The Association between the Affordable Care Act on Insurance Status, Cancer Stage, and Overall Survival in Patients with Kidney Cancer

( In a session of the best kidney cancer poster presentations at this year’s Society of Urologic Oncology (SUO) virtual annual meeting, Dr. Javier-Desloge tried to determine whether insurance extensions were being implemented through the Patient Protection and Affordable Care Act (ACA) have been associated with changes in insurance coverage status, stage diagnosis and overall survival in patients with renal cell carcinoma.

First, he stressed that the poverty line in 2020 is $ 12,389, so in Medicaid expanding states, individuals would qualify if they had an income below $ 17,236 (138% of the poverty line), while this threshold was $ 4,996 in non- expansion states. (40% of the poverty line).

The authors used the National Cancer Database to identify patients aged 40 to 64 who had been diagnosed with renal cell carcinoma between 2010 and 2016. They categorized patients based on whether their patients joined Medicaid extension on time or not. .


Patients living in the late and early Medicaid expansion states were excluded. The analysis was performed by tumor stage stratification (stage 1/2 vs 3/4) and by income level (low, medium, and high according to federal poverty guidelines). Stage trend analysis was used to assess for stage migration and difference-in-difference modeling was used to compare the reductions in being uninsured and diagnosed with advanced disease.

The authors identified 78,099 patients in whom they performed their analysis. The authors found that the ACA implementation was associated with an increase in the number of renal cell carcinoma (RCC) patients with insurance, with an absolute percent change of 4% in expansion states and 2.1% in non-expansion states.


In an adjusted difference-in-difference analysis, the percentage of uninsured status decreased significantly more in expansion states (1.14%, p <0.001). The greatest increases were seen in expansion states among low-income individuals (11%), compared to middle-income (4.2%) and high-income individuals (4.0%).


In low-income (4%) and middle-income (1.6%) patients, Medicaid expansion was associated with a higher percentage of patients with localized renal cell carcinoma after implementation of ACA.


In a Cox model of overall survival, ACA implementation was associated with a reduction in the increased mortality rate seen in low-income patients.

The authors conclude that ACA implementation was associated with increased insurance of patients with RCC and a stage migration to localized disease.

Presentation: Juan F. Javier-Desloge, MD, Urology Resident, Yale School of Medicine, Yale University, New Haven, Connecticut

Written by: Christopher JD Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC

Source link