{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:12:48Z","timestamp":1792080768928,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T00:00:00Z","timestamp":1696204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We evaluated whether Medicaid expansion (ME) was associated with improved 2\u2010year survival and time to treatment initiation (TTI) among patients with gastrointestinal (GI) cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>GI cancer patients diagnosed 40\u201364 years were queried from the National Cancer Database. Those diagnosed from 2010 to 2012 were considered pre\u2010expansion; those diagnosed from 2014 to 2016 were considered post\u2010expansion. Cox models estimated hazard ratios and 95% confidence intervals (CIs) for 2\u2010year overall survival. Generalized estimating equations (GEE) estimated odds ratios (OR) and 95% CI of TTI within 30\u2010 and 90 days. Multivariable Difference\u2010in\u2010Difference models were used to compare expansion\/nonexpansion cohorts pre\u2010\/post\u2010expansion, adjusting for patient, clinical, and hospital factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>377,063 patients were included. No significant difference in 2\u2010year survival was demonstrated across ME and non\u2010ME states overall or in site\u2010based subgroup analysis. In stage\u2010based subgroup analysis, 2\u2010year survival significantly improved among stage II cancer, with an 8% decreased hazard of death at 2 years (0.92; 0.87\u20130.97). Those with stage IV had a 4% increased hazard of death at 2 years (1.04; 1.01\u20131.07). Multivariable GEE models showed increased TTI within 30 days (1.12; 1.09\u20131.16) and 90 days (1.22; 1.17\u20131.27). Site\u2010based subgroup analyses indicated increased likelihood of TTI within 30\u00a0and 90 days among colon, liver, pancreas, rectum, and stomach cancers, by 30 days for small intestinal cancer, and by 90 days for esophageal cancer. In subgroup analyses, all stages experienced improved odds of TTI within 30 and 90 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ME was not associated with significant improvement in 2\u2010year survival for those with GI cancer. Although TTI increased after ME for both cohorts, the 30\u2010 and 90\u2010day odds of TTI was higher for those from ME compared with non\u2010ME states. Our findings add to growing evidence of associations with ME for those diagnosed with GI cancer.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27456","type":"journal-article","created":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T10:24:53Z","timestamp":1696242293000},"page":"1285-1301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Association of Medicaid expansion with 2\u2010year survival and time to treatment initiation in gastrointestinal cancer patients: A National Cancer Database study"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-6593","authenticated-orcid":false,"given":"Erin M.","family":"Mobley","sequence":"first","affiliation":[{"name":"Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Edgar","sequence":"additional","affiliation":[{"name":"Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keouna","family":"Pather","sequence":"additional","affiliation":[{"name":"Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan C.","family":"Daly","sequence":"additional","affiliation":[{"name":"Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad T.","family":"Awad","sequence":"additional","affiliation":[{"name":"Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Parker","sequence":"additional","affiliation":[{"name":"College of Medicine University of Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigang","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Public Health University of North Florida Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Suk","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Mathews","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young\u2010Rock","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,2]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Patient Protection and Affordable Care Act of 2010. 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