{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:19:08Z","timestamp":1787653148471,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01MD015720"],"award-info":[{"award-number":["R01MD015720"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["1NU58DP007156"],"award-info":[{"award-number":["1NU58DP007156"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the role of insurance coverage of lung cancer screening in driving shifts in lung cancer stage at diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We performed difference\u2010in\u2010differences (DID) analyses to compare changes in the proportion of early\u2010stage lung cancer diagnosis between pre\u2010coverage (2007\u20132014) and post\u2010coverage (2015\u20132019) periods across insurance groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, we identified patients with non\u2010small cell lung cancer aged 55\u201377\u2009years and diagnosed between 2007 and 2019. Health insurance at diagnosis was categorized as private, Medicare (fee\u2010for\u2010service [FFS], FFS with supplemental private coverage, FFS with Medicaid, and Medicare Advantage with and without Medicaid), Medicaid (FFS and managed care), military health plans, and uninsured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Among 227,112 patients, 63,676 (28.04%) had private insurance, 130,770 (57.58%) Medicare, 14,982 (6.60%) Medicaid, 5941 (2.62%) military health insurance, and 11,743 (5.17%) were uninsured. Compared with uninsured patients, a significantly greater increase in the proportion of early\u2010stage lung cancer diagnosis between pre\u2010coverage and post\u2010coverage periods was observed among Medicaid patients (DID\u2009=\u20092.88 percentage points [ppt], 95% CI 0.73\u20135.02\u2009ppt), but not patients with private insurance, Medicare, or military health insurance. Among Medicaid beneficiaries, those in managed care showed a significantly greater shift compared with those in FFS during 4\u20135\u2009years post\u2010coverage (DID\u2009=\u20098.22\u2009ppt, 95% CI 4.51\u201311.93\u2009ppt). Among Medicare FFS beneficiaries, dual enrollment in Medicaid was associated with a significantly smaller increase in the proportion of early\u2010stage diagnosis compared with FFS\u2010only enrollment during 4\u20135\u2009years post\u2010coverage (DID\u2009=\u2009\u22124.40\u2009ppt, 95% CI [\u22126.40]\u2013[\u22122.40] ppt).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results suggest that beneficial stage shifts following the recommendation for lung cancer screening varied by health insurance status and type. Addressing patient, provider, and system\u2010level barriers to lung cancer screening and downstream care is essential to translate lung cancer screening coverage into earlier\u2010stage diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70154","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:38:47Z","timestamp":1785883127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Insurance Type and Lung Cancer Stage Shift Following Coverage of Screening"],"prefix":"10.1111","volume":"61","author":[{"given":"Min","family":"Lian","sequence":"first","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics, Department of Medicine Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Alvin J. Siteman Cancer Center Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5678-2644","authenticated-orcid":false,"given":"Timothy","family":"McBride","sequence":"additional","affiliation":[{"name":"School of Public Health, Washington University  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Kozower","sequence":"additional","affiliation":[{"name":"Alvin J. Siteman Cancer Center Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Division of Cardiothoracic Surgery, Department of Surgery Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8918-3565","authenticated-orcid":false,"given":"Maria","family":"Baggstrom","sequence":"additional","affiliation":[{"name":"Alvin J. Siteman Cancer Center Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Division of Medical Oncology, Department of Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-990X","authenticated-orcid":false,"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Alvin J. Siteman Cancer Center Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Division of Public Health Sciences, Department of Surgery Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.70043"},{"key":"e_1_2_11_3_1","volume-title":"Cancer Facts & Figures\u00a02023","author":"American Cancer Society","year":"2023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/m13\u20102771"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1117"},{"key":"e_1_2_11_7_1","unstructured":"K.Garfield C.Gallenstein C.Worth andS.Sthapit\u2010Gaines \u201cLung Cancer Screening: Understanding Medicaid Medicare and Private Insurance Coverage \u201daccessed July 26 2025 https:\/\/chlpi.org\/wp\u2010content\/uploads\/2013\/12\/LuCa_insurance\u2010report\u20102019_web.pdf."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1008560"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.01.070"},{"key":"e_1_2_11_10_1","unstructured":"The American Lung Association \u201cLung Cancer Screening Coverage in State Medicaid Programs \u201d(2019) accessed July 26 2025 https:\/\/www.lung.org\/assets\/documents\/lung\u2010cancer\/lung\u2010cancer\u2010screening\u20101.pdf."},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911793"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa170"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3190"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac154"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102021\u2010069008"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/edbk_279951"},{"key":"e_1_2_11_17_1","unstructured":"P.Vankar \u201cPenetration of Medicare Advantage Into Medicare 2000\u20102022 \u201daccessed July 26 2026 https:\/\/www.statista.com\/statistics\/320663\/medicare\u2010advantage\u2010penetration\u2010into\u2010medicare\u2010in\u2010the\u2010us\/."},{"key":"e_1_2_11_18_1","unstructured":"KFF \u201cTotal Medicaid MCO Enrollment \u201daccessed July 26 2026 https:\/\/www.kff.org\/other\/state\u2010indicator\/total\u2010medicaid\u2010mco\u2010enrollment\/?activeTab=graph&currentTimeframe=0&startTimeframe=18&selectedRows=%7B%22wrapups%22:%7B%22united\u2010states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgz035"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201901\u2010094OC"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916623"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojs.2016.63039"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0b013e3181ff2aec"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16153"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010publhealth\u2010040617\u2010013507"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq439"},{"key":"e_1_2_11_27_1","first-page":"65","article-title":"A Simple Sequentially Rejective Multiple Test Procedure","volume":"6","author":"Holm S.","year":"1979","journal-title":"Scandinavian Journal of Statistics"},{"issue":"5","key":"e_1_2_11_28_1","first-page":"272","article-title":"Offering Lung Cancer Screening to High\u2010Risk Medicare Beneficiaries Saves Lives and Is Cost\u2010Effective: An Actuarial Analysis","volume":"7","author":"Pyenson B. 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