Researchers Find Increased Rates of CRC Screening in Kentucky After Medicaid Expansion

Kentucky is one of the poorest states in the United States. However, the state has been one of the most effective in reducing its uninsured rate, thanks in part to the expansion of Medicaid's Affordable Affordable Care Act which came into effect on January 1, 2014. In In the past, Kentucky reported low rates of colorectal cancer screening (CRC) and was ranked among the highest states in terms of incidence and mortality for the disease. A research team badessed the impact of Medicaid's expansion on CRC screening, incidence and survival rates among the low-income population of the state. The researchers found that the number of Medicaid patients screened after expansion was more than three times the number of patients screened prior to expansion. In addition, patients with Medicaid-based CRC experienced an improvement in their survival after expansion compared to before it was implemented. The results were published as "in press" on the website of the Journal of the American College of Surgeons ahead of the print.

The Medicaid expansion, under the Affordable Care Act, provided insurance coverage for those who accounted for 138% of the federal poverty line. In Kentucky, this expansion meant that 634,807 additional low-income people had access to Medicaid.2 Many people in this population have low levels of education and do not have easy access to a physician, especially the more rural population Appalachians located to the east. Kentucky, said lead author of the study, Avinash Bhakta, MD, colorectal surgeon at the Markey Cancer Center of the University of Kentucky in Lexington. Dr. Bhakta said that he was beginning to treat more and more patients from the Appalachian Kentucky and that he wanted to further study the possible link between the Affordable Care Act and the US. increase in the number of patients that he was treating.

"For me, this has been a bit of an awakening for our society and for seeing the people I treat in Kentucky, especially in the Appalachians," said Dr. Bhakta. "Many of these patients have charted their own roads to visit me in Lexington.We have not really studied the effect of expanding the Affordable Care Act Medicaid, and our population has the highest incidence rate. and mortality from CRC in the country, we felt that it was an ideal population to study this potential impact. "

To conduct this study, researchers obtained data on the screening, incidence, and outcomes of RCCs in Kentucky from the Kentucky Hospital Discharge Abstract Database and the Kentucky Cancer Registry. The study population included 930,176 patients over the age of 20 who had been screened for colorectal cancer from January 1, 2011 to December 31, 2016. A total of 408,500 patients were screened prior to the expansion of Medicaid (from January 1, 2011 to December 31, 2013) and 521,676 patients projected after the Medicaid expansion (from January 1, 2014 to December 31, 2016). The researchers obtained measures that included demographic data, insurance coverage based on information available at the time of diagnosis, socio-economic factors (below poverty line and county-level secondary education), and information about the population. clinical (degree of tumor, stage of diagnosis and survival).

Dr. Bhakta stated that one of the most significant results of this study was that patients with Medicaid had the greatest increase in CRC screening. A total of 69,328 Medicaid patients were screened after the extension, compared to 20,980 patients screened prior to the expansion, an increase of 230%. In addition, 43.7% more Appalachian patients were screened after enlargement. The researchers wrote that, specifically for Medicaid patients, people in the 51-65 age group had the greatest improvement in screening, with an increase of 292.5%. Medicaid coverage in Appalachian patients increased by 199%.

From January 1, 2011 to December 31, 2016, 11,441 Kentucky patients were diagnosed with CRC. When they were separated by insurance, the authors wrote that the proportion of Medicaid patients diagnosed with a CRC had increased by 132.4% after the Medicaid expansion. Dr. Bhakta said the increase was "a hard number to swallow for me" because with increased screening, the incidence is expected to decrease. However, Dr. Bhakta noted that this research is still young. If researchers track the data for another five or ten years, he expects a decline in incidence.

The researchers also reported that after the expansion, Medicaid patients exhibited an improvement in their survival compared to patients before expansion. Differences in survival after expansion were evident in Medicaid patients after the first year and increased each year thereafter. Appalachian patients covered by Medicaid had significantly improved their survival after expansion compared to before expansion, the researchers wrote.

"We found that, month after month, our Medicaid population had experienced an improvement in survival since the pre-expansion era," said Dr. Bhakta. "We have been able to follow many of these patients up to eight years and we continue to follow them, as well as their recurrence and overall survival."

According to Dr. Bhakta, the most important result of this study is that as the number of people screened for CRC screening increases, their survival will be improved.

"We know that with increased screening we are able to better detect earlier polyps," he said. "The expansion of Medicaid has allowed us to access a large number of almost poor patients who would otherwise not have been examined."

Now that researchers have identified the problem, they will continue to collect data and find solutions to CRC's high mortality rate in the state. "After screening and diagnosing colorectal cancer in these people, do not we properly guide them to surgery?" After surgery, do not patients with advanced tumors receive chemotherapy on time? Dr. Bhakta asked. "Finally, is this population of patients we are treating at the Markey Cancer Center in the UK resistant to traditional chemotherapeutic agents? These issues and barriers are issues that we need to investigate in order to continue our fight against colorectal cancer", said Dr. Bhakta.