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Impact of Medicaid Expansion on Incidence and Mortality from Gastric and Esophageal Cancer

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Abstract

Background and Aims

Individuals in Medicaid expanded states have increased access to treatment for medical conditions and other health care resources. Esophageal and gastric cancer are associated with several modifiable risk factors (e.g. smoking, drinking, Helicobacter pylori infection). The impact of Medicaid expansion on these cancers incidence and mortality remains uninvestigated.

Methods

We evaluated the association between Medicaid expansion and gastric and esophageal cancer incidence and mortality in adults aged 25–64. We employed an observational design using a difference-in-differences method with state level data, from 2010 to 2017. Annual, age-adjusted gastric and esophageal cancer incidence and mortality rates, from the CDC Wonder Database, were analyzed. Rates were adjusted for by several socio-demographic factors.

Results

Expansion and non-expansion states were similar in percent Hispanic ethnicity and female gender. The non-expansion states had significantly higher proportion of Black race, diabetics, obese persons, smokers, and those living below the federal poverty line. Adjusted analyses demonstrate that expansion states had significantly fewer new cases of gastric cancer: − 1.6 (95% CI 0.2–3.5; P = 0.08) per 1,000,000 persons per year. No significant association was seen between Medicaid expansion and gastric cancer mortality (0.46 [95% CI − 0.08 to 0.17; P = 0.46]) and esophageal cancer incidence (0.8 [95% CI − 0.08 to 0.24; P = 0.33]) and mortality (1.0 [95% CI − 0.06 to 0.26; P = 0.21]) in multivariable analyses.

Conclusion

States that adopted Medicaid expansion saw a decrease in gastric cancer incidence when compared to states that did not expand Medicaid. Though several factors may influence gastric cancer incidence, this association is important to consider during health policy negotiations.

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Abbreviations

ACA:

Affordable Care Act

FPL:

Federal poverty line

ME:

Medicaid expansion

H pylori :

Helicobacter pylori

DID:

Difference-in-differences

ICD-O-3:

International Classification of Diseases for Oncology, Third Edition

CDC Wonder:

Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research

ICD-10:

International Classification of Disease, 10th revision

SAIPE:

Small Area Income and Poverty Estimates

SAHIE:

Small Area Health Insurance Estimates

IQR:

Interquartile range

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Funding

None of the authors received any funding in relation to this manuscript.

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Author notes

  1. Elaheh Niroomand and Smriti Rajita Kumar have equally contributed to this study.

Authors and Affiliations

  1. Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA

    Elaheh Niroomand & Smriti Rajita Kumar

  2. Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA

    David Goldberg & Shria Kumar

  3. Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA

    David Goldberg & Shria Kumar

Authors
  1. Elaheh Niroomand
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  2. Smriti Rajita Kumar
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Contributions

EN: Conceptualizing study, data interpretation, reviewing and editing manuscript, finalizing manuscript, final approval of version to be published. SRK: Statistical analysis, data interpretation, reviewing and editing manuscript, finalizing manuscript, final approval of version to be published. DG: Statistical analysis, data interpretation, reviewing and editing manuscript, finalizing manuscript, final approval of version to be published. SK: Data interpretation. reviewing and editing manuscript, finalizing manuscript, final approval of version to be published.

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Correspondence to Shria Kumar.

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Niroomand, E., Kumar, S.R., Goldberg, D. et al. Impact of Medicaid Expansion on Incidence and Mortality from Gastric and Esophageal Cancer. Dig Dis Sci 68, 1178–1186 (2023). https://doi.org/10.1007/s10620-022-07659-6

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