Impact of the affordable care act and early Medicaid expansion on head and neck cancer mortality in the United States.

Abstract

7035 Background: Medicaid expansion has been associated with increased access to care and earlier stage at diagnosis among patients with head and neck cancer (HNC). However, it is unclear whether Medicaid expansion has impacted HNC mortality rates. We examined the associations between early Medicaid expansions (2010-2011) with mortality rates for HNC in the United States. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat was utilized to obtain mortality rates for early expansion (CA, CT, DC, MN, NJ, and WA) and non-early expansion states (all others) in the year ranges as available in SEER: 2005-2007 (pre-expansion) and 2012-2016 (post-expansion). Deaths in 2008-2011 were excluded as a phase-in/washout period. Difference-in-differences analyses were utilized to compare mortality rates pre- and post-early expansion in early expansion vs. non-early expansion states. The parallel trends assumption was tested comparing changes in HNC mortality rates between early expansion and non-early expansion states from 2002-2004 to 2005-2007 and from 2005-2007 to 2008-2011. Results: There were 6882 and 35459 deaths due to HNC in early expansion and non-early expansion states, respectively. HNC mortality rates (deaths per 100,000) decreased from 2005-2007 to 2012-2016 in both early expansion (2.17 to 1.85, difference = -0.32, 95% CI = -0.42 to -0.22) and non-expansion states (2.59 to 2.43, difference = -0.16, 95% CI = -0.22 to -0.11). Relative to non-expansion states, there was a reduction of 0.16 deaths per 100,000 (95% CI = 0.05 to 0.27, p = 0.007) after early Medicaid expansion in expansion states. However, in parallel trends testing, there was no difference in the change in mortality rates between early expansion and non-expansion states from 2002-2011 (p > 0.37). Conclusions: In this quasi-experimental analysis, there was an association between early Medicaid expansion with decreased HNC mortality. Thus, Medicaid expansion might help decrease disparities associated with access to care among HNC survivors. As longer-term data emerges, additional follow-up will be necessary to understand the mechanisms that underlie the HNC mortality benefits seen in early Medicaid expansion.