ArticleJournal of the National Cancer Institute2023
Changes in cancer mortality after Medicaid expansion and the role of stage at diagnosis.
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 18 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- The Affordable Care Act Improves Access, Survival, and Racial Disparities of Patients With Liver Disease: A Systematic Review.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Pooled it
- Medicaid Expansion and Overall Mortality Among Individuals With Renal Cell Carcinoma.The Journal of surgical research · 2026Article
- Low muscle mass, obesity, and cause-specific mortality in cancer patients: a nationwide cohort study.Cancer causes & control : CCC · 2026Article
- High-Deductible Health Plans and Mortality Among Cancer Survivors.JAMA network open · 2026Article
- Medicaid Expansion and Overall Mortality Among Women With Breast Cancer.JAMA network open · 2026Article
- Association of medicaid expansion with lung cancer-specific and overall mortality: A difference-in-differences analysis.PloS one · 2026Article
- Affordable care act and 4-year all-cause mortality among U.S. working-age adults with or without cancer: 2000-2015.American journal of translational research · 2026Article
- 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
- Political determinants of US states' screening-amenable cancer stage at diagnosis and premature cancer mortality.JNCI cancer spectrum · 2025Observational
- Social vulnerability is associated with advanced breast cancer presentation and all-cause mortality: a retrospective cohort study.Breast cancer research : BCR · 2024Article
- Association Between State Medicaid Policies and Accrual of Black or Hispanic Patients to Cancer Clinical Trials.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Article
- Medicaid Expansion Under the Affordable Care Act and Early Mortality Following Lung Cancer Surgery.JAMA network open · 2024Article
- State Public Assistance Spending and Survival Among Adults With Cancer.JAMA network open · 2023Article
- 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
- Bridging the cancer divide: Policy and structural solutions for equity in the United States.CA: a cancer journal for cliniciansArticle
- Late-Stage Oral Cancer Detection After California and Illinois Restored Medicaid Dental Benefits.OTO openArticle
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundMedicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates.
methodsNationwide state-level cancer data from 2001 to 2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs nonexpansion states using generalized estimating equations with robust standard errors. Mediation analyses were used to assess whether distant stage cancer incidence mediated changes in cancer mortality.
resultsThere were 17 370 state-level observations. For all cancers combined, there were Medicaid expansion-associated decreases in distant stage cancer incidence (adjusted odds ratio = 0.967, 95% confidence interval = 0.943 to 0.992; P = .01) and cancer mortality (adjusted odds ratio = 0.965, 95% confidence interval = 0.936 to 0.995; P = .022). This translates to 2591 averted distant stage cancer diagnoses and 1616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P = .008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality.
conclusionsMedicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses.
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