{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T13:12:03Z","timestamp":1768655523341,"version":"3.49.0"},"posted":{"date-parts":[[2025,9,2]]},"group-title":"Oncology","reference-count":39,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,9,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>The Affordable Care Act\u2019s Medicaid expansion aimed to enhance healthcare access for low-income individuals and minority groups, promoting early screening and treatment to improve health equity.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>This study examines the impact of Medicaid expansion on lung cancer-specific survival (CSM) and overall mortality (OS) by comparing outcomes in Texas (non-expansion of ACA) and California (expansion of ACA).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODOLOGY<\/jats:title>\n                  <jats:p>We conducted a retrospective study using data from SEER cancer registry (2007\u20132021) to evaluate the impact of Medicaid expansion on lung cancer survival in California (expansion) vs. Texas (non-expansion). The study included adults aged 18\u201364, with periods split into pre-ACA (2007\u20132013), one-year washout (2014), and post-ACA (2015\u20132021). We utilized a DID design and adjusted for important covariates.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 119,937 individuals with Lung cancer, 52.1% were in California (62,521), while 47.8% were in Texas (57,416). The pre-ACA period included 60,010 individuals (53.1% in California and 46.9% in Texas), and 59,927 patients were in the post-ACA period (51.2% in California and 48.8% in Texas). Overall, Medicaid expansion was associated with a 1.12-point (\u2212 1.12, 95% CI \u20131.46 to \u20130.77) reduction in the hazard of cancer-specific mortality. The policy was also associated with a 0.81point reduction in the hazard of overall mortality (\u22120.81, 95% CI \u20131.06 to \u20130.57).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSION<\/jats:title>\n                  <jats:p>Medicaid expansion was associated with a significant improvement in lung cancer outcomes among individuals with lung cancer in California, which implemented the policy in 2014, compared to Texas, which has not yet implemented the policy.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.08.31.25334804","type":"posted-content","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T01:55:16Z","timestamp":1756864516000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Medicaid Expansion on Lung Cancer Survival Outcomes: A Difference-in-Differences Analysis"],"prefix":"10.64898","author":[{"given":"Oluwasegun","family":"Akinyemi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mojisola","family":"Fasokun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7521-2224","authenticated-orcid":false,"given":"Akachukwu","family":"Eze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nkemdirim","family":"Ugochukwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumaiyya","family":"Arshad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orimisan","family":"Belie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kakra","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"III","given":"Edward","family":"Cornwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gal","family":"Levy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025090507501275000_2025.08.31.25334804v1.1","unstructured":"The American Cancer Society. Special Section: Lung Cancer, Cancer Facts & Figures, https:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/annual-cancer-facts-and-figures\/2023\/2023-cff-special-section-lung-cancer.pdf (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.2","unstructured":"American Lung Association. State of Lung Cancer 2023 Report, https:\/\/www.lung.org\/getmedia\/186786b6-18c3-46a9-a7e7-810f3ce4deda\/SOLC-2023-Print-Report.pdf (accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.3","unstructured":"The American Cancer Society. Key Statistics for Lung Cancer, Cancer Facts & Figures, https:\/\/www.cancer.org\/cancer\/types\/lung-cancer\/about\/key-statistics.html (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.4","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-0221"},{"key":"2025090507501275000_2025.08.31.25334804v1.5","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1089\/jwh.2018.7397","article-title":"Lung Cancer Among Women in the United States","volume":"27","year":"2018","journal-title":"Journal of Women\u2019s Health"},{"key":"2025090507501275000_2025.08.31.25334804v1.6","unstructured":"The American Cancer Society. 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Racial and Ethnic Disparities, State of Lung Cancer, https:\/\/www.lung.org\/research\/state-of-lung-cancer\/racial-and-ethnic-disparities (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.16","doi-asserted-by":"crossref","first-page":"e1921653","DOI":"10.1001\/jamanetworkopen.2019.21653","article-title":"Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer","volume":"3","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025090507501275000_2025.08.31.25334804v1.17","doi-asserted-by":"crossref","first-page":"e2351529","DOI":"10.1001\/jamanetworkopen.2023.51529","article-title":"Medicaid Expansion Under the Affordable Care Act and Early Mortality Following Lung Cancer Surgery","volume":"7","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2025090507501275000_2025.08.31.25334804v1.18","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa043"},{"key":"2025090507501275000_2025.08.31.25334804v1.19","unstructured":"Public Policy Institute of California. Medi-Cal Expansion Has Reduced Financial Barriers to Needed Health Care, https:\/\/www.ppic.org\/blog\/medi-cal-expansion-has-reduced-financial-barriers-to-needed-health-care\/ (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.20","doi-asserted-by":"crossref","first-page":"115609","DOI":"10.1016\/j.amjsurg.2023.12.021","article-title":"The impact of the affordable care act on access to bariatric surgery in Maryland","volume":"235","year":"2024","journal-title":"The American Journal of Surgery"},{"key":"2025090507501275000_2025.08.31.25334804v1.21","doi-asserted-by":"crossref","first-page":"e2024366","DOI":"10.1001\/jamanetworkopen.2020.24366","article-title":"Medicaid Expansion and Mortality Among Patients With Breast, Lung, and Colorectal Cancer","volume":"3","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025090507501275000_2025.08.31.25334804v1.22","unstructured":"National Cancer Institute. SEER Databases in SEERStat, https:\/\/seer.cancer.gov\/ (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.23","doi-asserted-by":"publisher","DOI":"10.1097\/pas.0000000000000749"},{"key":"2025090507501275000_2025.08.31.25334804v1.24","unstructured":"Statistical Modeling and Forecasting. Introduction To The DID Regression Model, https:\/\/timeseriesreasoning.com\/contents\/introduction-to-the-DID-regression-model\/ (2023, accessed 16 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.25","unstructured":"The American Cancer Society. 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Medicaid Expansion May Be Linked to Increase in Palliative Care for Patients With Advanced Cancers, https:\/\/ascopost.com\/news\/july-2023\/medicaid-expansion-may-be-linked-to-increase-in-palliative-care-for-patients-with-advanced-cancers\/ (2023, accessed 20 January 2025)."},{"key":"2025090507501275000_2025.08.31.25334804v1.33","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1186\/s13014-021-01949-5","article-title":"Continuity and coordination of care in highly selected chronic cancer patients treated with multiple repeat radiation therapy","volume":"16","year":"2021","journal-title":"Radiat Oncol"},{"key":"2025090507501275000_2025.08.31.25334804v1.34","first-page":"542","article-title":"Health insurance status and cancer stage at diagnosis and survival in the United States","volume":"72","year":"2022","journal-title":"CA A Cancer J Clinicians"},{"key":"2025090507501275000_2025.08.31.25334804v1.35","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.6258"},{"key":"2025090507501275000_2025.08.31.25334804v1.36","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/jamaoto.2019.4310","article-title":"Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma","volume":"146","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025090507501275000_2025.08.31.25334804v1.37","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1001\/jamaoncol.2018.3467","article-title":"Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act","volume":"4","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025090507501275000_2025.08.31.25334804v1.38","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1001\/jamaoncol.2022.0159","article-title":"Association of Medicaid Expansion With Mortality Disparity by Race and Ethnicity Among Patients With De Novo Stage IV Breast Cancer","volume":"8","year":"2022","journal-title":"JAMA Oncol"},{"key":"2025090507501275000_2025.08.31.25334804v1.39","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1177\/1077558718808709","article-title":"The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status","volume":"77","year":"2020","journal-title":"Med Care Res Rev"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.08.31.25334804","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:44:45Z","timestamp":1768509885000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.08.31.25334804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":39,"URL":"https:\/\/doi.org\/10.1101\/2025.08.31.25334804","relation":{},"subject":[],"published":{"date-parts":[[2025,9,2]]},"subtype":"preprint"}}