Association of Medicaid expansion with time to treatment of melanoma in Hispanic patients: A NCDB analysis

Summary: Abstract Body: Patients who are Hispanic are more likely to have delays in cancer treatment compared to non-Hispanic White (NHW) individuals, including melanoma. Treatment delays are likely multifactorial including poor access to care. In 2014, selected states expanded Medicaid to cover more underserved populations. However, its effects on melanoma time to treatment in patients of Hispanic origin is unclear. This hospital-based cohort study used the National Cancer Database (2008-2019) to evaluate differences in time to treatment in patients with melanoma aged 18 to 65 who resided in a state that expanded Medicaid on January 1, 2014. Those who had a time to treatment of zero or unknown were not included. A difference-in-difference (DID) analysis compared multivariate logistic regression and Cox regression models of time to treatment according to time period (pre-expansion [2008-2013] and post-expansion [2014-2019]) and ethnicity (NHW and Hispanic), stratified by insurance type (private vs. Medicaid). A total of 48,720 patients were included, 986 (2.0%) were Hispanic and 3,056 (6.3%) had Medicaid. Mean time to treatment pre-expansion was 32.3 days for NHW and 41.7 for Hispanics, post-expansion was 34.9 for NHW and 46.6 for Hispanics (p-values <0.01). In the Medicaid subgroup, patients who were Hispanic were 2.01 (pre-expansion) and 2.24 (post-expansion) times more likely to have time to treatment greater than 30 days compared to NHW, however adjusted DID analysis showed no significant effect associated with Medicaid expansion (1.06 [95%CI: 0.54-2.07]). Similar results were found for time to treatment greater than 60 and greater than 90 days. Cox regression model demonstrated similar findings (adjusted DID 1.09 [95%CI: 0.80-1.47]). This study reports that patients who are Hispanic have significantly longer time to treatment for melanoma compared to NHW. However, Medicaid expansion did not reduce this disparity. Gabriella V. Alvarez¹, Kai-Ping Liao¹, Mariana Chavez-Macgregor¹, Mackenzie Wehner¹ 1. Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Minoritized Populations and Health Disparities Research