Impact of Medicaid expansion on racial disparities among patients with gastrointestinal cancer

Background: Racial minority groups experience disparities in cancer treatment and mortality. This study aimed to investigate the effect of Medicaid expansion on the existing racial disparities in all-cause mortality among patients with gastrointestinal malignancies. Methods: A cross-sectional cohort study of patients with pancreatic ductal adenocarcinoma (PDAC), colorectal cancer (CRC), and gastric adenocarcinoma (GC) of any stage was conducted using data from the National Cancer Database (2009-2019). Using difference-in-difference (DID) analysis, the authors compared adjusted 2-year mortality rates among Black and White patients residing in states with expanded Medicaid benefits (MES) and non-MES before (2009-2013) and after (2014-2019) Medicaid expansion. Results: A total of 86,052 patients were included in this analysis, including 19,188 patients with PDAC, 60,404 with CRC, and 6460 with GC. Two-year mortality rates decreased among Black patients with PDAC residing in MES but not those residing in non-MES following Medicaid expansion (DID, -9.4%; 95% confidence interval [CI], -14.4% to -4.4%; p < .001). Mortality decreased more among Black and White patients with CRC in MES compared to those in non-MES following Medicaid expansion (DID, -2.9%; 95% CI, -5.7 to -0.04; p = .047 and DID, -4.2%; 95% CI, -5.8 to -2.5; p < .001, respectively). Black patients with GC in MES experienced a marked reduction in mortality compared to those in non-MES (DID, -7.7%, 95% CI, -16.1 to 0.56; p = .07). Conclusion: Medicaid expansion was associated with a greater reduction in 2-year mortality rates among Black patients residing in MES compared to those residing in non-MES. Existing racial disparities in mortality remained the same or worsened in non-MES but were mitigated in MES following Medicaid expansion in almost all comparisons.