Evidence map›Paper›PMID 36596980›Full record

ArticleJournal of racial and ethnic health disparities2023

Impact of Medicaid Expansion on Stage at Diagnosis for US Adults with Pancreatic Cancer: a Population-Based Study.

Erin M Mobley, Christina Guerrier, Ian Tfirn, Michael S Gutter, Kim Vigal, Keouna Pather, Dejana Braithwaite, Mochamad M Nataliansyah, Susan Tsai, Brett Baskovich and 2 more

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Article in Journal of racial and ethnic health disparities, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Erin M MobleyDepartment of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA. Erin.Mobley@jax.ufl.edu.ORCID 0000-0002-6278-6593
Christina GuerrierCenter for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA.
Ian TfirnCenter for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA.
Michael S GutterUniversity of Florida Health Cancer Center, Gainesville, FL, USA.
Kim VigalCenter for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA.
Keouna PatherDepartment of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA.
Dejana BraithwaiteUniversity of Florida Health Cancer Center, Gainesville, FL, USA.
Mochamad M NataliansyahDepartment of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Susan TsaiDepartment of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Brett BaskovichDepartment of Pathology, College of Medicine, University of Florida, Jacksonville, FL, USA.
Ziad T AwadDepartment of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA.
Alexander S ParkerUniversity of Florida Health Cancer Center, Gainesville, FL, USA.

Funding

The University of Florida Jacksonville Aging Studies Center (JAX-ASCENT)R33AG056540 · NIA · UNIVERSITY OF FLORIDA · PI ANTON, STEPHEN D · 2017 to 2021
$3.8M
NIA NIH HHS 5R33AG056540
6 · The paper itself

Abstract

introductionWe evaluated whether Medicaid expansion is associated with earlier stage at diagnosis for pancreatic cancer taking into account key demographic, clinical, and geographic factors.

methodsWe obtained Surveillance, Epidemiology, and End-Results (SEER-18) data on individuals diagnosed with pancreatic cancer from 2007 to 2016 (< 65 years of age). We defined non-metastatic as either local or regional disease (vs. metastatic disease). To estimate the association of Medicaid expansion with pancreatic cancer stage at diagnosis, we used a difference-in-differences 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 demographic factors (race, sex, insurance at diagnosis), clinical indicator (disease in the head of the pancreas), and county characteristics (Urban Influence Code, Social Deprivation Index).

resultsIn the univariable setting, the probability of non-metastatic disease at diagnosis increased by 3.9 percentage points (ppt) for those from Medicaid expansion states post-expansion (n = 36,609). After adjustment for covariates, the ppt was attenuated to 2.7. Of particular note, we observed evidence of interactions with sex and race. The beneficial effect was less pronounced for men (increase in the probability of non-metastatic 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).

conclusionMedicaid expansion is associated with increased probability of non-metastatic 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 and implementation strategies on pancreatic cancer survival disparities.

Indexed as

MedicaidPancreatic NeoplasmsAdultFemaleHumansInsurance CoverageInsurance, HealthMalePatient Protection and Affordable Care ActUnited StatesEarly detection of cancerHealth equityMedicaidPancreatic neoplasms

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.