Abstract A80: The Affordable Care Act dependent coverage expansion and cancer stage at diagnosis among young adults in the United States

Abstract

Abstract Objective: To examine whether the proportion of cancers diagnosed at early stage has increased after the implementation of the Affordable Care Act-Dependent Coverage Expansion provision (ACA-DCE) in 2010, which allows young adults to be covered under their parents' health insurance plan until age 26. Methods: A total of 44,669 young adults, including 12,016 aged 19-25 and 32,653 aged 26-34, newly diagnosed with cancer in 2007-2009 and 2011-2012 were identified from the 18 registries of the Surveillance, Epidemiology, and End Results Program (SEER). We conducted a difference-in-differences analysis to examine changes in the proportion of stage I disease in young cancer patients aged 19-25 from 2007-2009 (pre-ACA-DCE) to 2011-2012 (post-ACA-DCE), using the corresponding changes in patients aged 26-34 as a control group. Both unadjusted and adjusted linear probability models were fitted for total cancer cases and specific cancer sites controlling for sex, race/ethnicity, absolute age at diagnosis, urban/rural residence, marital status at diagnosis and county-level education. Results: The uninsured rate (95% confidence interval [95 CI]) in cancer patents aged 19-25 years decreased from 9.9 (8.4, 9.8) % pre-ACA-DCE to 7.7 (6.9, 8.4) % post-ACA-DCE, while it increased from 6.6 (6.2, 6.9) % to 7.2 (6.8, 7.7) % in patients aged 26-34 years. The proportion of stage I disease (95 CI) increased from 51.6 (50.4, 52.8) % to 54.0 (52.9, 55.4) % in patients aged 19-25 years, whereas it decreased from 55.1 (54.4, 55.8) % to 54.9 (54.0, 55.7) % in patients aged 26-34 years, resulting in a net change of 2.6 (0.5, 4.7) percentage-points (P = 0.0155). The net change in multivariate analysis was 2.7 (0.6, 4.8) percentage-points (P=0.0123). When analysis was stratified by specific cancer site, significant changes were confined to carcinoma of cervix and uterus and cases with Osseous & Chondromatous Neoplasms, with an adjusted net change of 11.23 (0.67, 21.79) percentage-points (P=0.0371) and 14.39 (0.3, 28.5) percentage-points (P=0.0453), respectively. Conclusions: These early observations suggest positive benefits of the ACA-DCE in cancer stage at diagnosis among young adults 19-25 years old. Monitoring cancer outcomes in populations targeted by the ACA will be important for assessing the short- and long-term effects of the policy on population health. Citation Format: Ka Zang Xiong, Ahmedin Jemal, Xuesong Han. The Affordable Care Act dependent coverage expansion and cancer stage at diagnosis among young adults in the United States. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A80.