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Impact of Medicaid Expansion Status and Race on Metastatic Disease at Diagnosis in Patients with Melanoma

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Abstract

Background

Black patients are diagnosed with melanoma at a later stage, as compared with their white counterparts. It is unknown if Medicaid expansion might ameliorate this disparity.

Methods

Using data from the 2016 National Cancer Database, we conducted a retrospective cohort study. The primary objective was to evaluate whether being diagnosed with melanoma at a Medicaid Expansion State (MES) and black race are associated with a late diagnosis of melanoma.  Main exposure: Being diagnosed in a MES. Secondary exposure: Race. Main outcome: Odds of Stage IV vs Stages 0-III at diagnosis. Univariate, multivariate logistic regression, and propensity score analyses were conducted to evaluate the potential associations. Sub-group analysis was conducted according to age < 65 or ≥ 65 years.

Results

A total of 216,604 patients were included, 40–90 years of age, \(\overline{X}\) 64 years [SD 12.47]. In univariate analysis, patients diagnosed in MES were 15% less likely (95% CI, 0.81–0.88) to be diagnosed with Stage IV melanoma. Black race (vs white) had 3.04 increased odds (95% CI, 2.56–3.60) of late diagnosis. In multivariate analysis, adjusting for socio-economic confounders, patients < 65 years of age were 13% less likely (95% CI, 0.82–0.92) to be diagnosed with Stage IV melanoma. By propensity score analysis, the strength of the associations remained. Black race (vs white) was associated with higher odds (95% CI, 1.91–3.08) of being diagnosed with Stage IV disease. For black patients < 65 years, being diagnosed in a state without Medicaid expansion had 2.55 higher odds (95% CI, 1.93–3.38) of being diagnosed with Stage IV melanoma, which decreased to 2.11 odds (95% CI, 1.34–3.33) in MES. The interaction between race and MES was statistically significant (P = 0.008).

Conclusions

This study suggests that patients are less likely to be diagnosed with Stage IV melanoma in MES. This beneficial effect is more pronounced among Black minorities.

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Availability of Data and Material

2016 National Cancer Database (NCDB).

Code Availability

Stata IC/SE 16.

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Acknowledgements

The authors gratefully acknowledge Yvonne Mullowney and Billings Clinic Collaborative Science & Innovation for assistance in technical editing and proofreading the manuscript.

Funding

Dr. Lutzky reported funding from Bristol-Myers Squibb, Novartis, Iovance Biotherapeutics, Immunocore, Regeneron, Replimune, and Vyriad. Dr. Brant reported NIH funding provided through the Moonshot Initiative. No funding was received for conducting this study.

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Authors and Affiliations

  1. University of Florida Health Cancer Center, University of Florida, 1600 SW Archer Road, D2-3, Gainesville, FL, 32610, USA

    Jesus C. Fabregas

  2. Billings Clinic, 2800 Tenth Avenue North, Billings, MT, 59107, USA

    Benjamin T. Carter & Jeannine M. Brant

  3. Collaborative Science & Innovation, 2800 Tenth Avenue North, Billings, MT, 59101, USA

    Benjamin T. Carter

  4. University of Miami – Sylvester Comprehensive Cancer Center, 1475 NW Ave, Floor 2, Miami, FL, 33136, USA

    Jose Lutzky

  5. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, J2500 N State St, Jackson, MS, 39216, USA

    William Russell Robinson III

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Contributions

Jesus C. Fabregas and Jeannine M. Brant conceived and designed the study. Material preparation and data collection were performed by Jesus C. Fabregas and Jeannine M. Brant. Data analysis was conducted by Jesus C. Fabregas, Jeannine M. Brant, and Benjamin T. Carter. The first draft of the manuscript was written by Jesus C. Fabregas and Jeannine M. Brant, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jeannine M. Brant.

Ethics declarations

Ethics Approval

This data-only study was approved with waiver of consent by the Billings Clinic Institutional Review Board.

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Not applicable.

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Not applicable.

Conflict of Interest

Authors Jesus C. Fabregas, Benjamin T. Carter, and William Russell Robinson, III, have no financial interests to disclose. Jose Lutzky reported consulting or advisory roles for Castle Biosciences, Iovance Biotherapeutics, Replimune, and Regeneron. Jeannine M. Brant reported serving on the Speakers’ Bureau for Daiichi Sankyo/Astra Zeneca.

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Fabregas, J.C., Carter, B.T., Lutzky, J. et al. Impact of Medicaid Expansion Status and Race on Metastatic Disease at Diagnosis in Patients with Melanoma. J. Racial and Ethnic Health Disparities 9, 2291–2299 (2022). https://doi.org/10.1007/s40615-021-01166-6

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  • DOI: https://doi.org/10.1007/s40615-021-01166-6

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