• Yasmin A Zerhouni, Quoc-Dien Trinh, Stuart Lipsitz, Joel Goldberg, Jennifer Irani, Ronald Bleday, Adil H Haider, and Nelya Melnitchouk.
• Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
• Dis. Colon Rectum. 2019 Jan 1; 62 (1): 97-103.

BackgroundColorectal cancer screening decreases incidence and improves survival. Minorities and low-income patients have lower screening rates. The Affordable Care Act increased insurance coverage for low-income Americans by funding Medicaid expansion. Not all states expanded Medicaid. The effect of Medicaid expansion on colorectal cancer screening is unknown.ObjectiveThis study aimed to evaluate if Medicaid expansion improved colorectal cancer screening for minorities and low-income patients.DesignWe used the Behavior Risk Factor Surveillance System, a nationally representative health-related telephone survey, to compare colorectal cancer screening rates from 2012 to 2016 based on Medicaid expansion status. A difference-in-difference analysis was used to compare the trends.SettingsAll states were included in this survey.PatientsRespondents aged 50 to 64 from the early expansion, 2014 expansion, and nonexpansion states were selected.InterventionsMedicaid expansion was funded by the Affordable Care Act.Main Outcome MeasuresThe primary outcome measured was the screening rate based on US Preventive Services Task Force guidelines.ResultsOverall screening in expansion states increased (early, +4.5%, p < 0.001; 2014, +1.3%, p = 0.17) compared with nonexpansion states. Screening among low-income respondents increased in early expansion states (+5.7%; p = 0.003), whereas there was no change in 2014 expansion states compared with nonexpansion states (2014, -0.3%, p = 0.89). For blacks, there was a significant increase in early expansion states, but no change in 2014 expansion states (early, +8.1%, p = 0.045; 2014, -1.5%, p = 0.64). There was no significant change for Hispanic respondents in early or 2014 expansion states compared with nonexpansion states (early, +6.5%, p = 0.11; 2014, +1.2%, p = 0.77).LimitationsSurvey data are subject to response and recall bias. Factors other than Medicaid expansion may have influenced the screening rate.ConclusionsThe colorectal cancer screening rate has increased in all settings, but expansion accelerated the increases in early expansion states and among low-income and black respondents; however, there was no similar increase for Hispanic respondents. It will be important to continue to monitor the effects of Medicaid expansion on colorectal cancer care, especially the incidence by stage and mortality. See Video Abstract at http://links.lww.com/DCR/A792.

26 keywords...

hide…