Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky

Tong Gan; Heather F. Sinner; Samuel C. Walling; Quan Chen; Bin Huang; Tom C. Tucker; Jitesh A. Patel; B. Mark Evers; Avinash S. Bhakta

doi:10.1016/j.jamcollsurg.2018.12.035

Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky

Tong Gan, Heather F. Sinner, Samuel C. Walling, Quan Chen, Bin Huang, Tom C. Tucker, Jitesh A. Patel, B. Mark Evers, Avinash S. Bhakta

Research output: Contribution to journal › Article › peer-review

68 Scopus citations

Abstract

Background: Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky. Study Design: The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation. Results: Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (−1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage. Conclusions: Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.

Original language	English
Pages (from-to)	342-353.e1
Journal	Journal of the American College of Surgeons
Volume	228
Issue number	4
DOIs	https://doi.org/10.1016/j.jamcollsurg.2018.12.035
State	Published - Apr 2019

Bibliographical note

Publisher Copyright:
© 2019

Funding

Support: Data collection activities of the Kentucky Cancer Registry are supported by the National Cancer Institute Surveillance Epidemiology and End Results Program (NCI HHSN26100001), and the Centers for Disease Control and Prevention National Program of Cancer Registries (CDC U58 DP005400). This study was also supported by the Markey Cancer Center Support Grant (NCI P30 CA177558) and T32 NIH Training Grant (T32CA160003). The Center for Clinical and Translational Sciences is funded through the NIH National Center for Advancing Translational Sciences (UL1TR001998).

Funders	Funder number
Centers for Disease Control and Prevention	U58 DP005400
National Center for Advancing Translational Sciences (NCATS)	UL1TR001998
National Computational Infrastructure	P30 CA177558, HHSN26100001
Norges Idrettshøgskole	T32CA160003

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jamcollsurg.2018.12.035

Cite this

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title = "Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky",

abstract = "Background: Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky. Study Design: The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation. Results: Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230\%, p < 0.001), with a higher increase in screening among the Appalachian (+44\%) compared with the non-Appalachian (+22\%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7\%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3\% for Appalachians (p = 0.09), while there was little change for non-Appalachians (−1.5\%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage. Conclusions: Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.",

author = "Tong Gan and Sinner, \{Heather F.\} and Walling, \{Samuel C.\} and Quan Chen and Bin Huang and Tucker, \{Tom C.\} and Patel, \{Jitesh A.\} and Evers, \{B. Mark\} and Bhakta, \{Avinash S.\}",

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doi = "10.1016/j.jamcollsurg.2018.12.035",

language = "English",

volume = "228",

pages = "342--353.e1",

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T1 - Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky

AU - Gan, Tong

AU - Sinner, Heather F.

AU - Walling, Samuel C.

AU - Chen, Quan

AU - Huang, Bin

AU - Tucker, Tom C.

AU - Patel, Jitesh A.

AU - Evers, B. Mark

AU - Bhakta, Avinash S.

PY - 2019/4

Y1 - 2019/4

N2 - Background: Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky. Study Design: The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation. Results: Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (−1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage. Conclusions: Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.

AB - Background: Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky. Study Design: The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation. Results: Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (−1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage. Conclusions: Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.

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Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

UN SDGs

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