EFFECT OF MEDICAID EXPANSION ON COLORECTAL CANCER MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Cintia Mayumi S. Kimura*1,2, Kandice A. Kapinos1, Ashraf Abugroun1, Eric Yen1, Evan Siau1, JOSE A. ACOSTA1
1Harvard University T H Chan School of Public Health, Boston, MA; 2Stanford Medicine, Stanford, CA
Background: The Affordable Care Act (ACA) allowed states to expand Medicaid eligibility to adults younger than 65 years old with an income below 133% of the federal poverty level. As the number of uninsured people decreases in Medicaid expansion states, health outcomes are expected to improve. Colorectal cancer is a highly preventable cancer and the third most common cause of cancer-related deaths in the United States. Therefore, we aimed to determine whether Medicaid expansion was associated with decreased colorectal cancer mortality.
Methods: A systematic search of Pubmed and Embase was performed for all studies on the Affordable Care Act Medicaid Expansion and colorectal cancer mortality. Inclusion criteria were studies published after January 2014, available in English, and that included a comparison group. Random effects meta-analysis was performed with studies that reported survival data. Two independent reviewers screened each eligible study, and differences were resolved by consensus or by a third reviewer. Risk of bias was assessed with the ROBINS-E tool.
Results: After removal of duplicates, 1094 studies were screened, and 20 studies underwent full text review. Seven eligible studies were included, of which three were retrospective, and four had a quasi-experimental design (Table 1). The studies included data from 2003 to 2018, and those reporting hazard ratios were included in the meta-analysis (n=115,860). The pooled estimate was 0.93 (95%CI 0.83; 1.04, p-value 0.196), and there was evidence of heterogeneity (Figure 1).
Conclusions: The effect of Medicaid expansion on colorectal cancer mortality is still unclear, but most studies showed an association with decreased mortality. Given that adoption of Medicaid expansion began in 2014, it is possible that the period studied was insufficient for a significant change in mortality to be noted. Moreover, insurance marketplace reforms under the ACA may have also improved outcomes in non-expansion states, decreasing the gap between expansion and non-expansion states.
Figure 1. Forest plot of random-effect meta-analysis
Table 1. Characteristics of studies
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