(UroToday.com) In a session of the Best Kidney Cancer Poster Presentations at this year's Society of Urologic Oncology (SUO) virtual annual meeting, Dr. Javier-Desloges sought to determine whether insurance expansions implemented through the Patient Protection and Affordable Care Act (ACA) were associated with changes in insurance coverage status, stage a diagnosis and overall survival in patients with renal cell carcinoma.
First, he emphasized that the poverty line in 2020 is $12,389, thus, in Medicaid expansion states, individuals would be eligible if they had an income less than $17,236 (138% of the poverty line) while this threshold was $4,996 in non-expansion states (40% of the poverty line).
The authors utilized the National Cancer Database to identify patients aged 40 to 64 years of age who were diagnosed with renal cell carcinoma between 2010 and 2016. They categorized patients on the basis of whether their patients were participating in on-time in Medicaid expansion or not.
Patients living in late and early Medicaid expansion states were excluded. The analysis was performed following stratification according to tumor stage (Stage 1/2 vs 3/4) and according to income level (low, middle, and high according to Federal Poverty Guidelines). Stage trend analysis was used to assess for stage migration and difference-in-difference modeling was used to compared reductions in being uninsured and being diagnosed with advanced disease.
The authors identified 78,099 patients in whom they performed their analysis. The authors found that the ACA implementation was associated with increases in renal cell carcinoma (RCC) patients with insurance, by an absolute percentage change of 4% in expansion states and 2.1% in non-expansion states.
In an adjusted difference-in-difference analysis, rates of uninsured status declined to a significantly greater degree in expansion states (1.14%, p<0.001). The largest increases were observed in expansion states among low-income individuals (11%), compared to the middle (4.2%) and high-income individuals (4.0%).
Among low-income (4%) and middle-income patients (1.6%), Medicaid expansion was associated with a higher proportion of patients with localized renal cell carcinoma following ACA implementation.
In a Cox model of overall survival, the ACA implementation was associated with a diminution of the increased risk of mortality observed among low-income patients.
The authors conclude that ACA implementation was associated with increased insurance of patients with RCC and a stage migration towards localized disease.
Presented by: Juan F. Javier-Desloges, MD, UCSD Urologic Oncology Fellow, Yale School of Medicine, Yale University, New Haven, Connecticut
Written by: Christopher J.D. Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC