A new study led by our faculty reports that living in a state with expanded Medicaid is associated with improved pancreatic cancer survival at one year; however, this benefit was not experienced uniformly across race and gender.
The study, “Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival,” leveraged data from more than 35,000 patients nationwide and was published in the Journal of the American College of Surgeons. The paper was also selected for podium presentation at the American College of Surgeons Clinical Congress in October 2021. The efforts were led by Erin M. Mobley, Ph.D., M.P.H., an assistant professor in the division of general surgery and surgical oncology in the department of surgery and affiliate member of the Center for Health Equity and Engagement Research, or CHEER.
The multidisciplinary team of authors primarily focused on the impact of Medicaid expansion on pancreatic cancer survival after accounting for other factors that could also influence patients’ survival times (e.g., race, insurance, rurality, social deprivation). The authors also explored the impact of Medicaid expansion on pancreatic cancer survival within key subgroups. The group noted that the overall beneficial effect of Medicaid expansion on pancreatic cancer survival was not apparent across all groups. Most notably, there was no beneficial effect of living in a state that expanded Medicaid for black males or black females with pancreatic cancer.
These results suggest the existence of equity issues with respect to access to Medicaid expansion and underscore the importance of the type analysis the investigators performed. According to Dr. Mobley, “If we had stopped with just the overall analysis, we would have concluded that expanding Medicaid improves pancreatic cancer survival and missed the most important part of this story. That is, while our results suggest there is a benefit, this is not equally experienced across all categories of race. These are the exact type of inequities that we can and must continue to identify and explore.”
The study also generated invited commentary from Aaron M. Delman, M.D., M.S., which was published in tandem and included this observation:
“As a community of surgeons and researchers committed to mitigating disparity in care, we must further investigate the patient experience to identify actionable policies and protocols for improvement. Prospective, qualitative and quantitative research with a focus on including diverse populations by race and ethnicity, rurality and insurance status are warranted to better understand the barriers to care beyond access that impact patient survival from pancreas cancer. This work by Mobley and colleagues may serve as a foundation for understanding the impact of Medicaid expansion in pancreatic cancer broadly, but it should also be a springboard for identifying and mitigating subsequent barriers to care experienced by minority patients.”