-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

2343 Medicaid Expansion and Cancer-Specific Survival Among Individuals with Acute Lymphoblastic Leukemia

Program: Oral and Poster Abstracts
Session: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Poster I
Hematology Disease Topics & Pathways:
Research, Epidemiology, Translational Research, Clinical Research, Health outcomes research, Health disparities research, Diversity, Equity, and Inclusion (DEI)
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Oluwasegun Austine Akinyemi, MD1*, Olufunmilayo Abobarin-Aofolaju, MD2*, Tayo Adeoye, MD3*, Faith Abodunrin, MD4, Oreoluwa Adubi, MD5*, Seun Ikugbayigbe, MD MPH6*, Eunice Odusanya, BS7*, Mojisola Fasokun, MD MPH8*, Miriam Michael, MD9* and Kakra Hughes, MD, PHD7*

1The Clive O Callender Outcomes Research Center, Howard University College of Medicine, Macomb, IL
2Department of Pathology, National Children's Hospital, Columbus, OH
3Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
4Department of Hematology and Oncology, University of Chicago, Chicago, IL
5Ross University School of Medicine, Miramar, FL
6Eastern Illinois University, Charleston, IL
7Department of Surgery, Howard University College of Medicine, Washington, DC
8Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
9Department of Internal Medicine, Howard University College of Medicine, Washington DC, DC

INTRODUCTION: Medicaid expansion under the Affordable Care Act (ACA) has aimed to improve healthcare access and outcomes for low-income individuals across the United States. Acute Lymphoblastic Leukemia (ALL), a rapidly progressing hematological malignancy, demands timely and comprehensive medical intervention to optimize patient survival rates. Despite advancements in treatment, disparities in cancer-specific survival persist (CSS), particularly among socioeconomically disadvantaged populations.

OBJECTIVE: This study investigates the impact of Medicaid expansion on CSS among individuals diagnosed with ALL, aiming to explore the extent to which increased healthcare access through Medicaid expansion may influence survival outcomes in this vulnerable patient population.

METHODOLOGY: We utilized the Surveillance, Epidemiology, and End Results (SEER) cancer registry to examine the impact of Medicaid expansion on CSS among individuals diagnosed with ALL. A difference-in-difference analysis (DID) was conducted to evaluate the effect of the policy on survival outcomes. Texas, a state that has not implemented Medicaid expansion, was compared with California, which adopted the policy in 2014. The analysis adjusted for significant covariates including age, sex, race/ethnicity, socioeconomic status, and treatment modalities. By comparing pre- and post-expansion periods in these two states, we aimed to isolate the impact of Medicaid expansion on CSS in ALL patients.

RESULT: Among 22,303 patients, 60.0% were in California (13,384), while 40.0% were in Texas (8,919). The pre-ACA period included 14,129 patients (62.0% in California and 38.0% in Texas), and 8,174 patients were in the post-ACA period (56.6% in California and 43.4% in Texas). In the post-ACA implementation period, there was a 23.5% reduction in the hazard of deaths (HR=0.77, 95% CI 0.70-0.85). Medicaid expansion significantly improved cancer-specific survival among individuals with ALL across different race/ethnicity and income levels (DID=-0.69, 95% CI -1.18 to -0.19). The most significant improvements were observed among minority groups: Blacks (DID=-0.80, 95% CI -1.39 to -0.21) and Hispanics (DID=-0.72, 95% CI -1.35 to -0.22), as well as individuals with lower income levels (DID=-0.66, 95% CI -1.14 to -0.18).

CONCLUSION: The implementation of the ACA and its Medicaid expansion component led to a substantial improvement in cancer-specific survival among individuals with acute lymphoblastic leukemia in California compared to non-expansion Texas.

Disclosures: No relevant conflicts of interest to declare.

See more of: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Poster I
See more of: Oral and Poster Abstracts
<< Previous Abstract | Next Abstract >>
*signifies non-member of ASH