cancer Med. 2021;10(6):2080–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Dozois EJ, et al. Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome? Medicine (Baltimore). 2008;87(5):259–63.

    Article  PubMed  Google Scholar 

  15. Mazurenko O, et al. The effects of medicaid expansion under the aca: a systematic review. health aff (Millwood). 2018;37(6):944–50.

    Article  PubMed  Google Scholar 

  16. Sommers BD, Grabowski DC. What is medicaid? More than meets the eye. JAMA. 2017;318(8):695–6.

    Article  PubMed  Google Scholar 

  17. Claxton G, Rae M, Long M, Damico A, Whitmore H. Health benefits in 2018: modest growth in premiums, higher worker contributions at firms with more low-wage workers. Health Aff (Millwood). 2018;37(11):1892–1900. https://doi.org/10.1377/hlthaff.2018.1001

  18. Rosenbaum S, Westmoreland TM. The supreme court’s surprising decision on the medicaid expansion: how will the federal government and states proceed? Health Aff (Millwood). 2012;31(8):1663–1672. https://doi.org/10.1377/hlthaff.2012.0766

  19. Qian Z, et al. Long-term impact of medicaid expansion on colorectal cancer screening in its targeted population. Dig Dis Sci. 2023;68(5):1780–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zerhouni YA, et al. Effect of medicaid expansion on colorectal cancer screening rates. Dis Colon Rectum. 2019;62(1):97–103.

    Article  PubMed  Google Scholar 

  21. Merkow RP, Rademaker AW, Bilimoria KY. Practical guide to surgical data sets: national cancer database (NCDB). JAMA Surg. 2018;153(9):850–1.

    Article  PubMed  Google Scholar 

  22. Sommers BD, et al. Health reform and changes in health insurance coverage in 2014. N Engl J Med. 2014;371(9):867–74.

    Article  CAS  PubMed  Google Scholar 

  23. Munira Z, Gunja SRC, Bhupal HK. Is the affordable care act helping consumers get health care? Commonwealth Fund. 2017. https://www.commonwealthfund.org/publications/issue-briefs/2017/dec/affordable-care-act-helping-consumers-gethealth-care. Accessed 14 Aug 2023

  24. Jemal A, et al. Changes in insurance coverage and stage at diagnosis among nonelderly patients with cancer after the affordable care act. J Clin Oncol. 2017;35(35):3906–15.

    Article  PubMed  Google Scholar 

  25. Timothy Stoltzfus Jost, T.A.C.A.U.T.T.A., ” To the Point (blog), Commonwealth Fund, Aug. 30, 2018. https://www.commonwealthfund.org/blog/2018/affordable-care-act-under-trump-administration. Accessed 14 Aug 2023

  26. Health coverage by race and ethnicity, 2010–2019. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/. Accessed 4 Aug 2023

  27. How trump’s policies have hurt aca marketplace enrollment https://www.americanprogress.org/article/trumps-policies-hurt-aca-marketplace-enrollment/. Accessed 4 Aug 2023

  28. U.S. Hispanic population continued its geographic spread in the 2010s. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/.

  29. Jones RMN, Ramirez R, Ríos-Vargas M. Census illuminates racial and ethnic composition of the country. 2020. https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-populationmuch-more-multiracial.html. Accessed 14 Aug 2023

  30. Gushulak BD, MacPherson DW. The basic principles of migration health: population mobility and gaps in disease prevalence. Emerg Themes Epidemiol. 2006;3:3.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Karlitz JJ, et al. The American college of gastroenterology and the 80% by 2018 colorectal cancer initiative: a multifaceted approach to maximize screening rates. Am J Gastroenterol. 2017;112(9):1360–2.

    Article  PubMed  Google Scholar 

  32. Hofseth LJ, et al. Early-onset colorectal cancer: initial clues and current views. Nat Rev Gastroenterol Hepatol. 2020;17(6):352–64.

    Article  PubMed  Google Scholar 

  33. Laiyemo AO, et al. Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities. J Natl Cancer Inst. 2010;102(8):538–46.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Montminy EM, et al. Trends in the incidence of early-onset colorectal adenocarcinoma among black and white US residents aged 40 to 49 years, 2000–2017. JAMA Netw Open. 2021;4(11):e2130433.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lin JS, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US preventive services task force. JAMA. 2021;325(19):1978–98.

    Article  PubMed  Google Scholar 

  36. Ladabaum U, et al. Cost-effectiveness and national effects of initiating colorectal cancer screening for average-risk persons at age 45 years instead of 50 years. Gastroenterology. 2019;157(1):137–48.

    Article  PubMed  Google Scholar 

  37. Lyudmer M, et al. Racial ethnic disparities in clinical/pathological features, treatment, and survival among patients with early-onset colorectal cancer. J Clin Oncol. 2021;39(3_suppl):21–21.

    Article  Google Scholar 

  38. Lam MB, et al. Medicaid expansion and mortality among patients with breast, lung, and colorectal cancer. JAMA Netw Open. 2020;3(11):e2024366–e2024366.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Davidson KW, et al. Screening for colorectal cancer: us preventive services task force recommendation statement. JAMA. 2021;325(19):1965–77.

    Article  PubMed  Google Scholar 

  40. Carethers JM. Racial and ethnic disparities in colorectal cancer incidence and mortality. Adv Cancer Res. 2021;151:197–229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Gaba AG, Cao L, Renfrew RJ, Witte D, Wernisch JM, Sahmoun AE, Goel S, Egland KA, Crosby RD. Differences in breast cancers among American Indian/Alaska native and non-hispanic whites in the USA. J Racial Ethn Health Disparities. 2023; https://doi.org/10.1007/s40615-023-01704-4

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Funding

Sanjay Goel was funded by NIH/AG1R21 NIH AG 1R21AG058027-01.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Ohio State University, Columbus, OH, USA

    Shafia Rahman

  2. Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Riya Patel

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Jianyou Liu & Mimi Kim

  4. Department of Medical Oncology, Sanford Health, Fargo, ND, USA

    Anu Gaba

  5. Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, NY, USA

    Radhashree Maitra

  6. Department of Biology, Yeshiva University, New York, NY, USA

    Radhashree Maitra

  7. Department of Medical Oncology, Mt. Sinai School of Medicine, New York, NY, USA

    Ana Acuna-Villaorduna

  8. Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, 08903, New Brunswick, NJ, USA

    Sanjay Goel

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  1. Shafia Rahman
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Shafia Rahman, Riya Patel, Jianyou Liu, Mimi Kim, and Sanjay Goel. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sanjay Goel.

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This is an observational study using publicly available data and the institutional review board of the Albert Einstein College of Medicine determined that no ethics committee approval was required.

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Rahman, S., Patel, R., Liu, J. et al. Effect of Medicaid Expansion in Reducing Racial Disparities in Early Onset Colorectal Cancer. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01756-6

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  • DOI: https://doi.org/10.1007/s40615-023-01756-6

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