{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:09:39Z","timestamp":1789049379443,"version":"build-2803163510"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medicaid expansion under the Affordable Care Act broadened eligibility for government-funded health coverage. This may have improved access to early diagnosis and rapid treatment, potentially impacting survival in patients with resectable non\u2013small cell lung cancer (NSCLC), a leading cause of cancer-related death in the US.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between state-level Medicaid expansion and all-cause mortality in patients with resectable NSCLC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study of patients aged 20 to 64 years who were diagnosed with stage I to IIIA NSCLC used data from the Surveillance, Epidemiology, and End Results registry collected between January 1, 2006, to December 31, 2019, with outcomes administratively censored at 2 and 4 years. Data were analyzed between March 1 and September 10, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Medicaid expansion status of patients\u2019 state of residence at diagnosis. Patients\u2019 states of residence were categorized as nonexpansion, early expansion (2011), 2014 expansion, or late expansion (after 2014).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were 2- and 4-year all-cause mortality. Cox proportional hazards regression models within a difference-in-differences framework were used to estimate adjusted hazard ratios (HRs) for death. Secondary analyses evaluated postexpansion mortality trends and changes in early-stage (I-II) diagnoses using logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 53\u202f842 patients included in the analysis (24 849 [46.2%] 60-64 years of age; 27 027 [50.2%] male), propensity score\u2013matched analyses showed lower 2-year mortality in states with early expansion (HR, 0.95; 95% CI, 0.91-0.99;\n P<\/jats:italic>\n \u2009=\u2009.02) and 2014 expansion (HR, 0.91; 95% CI, 0.86-0.95;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) compared with nonexpansion control states, whereas no significant difference was observed in late expansion states (HR, 0.95; 95% CI, 0.89-1.02;\n P<\/jats:italic>\n \u2009=\u2009.15). All expansion groups showed decreased mortality. Mortality decreases were observed after the first 3 years and persisted throughout the study period. The proportion of early-stage diagnoses did not change post expansion, suggesting benefits may have been mediated by improved postdiagnostic care rather than earlier detection.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of patients with stage I to IIIA NSCLC, Medicaid expansion was associated with lower mortality at 2 and 4 years. These findings suggest that expanded insurance coverage may have enhanced access to effective cancer care and improved population-level outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.45996","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T16:00:29Z","timestamp":1764604829000},"page":"e2545996","source":"Crossref","is-referenced-by-count":3,"title":["Statewide Medicaid Expansion and Survival in Resectable Non\u2013Small Cell Lung Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Rohin","family":"Gawdi","sequence":"first","affiliation":[{"name":"Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Manhasset, New York"},{"name":"Division of Thoracic Surgery, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahidul","family":"Islam","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Office of Academic 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