Abstract
INTRODUCTION: Medicaid expansion (ME) has positively impacted colon cancer screening. ME's effect on colon cancer treatment is less clear. This study analyses the effect of ME on patterns of colon cancer treatment. METHODS: Patients with primary invasive colon cancer were identified using the Louisiana Tumor Registry. Patients diagnosed with colon cancer prior to ME (2014-2015) were compared to those diagnosed after (2017-2018). Coordinate variables were analyzed using Fisher's exact test. Treatment status was modeled with multivariable logistic regression and the results are reported as adjusted odds ratios. RESULTS: The proportion of uninsured patients decreased following ME (5.5 versus 1.9, p < 0.001), with the greatest reductions among patients between 45 and 54 years old (13.5% to 3.5%, p < 0.0001), African Americans (8.9 to 2.1%, p < 0.0001), and those in high-poverty neighborhoods (7.1 to 2.1%, p < 0.0001). Following ME, all patients with Stage I-III disease were more likely to receive surgery (OR = 1.95; 95%: CI 1.21-3.14)-especially the extremely impoverished (OR = 2.39; 95% CI 1.41-4.02). Young patients with Stage IV colon cancer were more likely to receive chemotherapy (OR-1.6; 95% CI 1.03-2.4). Patients with Stage IV colon cancer were less likely to receive treatment within 30 days of diagnosis (OR = 0.7; 95% CI 0.5-0.9), but, on subset analysis, this was only observed in non-Medicaid patients. CONCLUSION: ME is associated with increased treatment for patients with colon cancer, and it did not appear to affect time to treatment. However, it seems to affect different subsets of the population differently.