Abstract
OBJECTIVE: The Affordable Care Act (ACA) of 2010 aimed to improve access to care in the United States by expanding the population eligible for Medicaid coverage and has been associated with decreased rates of uninsurance and increased likelihood of early head and neck cancer diagnosis. This study aims to assess the impact of the ACA and expansion of Medicaid on disease presentation and overall survival for patients with laryngeal carcinoma. STUDY DESIGN: Cross-sectional study. SETTING: Multicenter clinical database. METHODS: Overall survival was assessed with Cox proportional hazard regression analyses for patients diagnosed with laryngeal carcinoma (n = 28,843) between 2004 and 2018 in the National Cancer Database. RESULTS: The annual prevalence of laryngeal carcinoma significantly increased post-ACA (2010-2018) compared to pre-ACA (2004-2010) for both non-expansion (P < .001) and expansion states (P < .001). There was a statistically significant increase in stage IV disease post-ACA for both non-expansion states (45.1% post vs 33.1% pre, P < .001) and expansion states (41.8% post vs 32.5% pre, P < .001). There was no significant difference in survival for patients diagnosed with laryngeal cancer post-ACA (hazard ratio [HR] 0.990, 95% CI 0.933-1.052) compared to pre-ACA in non-expansion states. Expansion states had improved survival post-ACA (HR 0.904, 95% CI 0.857-0.954) compared to pre-ACA. CONCLUSION: Increased access to care with the ACA led to increased diagnosis of laryngeal carcinoma and increased diagnosis of late-stage disease. Although there were significant differences in survival between expansion and non-expansion states, significant differences in survival outcomes post-ACA were only noted in expansion states.