Abstract PO-207: Impact of Medicaid expansion on stage at diagnosis for US adults with pancreatic cancer: A population-based study

Abstract

Abstract Introduction: We evaluated whether expansion of state Medicaid programs is associated with earlier-stage at diagnosis for pancreatic cancer among those under the age of 65, before and after Medicaid expansion considering key demographic, clinical, and geographic covariates. Methods: We obtained Surveillance, Epidemiology, and End-Results (SEER-18) data on individuals under 65 years of age diagnosed with pancreatic cancer from 2007-2016, including Urban Influence Code (UIC) and Social Deprivation Index (SDI) data. We defined early stage as either local or regional disease (versus advanced disease). To estimate the effect of Medicaid expansion on stage at diagnosis, we used a Difference-in-Differences (DD) model, at the individual level, comparing those from early-adopting states in 2014 to non-early-adopting states. We utilized cluster-robust standard errors and explored the role of covariates including demographic factors (race, sex, insurance coverage at diagnosis), clinical indicators (disease located in the head of the pancreas), and county characteristics (UIC and SDI). Results: The probability of early-stage disease at diagnosis increased by 3.9 percentage points (ppt) for those from Medicaid expansion states post-expansion (n=36,609). After adjustment for key covariates, the ppt was attenuated to 2.7. Of note, we observed evidence of interactions with sex and race. Indeed, the beneficial effect of living in an expansion state on stage at diagnosis was less pronounced for men (increase in the probability of early stage at diagnosis by 2.1ppt) than women (3.6ppt) and non-existent for blacks (-3.1ppt) compared to whites (4.9ppt) and other races (4.8ppt). Redefining early stage to only local stage attenuated the beneficial effect for all groups and increased the negative effect for blacks. Conclusion: Medicaid expansion is associated with earlier stage at diagnosis for pancreatic cancer; however, this beneficial effect is not uniform across sex and race. This underscores the need to investigate the impact of policy changes and implementation strategies on disparities in pancreatic cancer survival. Citation Format: Erin M. Mobley, Christina Guerrier, Ian Tfirn, Michael S. Gutter, Kimberly Vigal, Keouna Pather, Brett Baskovich, Ziad Awad, Alexander S Parker. Impact of Medicaid expansion on stage at diagnosis for US adults with pancreatic cancer: A population-based study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-207.