An Analysis of Disparity in Cancer Outcomes in Medicaid and Uninsured Populations

Background:  Expanding Medicaid coverage up to 138% of the Federal Poverty Level is central to the effectiveness of the Affordable Care Act. Previous research indicates that patients with non-Medicaid insurance have better survival and a younger age at diagnosis than patients with Medicaid and uninsured patients, but the difference between Medicaid and uninsured patients has not been examined.

Objective: This study aims to compare cancer patient outcomes in those with Medicaid to the uninsured population.

Methods: The Surveillance, Epidemiology, and End Results database was utilized to examine 2010-2011 data on patients, aged 18-64 years, who were diagnosed with lung cancer (N = 32,264), colorectal cancer (N = 10,845), and breast cancer (N = 11,727). Patients were categorized based on sex, marital status, age, and insurance status. Cancer survival in months, stage at diagnosis, and the receipt of treatment were examined using a three-way ANOVA to determine if insurance status was a significant predictor.

Results: Among women with breast cancer (600 uninsured and 3189 Medicaid), Medicaid group has a longer survival of 0.849 months, p-value <0.05. Neither colorectal cancer (498 uninsured and 1,298 Medicaid) nor respiratory cancer (614 uninsured and 2,244 Medicaid) showed statistically significant differences in survival months by insurance status. Future analyses will show potential differences in stage at diagnosis and receipt of treatment between the populations, and potential confounders, such as sex.

Conclusions: Results show that Medicaid coverage improves survival outcomes for those diagnosed with breast cancer. This supports Medicaid expansion in all states.