ArticleJournal of the National Cancer Institute2023
Medicaid expansion, chemotherapy delays, and racial disparities among women with early-stage breast cancer.
Article in Journal of the National Cancer Institute, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ethnoracial disparities in breast cancer treatment time and survival: a systematic review with a DAG-based causal model.Epidemiologic reviews · 2025Pooled it
- ASO Author Reflections: Medicaid's Impact on Breast Cancer.Annals of surgical oncology · 2025Article
- Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer.Annals of surgical oncology · 2025Article
- Impact of Medicaid Expansion on Lung Cancer Survival Outcomes: A Difference-in-Differences Analysis.medRxiv : the preprint server for health sciences · 2025Article
- Geographic Access to Cancer Care and Breast Cancer Treatment in Low-Income Women.Medical care · 2025Article
- Route and efficiency analysis of cancer health care (REACH): Investigating sociodemographic and rurality of metastatic breast cancer patients at an NCI-designated facility.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer.Journal of the National Comprehensive Cancer Network : JNCCN · 2024Article
- Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women.JAMA network open · 2024Article
- Influence of Health Insurance Types on Clinical Cancer Care Accessibility and Quality UsingMedicina (Kaunas, Lithuania) · 2024Article
- The Impact of Medicaid Expansion Under the Affordable Care Act on the Gap Between American Indians and Whites in Breast Cancer Management and Prognosis.Clinical breast cancer · 2024Article
- An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals.JNCI cancer spectrum · 2023Article
- The Impact of Medicaid Expansion on Patients with Cancer in the United States: A Review.Current oncology (Toronto, Ont.) · 2023Review
- The effect of Medicaid expansion on female gynecologic cancer-related inpatient admissions.Women's health (London, England)Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundMedicaid expansion under the Affordable Care Act extends eligibility for participating states and has been associated with improved outcomes by facilitating access to care. Delayed initiation of adjuvant chemotherapy is associated with worse outcomes among patients with early-stage breast cancer (BC). The impact of Medicaid expansion in narrowing delays by race and ethnicity has not been studied, to our knowledge.
methodsThis was a population-based study using the National Cancer Database. Patients diagnosed with primary early-stage BC between 2007 and 2017 residing in states that underwent Medicaid expansion in January 2014 were included. Time to chemotherapy initiation and proportion of patients experiencing chemotherapy delays (>60 days) were evaluated using difference-in-difference and Cox proportional hazards models in preexpansion and postexpansion periods according to race and ethnicity.
resultsA total 100 643 patients were included (63 313 preexpansion and 37 330 postexpansion). After Medicaid expansion, the proportion of patients experiencing chemotherapy initiation delay decreased from 23.4% to 19.4%. The absolute decrease was 3.2, 5.3, 6.4, and 4.8 percentage points (ppt) for Black, Hispanic, White, and Other patients. Compared with White patients, statistically significant adjusted difference-in-differences were observed for Black (-2.1 ppt, 95% confidence interval [CI] = -3.7% to -0.5%) and Hispanic patients (-3.2 ppt, 95% CI = -5.6% to -0.9%). Statistically significant reductions in time to chemotherapy between expansion periods were observed among White patients (adjusted hazard ratio = .11, 95% CI = 1.09 to 1.12) and those belonging to racialized groups (adjusted hazard ratio = 1.14, 95% CI = 1.11 to 1.17).
conclusionsAmong patients with early-stage BC, Medicaid expansion was associated with a reduction in racial disparities by decreasing the gap in the proportion of Black and Hispanic patients experiencing delays in adjuvant chemotherapy initiation.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.