MP45-12 THE ASSOCIATION BETWEEN THE AFFORDABLE CARE ACT ON INSURANCE STATUS, CANCER STAGE, AND OVERALL SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-12 THE ASSOCIATION BETWEEN THE AFFORDABLE CARE ACT ON INSURANCE STATUS, CANCER STAGE, AND OVERALL SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA Juan Javier-DesLoges, Kevin Hakimi, Julia Yuan, Shady Soliman, Margaret Meagher, Fady Ghali, Vinit Nawalade, Devin Patel, James Murphy, La Jolla, CA, Simon Kim, and Ithaar Derweesh Juan Javier-DesLogesJuan Javier-DesLoges More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Julia YuanJulia Yuan More articles by this author , Shady SolimanShady Soliman More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Fady GhaliFady Ghali More articles by this author , Vinit NawaladeVinit Nawalade More articles by this author , Devin PatelDevin Patel More articles by this author , James MurphyJames Murphy More articles by this author , La Jolla, CALa Jolla, CA More articles by this author , Simon KimSimon Kim More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine whether insurance expansion implemented through the Affordable Care Act (ACA) were associated with changes in insurance coverage, stage at diagnosis, and survival in Renal Cell Carcinoma (RCC). METHODS: We analyzed RCC patients 40-64 years old between 2010 and 2016 in the National Cancer Database. States were categorized as participating on-time in Medicaid expansion or not participating, excluding late and early Medicaid expansion states. Patients were stratified into localized (Stage 1/2) and advanced (Stage 3/4) RCC and low-[(≤153% Federal Poverty Guidelines (FPG)], middle-(>153% to 241% FPG) and high-income (≥241% FPG)] groups. Stage trend analysis assessed for stage migration based on income status in expansion and non-expansion states. Cox Regression was assessed predictors for all-cause mortality (ACM) pre- and post-ACA. RESULTS: We analyzed 78,099 patients. Following ACA implementation, Absolute Percentage Change (APC) of patients with insurance increased in both expansion and non-expansion states by 4.0% and 2.1%, respectively. Largest increases occurred in expansion states, with increased acquisition of Medicaid by low-income (APC +11.0% p<0.001), middle-income (APC +4.2% p<0.001), and high-income (+4.0%, p<0.001). Stage trend analysis revealed higher proportions with localized RCC after ACA implementation in low-income (APC +4.0% p<0.001) and middle-income (APC +1.6% p=0.023) groups in expansion states. Cox Regression revealed that before ACA implementation, low-income was associated with higher risk of mortality (HR 1.29, p=0.001), which was attenuated following ACA (HR 1.10, p=0.201). CONCLUSIONS: ACA implementation has been associated with downward stage migration in low-income patients and attenuation of low-income status as a risk for mortality in RCC. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e807-e808 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Javier-DesLoges More articles by this author Kevin Hakimi More articles by this author Julia Yuan More articles by this author Shady Soliman More articles by this author Margaret Meagher More articles by this author Fady Ghali More articles by this author Vinit Nawalade More articles by this author Devin Patel More articles by this author James Murphy More articles by this author La Jolla, CA More articles by this author Simon Kim More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Loading ...