Disparities in hepatocellular carcinoma survival by Medicaid-status: A national population-based risk analysis
Section snippets
Funding
None.
Data and linkage
Cancer-related data consisted of de-identified patient information from SEER, thus IRB exemption from review was granted. The SEER program, which began collecting data in 1973, is a robust source of information regarding cancer survival and incidence in the United States and has been widely utilized. Patients' information was collected from SEER registries from 12 states for all persons diagnosed with cancer between 2006 and 2013.
Cancer data files were linked to Medicaid enrollment files from
Patient characteristics
Table 1 describes the baseline characteristics of our studied cohort. There were ultimately 17,059 patients with HCC that were analyzed (4875 enrolled in Medicaid, 12,184 not enrolled). All patients were diagnosed between 2006 and 2013. The final follow-up date was December 31st, 2018. The mean clinical follow up time among all patients was 454 days.
Unadjusted survival outcomes
The median days of survival for those not enrolled in Medicaid (456 days; 95% CI, 426–487) was significantly higher than that of those enrolled in
Medicaid as an equalizer
In our unadjusted analysis, there was an indication that those enrolled in Medicaid had worse outcomes than those not enrolled in Medicaid across all stratifications. We found in our analysis that patients were more likely to be coded as Black, live in a high poverty neighborhood, and more likely to be unmarried (p < .001). Numerous studies, for both HCC and other cancer types, have shown that living in a high-poverty neighborhood and being unmarried are significant risk factors for high rates
Conclusions
We found that Medicaid was associated with approximately equal survival of hepatocellular carcinoma when compared to non-Medicaid patients, even after controlling for factors such as stage of diagnosis and tumor-directed surgery. Our results warrant additional study into the role of Medicaid status and cancer survival as more nuanced research is needed to better understand the factors that drive cancer survival.
CRediT authorship contribution statement
Eric J. Kim: Conceptualization, Data curation, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Roles, Writing – original draft, Writing – review & editing. Arjun Ganga: Conceptualization, Data curation, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Roles, Writing – original draft, Writing – review & editing. James Y. Lee: Conceptualization, Data curation, Investigation, Methodology, Project administration,
Declaration of competing interest
The authors (EJK, AG, JYL, RSZ, WA, RW, GC, PSS) of this work report no competing interests.
Acknowledgments
This study used the linked SEER-Medicaid database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicaid database.
The collection of cancer incidence data used in this
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