{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T01:02:35Z","timestamp":1778893355014,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:00:00Z","timestamp":1644537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The United States Patient Protection and Affordable Care Act allocated funds for states to expand Medicaid coverage. However, several states declined expansion. We aim to determine whether Medicaid expansion is associated with healthcare coverage, cancer stage at diagnosis, treatment, and survival among patients with rhinologic cancer. Rhinologic cancer was defined to include cancer of the nasal cavity, paranasal sinus, nasopharynx, or olfactory nerve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income\/education was utilized to examine associations between Medicaid expansion\/insurance status and stage at diagnosis, treatment, and survival. Overall and disease\u2010specific survival were examined using Kaplan\u2013Meier analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (<jats:italic>N<\/jats:italic>\u00a0=\u00a02,364; OR\u00a0=\u00a01.27, 95% CI 1.01\u20131.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR\u00a0=\u00a01.75, 95% CI 1.41\u20132.22) and increased risk of disease\u2010specific death (HR\u00a0=\u00a01.54, 95% CI 1.32\u20131.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3 <jats:italic>Laryngoscope<\/jats:italic>, 133:43\u201350, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30049","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T10:09:42Z","timestamp":1644574182000},"page":"43-50","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Medicaid Expansion on Rhinologic Cancer Presentation, Treatment, and Outcomes"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4758-3146","authenticated-orcid":false,"given":"Alexandria L.","family":"Irace","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons, New York\u2014Presbyterian\/Columbia University Irving Medical Center  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3120-6194","authenticated-orcid":false,"given":"Rahul K.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons, New York\u2014Presbyterian\/Columbia University Irving Medical Center  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6424-7083","authenticated-orcid":false,"given":"Timothy L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Oregon Sinus Center Oregon Health &amp; Science University  Portland Oregon U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Weill Cornell Medicine  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-9349","authenticated-orcid":false,"given":"David A.","family":"Gudis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons, New York\u2014Presbyterian\/Columbia University Irving Medical Center  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,2,11]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"UberoiN Finegold.K&EmilyGHealth insurance coverage and the affordable care act 2010\u20132016. 2016. Department of Health and Human Services\u2014Office of the Assistant Secretary for Planning and Evaluation. Available at:https:\/\/aspe.hhs.gov\/system\/files\/pdf\/187551\/ACA2010-2016.pdf. Accessed July 1 2021."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60259-2"},{"key":"e_1_2_7_4_1","unstructured":"CohenRA&TerlizziEPHealth insurance coverage: early release of quarterly estimates from the National Health Interview Survey April 2019 to June 2020. 2021. National Center for Health Statistics. Available at:https:\/\/www.cdc.gov\/nchs\/nhis\/releases.htm. 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