The Impact of the Affordable Care Act on Lung Cancer Stage at Presentation

Abstract

Introduction

This study assesses the impact of the Affordable Care Act (ACA) on lung cancer stage at diagnosis and cancer-specific survival, focusing on whether increased access to care for minorities and low-income individuals improves detection and outcomes.

Methodology

A retrospective analysis of SEER database data (2007-2020) compared lung cancer cases in pre-ACA (2007-2013) and post-ACA (2014-2020) periods. California, a Medicaid expansion state, and Texas, a non-expansion state, were analyzed. Patients aged 18-64 years were followed for up to 6 years. Difference-in-differences and multinomial logistic regression were used to evaluate the ACA Medicaid expansion impact on disease stage and cancer-specific mortality.

Results

Among 104,415 lung cancer patients, 59,825 (57.3%) were diagnosed pre-ACA, and 44,590 (42.7%) post-ACA. The cohort was predominantly White (63.7%) and male (52.9%), with an average age of 56.8 years. In California, ACA implementation led to a 1.2 percentage point increase in localized disease (95% CI: 0.2%-2.2%, P < 0.001) and a 2.8 percentage point reduction in metastatic disease (95% CI: -4.1% to -1.4%, P < 0.001) compared to Texas. Cancer-specific mortality in California decreased by 15.9% (95% CI: -23.9% to -7.8%, P < 0.001) vs Texas.

Conclusion

ACA Medicaid expansion in California resulted in earlier lung cancer detection, reduced metastatic disease, and lower cancer-specific mortality compared to Texas. These improvements spanned all racial and ethnic groups, underscoring the benefits of Medicaid expansion in improving cancer outcomes.