ArticleThe Journal of surgical research2026
Medicaid Expansion and Overall Mortality Among Individuals With Renal Cell Carcinoma.
Article in The Journal of surgical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRenal cell carcinoma (RCC) remains a major cause of cancer-related morbidity, mortality, and economic burden in the United States. Medicaid expansion under the Affordable Care Act increased access to insurance coverage for low-income adults, yet evidence regarding its impact on RCC survival remains limited. We evaluated the association between Medicaid expansion and overall and 5-year survival among adults aged 40-64 years diagnosed with RCC.
methodsWe conducted a retrospective cohort study using National Cancer Database data (2006-2021). States were classified as Medicaid expansion or nonexpansion using National Cancer Database policy variables. The pre-expansion period was defined as 2006-2013 and the postexpansion period as 2014-2021. Difference-in-differences Cox proportional hazards models estimated the association between Medicaid expansion and mortality, adjusting for demographic, clinical, tumor, facility, and socioeconomic characteristics. Royston-Parmar flexible parametric models estimated absolute differences in 5-y survival.
resultsA total of 284,967 adults with RCC were identified. Medicaid coverage increased from 7.9% to 16.7% in expansion states and from 6.9% to 9.3% in nonexpansion states (P < 0.001). The uninsured rate declined from 7.3% to 1.9% in expansion states, versus 8.2%-4.7% in nonexpansion states (P < 0.001). Medicaid expansion was associated with a 7.5% reduction in overall mortality (hazard ratio, 0.93; 95% confidence interval [CI], 0.91-0.94; P < 0.001). Five-year mortality decreased by 1.4 percentage points overall (95% CI, -1.6 to -1.3; P < 0.001), with the largest benefit among Hispanic patients (-6.3 percentage points; 95% CI, -7.5 to -5.0; P < 0.001). No significant 5-y survival changes were observed among non-Hispanic Black patients (-0.3 percentage points; P = 0.57).
conclusionsMedicaid expansion was associated with substantial improvements in insurance coverage and clinically meaningful reductions in RCC mortality, particularly among Hispanic and non-Hispanic White patients. Persistent survival gaps among non-Hispanic Black patients highlight the need for interventions beyond insurance coverage alone to achieve equity in RCC outcomes.
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