Ontology highlight
ABSTRACT: Importance
Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC.Objective
To determine the association of Medicaid coverage with survival compared with other insurance statuses.Design, setting, and participants
This cohort study included adult patients with limited-stage (LS) and extensive-stage (ES) SCLC in the US National Cancer Database from 2004 to 2013. Data were analyzed in January 2019.Main outcomes and measures
Patients were analyzed with respect to insurance status. Associations of insurance status with survival were interrogated with univariate analyses, multivariable analyses, and propensity score matching.Results
A total of 181?784 patients with SCLC (93?131 [51.2%] female; median [interquartile range] age; 67 [60-75] years for patients with LS-SCLC and 68 [60-75] years for patients with ES-SCLC) were identified, of whom 70?247 (38.6%) had LS-SCLC and 109?479 (60.2%) had ES-SCLC. On univariate analyses of patients with LS-SCLC, Medicaid coverage was not associated with a survival advantage compared with being uninsured (hazard ratio, 1.02; 95% CI, 0.96-1.08; P?=?.49). Likewise, on multivariable analyses of patients with ES-SCLC, compared with being uninsured, Medicaid coverage was not associated with a survival advantage (hazard ratio, 1.00; 95% CI, 0.96-1.03; P?=?.78). After propensity score matching, median survival was similar between the uninsured and Medicaid groups both among patients with LS-SCLC (14.4 vs 14.1 months; hazard ratio, 1.05; 95% CI, 0.98-1.12; P?=?.17) and those with ES-SCLC (6.3 vs 6.4 months; hazard ratio, 1.00; 95% CI, 0.96-1.04; P?=?.92).Conclusions and relevance
Despite of billions of dollars in annual federal and state spending, Medicaid was not associated with improved survival in patients with SCLC compared with being uninsured in the US National Cancer Database. These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act.
SUBMITTER: Pezzi TA
PROVIDER: S-EPMC7177199 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Pezzi Todd A TA Schwartz David L DL Pisters Katherine M W KMW Mohamed Abdallah S R ASR Welsh James W JW Chang Joe Y JY Liao Zhongxing Z Gandhi Saumil J SJ Byers Lauren A LA Minsky Bruce D BD Fuller Clifton D CD Chun Stephen G SG
JAMA network open 20200401 4
<h4>Importance</h4>Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC.<h4>Objective</h4>To determine the association of ...[more]