Table 3.
Changes in the percentage of stage I disease at diagnosis associated with Medicaid expansion among newly diagnosed young adult cancer patients aged 18-39 years, 2011-2016a,b
| Cancer site | Expansion states |
Nonexpansion states |
Crude model |
Adjusted modelc |
||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Pre-ME, % | Post-ME, % | Absolute difference (95% CI), ppt | Pre-ME, % | Post-ME, % | Absolute difference (95% CI), ppt | DD (95% CI), ppt | P d | DD (95% CI), ppt | P d | |
| All cancer types combined | 51.6 | 53.5 | 1.9 (1.4 to 2.4) | 49.1 | 49.6 | 0.4 (−0.2 to 1.1) | 1.4 (0.6 to 2.2) | <.001 | 1.4 (0.6 to 2.2) | <.001 |
| Thyroid | 91.3 | 94.3 | 3.0 (2.5 to 3.6) | 88.6 | 92.0 | 3.4 (2.6 to 4.3) | −0.4 (−1.4 to 0.6) | .43 | −0.7 (−1.6 to 0.3) | .18 |
| Female breast | 32.2 | 34.9 | 2.7 (1.6 to 3.8) | 32.4 | 33.2 | 0.8 (−0.5 to 2.2) | 1.9 (0.1 to 3.6) | .04 | 1.8 (0.03 to 3.5) | .046 |
| Melanoma | 67.8 | 69.5 | 1.7 (0.1 to 3.2) | 64.8 | 64.7 | −0.2 (−2.4 to 2.0) | 1.8 (−0.9 to 4.5) | .18 | 2.0 (−0.6 to 4.7) | .13 |
| Colon and rectum | 17.0 | 17.4 | 0.4 (−1.1 to 2.0) | 15.9 | 15.4 | −0.5 (−2.4 to 1.3) | 0.9 (−1.5 to 3.3) | .45 | 0.9 (−1.6 to 3.3) | .49 |
| Non-Hodgkin lymphoma | 31.0 | 30.7 | −0.3 (−2.2 to 1.6) | 28.9 | 28.4 | −0.5 (−2.9 to 1.9) | 0.2 (−2.8 to 3.2) | .90 | 0.2 (−2.8 to 3.2) | .89 |
| Cervix | 62.1 | 61.4 | −0.7 (−2.8 to 1.4) | 58.5 | 57.3 | −1.2 (−3.7 to 1.2) | 0.5 (−2.7 to 3.8) | .74 | 0.3 (−3.0 to 3.5) | .87 |
| Hodgkin lymphoma | 10.1 | 9.8 | −0.3 (−1.5 to 0.9) | 11.7 | 10.1 | −1.6 (−3.3 to 0.05) | 1.3 (−0.8 to 3.4) | .21 | 1.3 (−0.8 to 3.3) | .23 |
| Other | 44.4 | 45.5 | 1.0 (0.02 to 2.0) | 45.2 | 45.3 | 0.2 (−1.1 to 1.4) | 0.8 (−0.7 to 2.4) | .30 | 1.1 (−0.5 to 2.7) | .16 |
Authors’ analysis of the 2011-2016 National Cancer Database. CI = confidence interval; DD = difference in difference; ME = Medicaid expansion; ppt = percentage points.
Cases without applicable stages (eg, leukemia, brain tumor) were excluded. Testicular cancer cases were excluded due to high percentage of unknown stage observed exclusively among patients with testicular cancer.
Adjusted model: regression models also adjusted for age, sex, race or ethnicity, zip code–level income, residence metropolitan statistical area status, and linear time trends as well as state adjusted as a random effect.
P values were calculated from linear probability regression models and reflect 2-sided test of statistical significance.