Impact of Medicaid Expansion on Pancreatic Adenocarcinoma Survival in the Southern US.

Abstract

The Affordable Care Act and the Recalcitrant Cancer Research Act are health policies that can impact cancer survival. Of the 10 states that did not adopt Medicaid expansion, 7 are in the South. Here, we examine these policies' impact on pancreatic cancer treatment and survival. The National Cancer Database was used, identifying patients with pancreatic adenocarcinoma between 2008 and 2022. Trend analysis was conducted to evaluate changes in treatment over time. Survival analysis and logistic regression were used. The rate of pancreatectomy remained stable: 2008 to 2012: 19.7%; 2013 to 2017: 20.5%; 2018 to 2022: 19.8% (Cochran-Armitage Trend test: p = 0.96). Median survival for surgical patients significantly increased: 20.7 months in 2008 to 2012 vs 25.6 and 31.1 months in 2013 to 2017 and 2018 to 2021, respectively (Log-rank: p < 0.0001). Systemic therapy use significantly increased: 68.9% in 2008 to 2012 vs 76.7% in 2013 to 2017 and 83.1% in 2018 to 2022 (Cochran-Armitage: p < 0.0001). The overall survival (OS) was worse in the south, 23.7 months compared with 29.3, 26.3, and 25.3 months in the northeast, west, and midwest, respectively (Log-Rank: p < 0.0001). After adjusting for factors associated with survival, limited Medicaid expansion was associated with worse OS (hazard ratio: 1.12, 95% CI 1.07 to 1.17, p < 0.0001). Multivariable analysis showed that patients treated in the midwest (odds ratio [OR] 1.46, 95% CI 1.39 to 1.54), northeast (OR 1.27, 95% CI 1.20 to 1.34), and west (OR 1.14, 95% CI 1.08 to 1.21) had higher odds of receiving systemic therapy compared with the south. Although the rate of pancreatectomy did not change, the OS significantly improved during the study period, likely due to the increased use of systemic therapy. Patients in the south of the US had worse OS and lower odds of receiving systemic therapy, suggesting that limited Medicaid expansion police could have driven these outcomes.