Introduction:
We hypothesized Medicaid expansion under the Affordable Care Act resulted in improved access to prostate cancer screening. We assessed this by measuring the percentage of men presenting with high-risk PSA (≥20 ng/ml) at the time of prostate cancer diagnosis in a national cohort.
Methods:
From the National Cancer Database, we assessed 122,324 aged <65 years who were diagnosed with prostate cancer pre- (2012-2013) or post-expansion (2015-2016). Difference-in-difference (DID) analyses adjusting for sociodemographics using linear regression were used to compare PSA at diagnosis between patients living in states that did and did not expand Medicaid on January 1, 2014.
Results:
The percentage of men presenting with PSA ≥20ng/mL at diagnosis was 19% in both expansion and non-expansion states (p=0.4). The percentage of men in expansion states presenting with PSA ≥20 ng/mL declined 2.33% (95% CI -3.21% to -1.44%, p<0.001) relative to that of men in non-expansion states. Medicaid expansion was not associated with significant changes in metastatic disease at diagnosis (p=0.3) or rates of no insurance (p=0.061). In subset analyses, men living in regions of low annual household income did not experience a change in PSA≥20 ng/mL (-1.07%, 95% CI -3.29% to 1.14%, p=0.3) while there was a significant decline among Black men (-3.11%, 95% CI -5.25% to 0.96%, p=0.005).
Conclusion:
Medicaid expansion was associated with a decrease in the percentage of young men presenting with PSA≥20 ng/ml at the time of diagnosis of PCa. These results may be related to improvement in access to PCa screening.
Funding: 2019 Urology Care Foundation Residency Research Award Program and the Russell Scott, Jr., MD Urology Research Fund (ABW).
CHANGES IN PROSTATE-SPECIFIC ANTIGEN AT TIME OF PROSTATE CANCER DIAGNOSIS FOLLOWING MEDICAID EXPANSION IN YOUNG MEN
Category
Health Services
Description
Poster #38 / Podium #
Poster Session I
12/4/2019
2:00 PM - 5:30 PM
Presented By: Adam Weiner
Authors:
Adam Weiner
Amanda Vo
Anuj Desai
Edward Schaeffer