{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:32:46Z","timestamp":1789788766463,"version":"4.0.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Affordable Care Act expanded Medicaid eligibility to states on staggered timelines, creating a natural experiment to assess health policy effects on colorectal cancer (CRC) outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective quasi-experimental cohort study using the Surveillance, Epidemiology, and End Results database (2006-2019). Patients with CRC &amp;lt;65\u2009years were included in primary analyses; an early-onset colorectal cancer (EOCRC) cohort aged &amp;lt;50\u2009years was examined. States were classified by Medicaid expansion timing, and each expansion group was propensity score-matched against non-expansion controls. The primary analysis used pooled Bayesian difference-in-differences survival models with censoring at 36\u2009months, with sensitivity analyses at 60\u2009months and uncapped follow-up. Secondary Bayesian logistic models evaluated stage at diagnosis and receipt of surgical resection. Results are reported as hazard ratios (HR) or odds ratios (OR) with 95% credible intervals (CrI) and posterior probabilities of benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In pooled analyses among patients younger than 65\u2009years, Medicaid expansion was associated with reduced mortality (36-month HR\u2009=\u20090.86; 95% CrI = 0.81-0.92; P[HR\u2009&amp;lt;\u20091]&amp;gt;.999), with consistent findings across follow-up endpoints. Survival benefit was larger among patients with early-onset CRC (age &amp;lt;50\u2009years). No consistent association was observed among Medicare-eligible patients aged \u226565. Medicaid expansion was not associated with population-level shifts in stage at diagnosis or increased surgical resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medicaid expansion under the Affordable Care Act was associated with a high probability of improved CRC survival among non\u2013Medicare-eligible adults, including patients with early-onset disease. Survival gains occurred without corresponding changes in stage or surgical treatment, suggesting benefits mediated through improved access, continuity, and delivery of cancer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag109","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T11:50:25Z","timestamp":1775217025000},"page":"1724-1730","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating the role of Medicaid expansion on survival in early-onset colorectal cancer"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2088-2253","authenticated-orcid":false,"given":"Rohin","family":"Gawdi","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Northwell Health , New Hyde Park, NY,","place":["United States"]},{"name":"Department of Surgery, Northwell Health , Manhasset, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6482-1022","authenticated-orcid":false,"given":"Elizabeth Nilsson","family":"Sjolander","sequence":"additional","affiliation":[{"name":"Northwell Health , New Hyde Park, NY,","place":["United States"]},{"name":"Department of Surgery, Northwell Health , Manhasset, NY,","place":["United States"]},{"name":"Department of Colorectal Surgery, Lenox Hill Hospital , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1151-1343","authenticated-orcid":false,"given":"Joon Sub","family":"Lee","sequence":"additional","affiliation":[{"name":"Northwell Health , New Hyde Park, NY,","place":["United States"]},{"name":"Department of Surgery, Northwell Health , Manhasset, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L","family":"Whelan","sequence":"additional","affiliation":[{"name":"Northwell Health , New Hyde Park, NY,","place":["United States"]},{"name":"Department of Surgery, Northwell Health , Manhasset, NY,","place":["United States"]},{"name":"Department of Colorectal Surgery, Lenox Hill Hospital , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"2026090719570303000_djag109-B1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3322\/CA.2007.0011","article-title":"Association of insurance with cancer care utilization and outcomes","volume":"58","author":"Ward","year":"2008","journal-title":"CA Cancer J Clin"},{"key":"2026090719570303000_djag109-B2","doi-asserted-by":"publisher","first-page":"qxad083","DOI":"10.1093\/haschl\/qxad083","article-title":"Health insurance coverage among incident cancer cases from population-based cancer registries in 49 US states, 2010\u20132019","volume":"2","author":"Hu","year":"2024","journal-title":"Health Aff Sch"},{"key":"2026090719570303000_djag109-B3","year":"2025"},{"key":"2026090719570303000_djag109-B4","author":"Filtered Medicaid enrollment \u2013 new adult group","year":"2025"},{"key":"2026090719570303000_djag109-B5","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.3748\/wjg.v29.i8.1289","article-title":"Early-onset colorectal cancer: a review of current knowledge","volume":"29","author":"Saraiva","year":"2023","journal-title":"World J Gastroenterol"},{"key":"2026090719570303000_djag109-B6","author":"Colorectal cancer statistics. 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