Background: This study addresses the lack of research on Medicaid expansion’s impact on melanoma staging, treatment utilization, and outcomes by evaluating its effects under the Affordable Care Act (ACA), particularly focusing on staging at diagnosis, treatment use, and 3-year mortality outcomes. The objective is to determine whether Medicaid expansion led to earlier melanoma diagnosis and improved survival rates among non-elderly adults (ages 40–64) by analyzing data from the National Cancer Database (NCDB). Methods: A total of 12,667 patients, aged 40–64, diagnosed with melanoma from 2010 to 2020 were identified using the NCDB. Difference-in-difference (DID) analysis was performed to analyze tumor staging at presentation between Medicaid expansion states and non-Medicaid expansion states both prior to the expansion and after the expansion. Results: Of the total patients, 2307 were from the pre-expansion time period residing in Medicaid expansion states (MES) and 1804 in non-Medicaid expansion states. In the post-expansion time period there were 5571 residing in the MES and 2985 in the non-MES. DID analysis revealed a decrease in stage IV melanoma at diagnosis (DID −0.222,p< 0.001) between MES and non-MES before and after Medicaid expansion. After expansion, in stage IV, the occurrence of primary surgery was 0.42 in non-MES and 0.44 (difference 0.02); DID analysis was not statistically significant. The use of immunotherapy in MES was significantly higher than in non-MES after expansion (p< 0.001), although DID analysis did not reveal a statistically significant difference. DID analysis showed a statistically significant decrease in 3-year mortality (DID −0.05,p= 0.001) between MES and non-MES before and after Medicaid expansion. Conclusions: This study revealed the positive impact of the ACA’s Medicaid expansion on melanoma stage at presentation, highlighting the importance of public health policies in reducing disparities in mortality rates and early-stage diagnoses. Future research should explore additional barriers to care and evaluate the long-term outcomes of Medicaid expansion to optimize cancer care for vulnerable populations.
背景：本研究旨在评估《平价医疗法案》（ACA）下医疗补助计划扩展对黑色素瘤分期、治疗利用及预后的影响，以弥补现有研究空白，重点关注诊断分期、治疗应用及三年死亡率。通过分析美国国家癌症数据库（NCDB）数据，旨在探究医疗补助扩展是否促使非老年成人（40-64岁）黑色素瘤更早诊断并提高生存率。 方法：从NCDB中筛选出2010年至2020年期间确诊的12,667名40-64岁黑色素瘤患者。采用双重差分法（DID）比较医疗补助扩展州与非扩展州在政策实施前后肿瘤分期的差异。 结果：在总患者中，政策实施前医疗补助扩展州有2307例，非扩展州有1804例；政策实施后扩展州有5571例，非扩展州有2985例。DID分析显示，医疗补助扩展后，扩展州与非扩展州相比，诊断时IV期黑色素瘤比例显著下降（DID -0.222, p<0.001）。扩展后非扩展州IV期患者接受原发手术比例为0.42，扩展州为0.44（差值0.02），DID分析无统计学显著性。扩展后扩展州免疫治疗使用率显著高于非扩展州（p<0.001），但DID分析未显示统计学显著差异。DID分析表明，扩展州与非扩展州在政策实施前后的三年死亡率显著降低（DID -0.05, p=0.001）。 结论：本研究揭示了ACA医疗补助扩展对黑色素瘤诊断分期的积极影响，凸显了公共卫生政策在降低死亡率差异和促进早期诊断方面的重要性。未来研究应进一步探索医疗可及性障碍，并评估医疗补助扩展的长期效果，以优化弱势群体的癌症诊疗。
The Impact of Medicaid Expansion on Stage at Diagnosis of Melanoma Patients: A Retrospective Study
肿瘤(癌症)患者之家