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Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States

  • Pancreatic Tumors
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Abstract

Introduction

Medicaid expansion (ME) impacted patients when assessed at a national level. However, of the 32 states in which Medicaid expansion occurred, only 3 were Southern states. Whether results apply to Southern states that share similar geopolitical perspectives remains elusive. We aimed to assess the impact of ME on pancreatic ductal adenocarcinoma (PDAC) treatment in eight Southern states in the USA.

Patients and Methods

We identified uninsured or Medicaid patients (age 40–64 years) diagnosed with PDAC between 2011 and 2018 in Southern states from the North American Association of Central Cancer Registries–Cancer in North America (NAACCR–CiNA) research dataset. Medicaid-expanded states (MES; Louisiana, Kentucky, and Arkansas) were compared with non-MES (NMES; Tennessee, Alabama, Mississippi, Texas, and Oklahoma) using multivariate logistic regression. P < 0.05 was considered statistically significant.

Results

Among 3036 patients, MES significantly increased odds of Medicaid insurance by 36%, and increased proportions of insured Black patients by 3.7%, rural patients by 3.8%, and impoverished patients by 18.4%. After adjusting for age, race, rural–urban status, poverty status, and summary stage, the odds of receiving radiation therapy decreased by 26% for each year of expansion in expanded states (P = 0.01). Last, ME did not result in a significant difference between MES and NMES in diagnosing early stage disease (P = 0.98) nor in receipt of chemotherapy or surgery (P = 0.23 and P = 0.63, respectively).

Conclusions

ME in Southern states increased insurance access to traditionally underserved groups. Interestingly, ME decreased the odds of receiving radiation therapy yearly and had no significant impact on receipt of chemotherapy or surgery.

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Authors and Affiliations

  1. Orlando Health Cancer Institute, Orlando, FL, USA

    Hemanth Venkatesh MD

  2. Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center, New Orleans, LA, USA

    Tingting Li PhD, Qingzhao Yu PhD, Xiao-Cheng Wu MD, MPH, Yong Yi PhD & Mei-Chin Hsieh PhD

  3. Division of Surgical Oncology, Howard University College of Medicine, Washington, DC, USA

    Quyen D. Chu MD, MBA, FACS

Authors
  1. Hemanth Venkatesh MD
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  2. Tingting Li PhD
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  3. Qingzhao Yu PhD
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  4. Xiao-Cheng Wu MD, MPH
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  7. Quyen D. Chu MD, MBA, FACS
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Correspondence to Quyen D. Chu MD, MBA, FACS.

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Venkatesh, H., Li, T., Yu, Q. et al. Medicaid Expansion Increases Access for Rural and Impoverished Patients with Pancreatic Ductal Adenocarcinoma in Southern States. Ann Surg Oncol 31, 2925–2931 (2024). https://doi.org/10.1245/s10434-024-15039-9

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  • DOI: https://doi.org/10.1245/s10434-024-15039-9

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