State mandatory paid medical leave policies and cancer stage at diagnosis in US adults.

Abstract

11008 Background: Since 2012, several states implemented mandatory paid medical leave policies. Mandatory paid medical leave may alleviate time and financial burdens, enabling patients to undergo screening and/or timely diagnostic workup for new cancer-related symptoms. These policies have been associated with increased cancer screening. We investigated whether state mandatory paid medical leave policies were associated with stage at cancer diagnosis. Methods: Adults ages 18-64 years diagnosed with cancer from 2010-2019 were identified from the Surveillance, Epidemiology, and End Results program. Differences-in-differences (DID) analyses using the updated method of accounting for heterogeneity in policy enactment compared proportions of stage I and IV cancer diagnoses from pre- to post-policy implementation in states with vs. without paid medical leave policies. Analyses adjusted for age, sex, race, ethnicity, rurality, cancer site, county-level income, and time-varying state Medicaid eligibility levels. Since some cities enacted city-wide policies prior to state-wide implementation, cases from affected states between the time of city and state policy enactment were excluded. Sensitivity analyses were conducted excluding counties with cities that enacted paid leave policies. The plausibility of the parallel trends assumption was assessed by comparing stage at diagnosis between state groups in the pre-policy period and was satisfied for all reported results. Results: A total of 1,052,307 adults with cancer were identified. 39.8% and 19.7% of patients were diagnosed with stage I and IV cancers, respectively. In adjusted DID analyses, there was a 1.34 percentage point (PP) increase in stage I diagnoses and a 2.05 PP decrease in stage IV diagnoses associated with mandatory paid medical leave policy implementation (Table). Results were similar in sensitivity analyses. In subgroup analyses, policy-associated stage shifts were seen in males, Hodgkin lymphoma, and liver and lung cancers, with less clear patterns for cervix and pancreas cancers. Conclusions: State mandatory paid medical leave was associated with increased early-stage cancer diagnoses and decreased late-stage diagnoses. Paid leave policies may promote earlier detection of non-screenable cancers by enabling employees to promptly seek care for new cancer-related symptoms. Policies that improve opportunities to seek medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes. [Table: see text]