{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:01:23Z","timestamp":1783605683224,"version":"3.55.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study assesses the impact of the Affordable Care Act (ACA) on lung cancer stage at diagnosis and cancer-specific survival, focusing on whether increased access to care for minorities and low-income individuals improves detection and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>A retrospective analysis of SEER database data (2007-2020) compared lung cancer cases in pre-ACA (2007-2013) and post-ACA (2014-2020) periods. California, a Medicaid expansion state, and Texas, a non-expansion state, were analyzed. Patients aged 18-64 years were followed for up to 6 years. Difference-in-differences and multinomial logistic regression were used to evaluate the ACA Medicaid expansion impact on disease stage and cancer-specific mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 104,415 lung cancer patients, 59,825 (57.3%) were diagnosed pre-ACA, and 44,590 (42.7%) post-ACA. The cohort was predominantly White (63.7%) and male (52.9%), with an average age of 56.8 years. In California, ACA implementation led to a 1.2 percentage point increase in localized disease (95% CI: 0.2%-2.2%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) and a 2.8 percentage point reduction in metastatic disease (95% CI: -4.1% to -1.4%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) compared to Texas. Cancer-specific mortality in California decreased by 15.9% (95% CI: -23.9% to -7.8%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) vs Texas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACA Medicaid expansion in California resulted in earlier lung cancer detection, reduced metastatic disease, and lower cancer-specific mortality compared to Texas. These improvements spanned all racial and ethnic groups, underscoring the benefits of Medicaid expansion in improving cancer outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251339526","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:13:57Z","timestamp":1747185237000},"page":"1086-1092","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of the Affordable Care Act on Lung Cancer Stage at Presentation"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2743-9785","authenticated-orcid":false,"given":"Sumaiyya","family":"Arshad","sequence":"first","affiliation":[{"name":"Department of Surgery, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwasegun A.","family":"Akinyemi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojisola","family":"Fasokun","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Edward E.","family":"Cornwell","sequence":"additional","affiliation":[{"name":"Department of Surgery, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Surgery, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"World Health Organization. Lung cancer. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/lung-cancer. Accessed October 1 2025."},{"key":"e_1_3_5_3_2","unstructured":"American Cancer Society. Key statistics for lung cancer. https:\/\/www.cancer.org\/cancer\/types\/lung-cancer\/about\/key-statistics.html. Accessed October 1 2025."},{"key":"e_1_3_5_4_2","unstructured":"CDC USCS. U.S. cancer statistics lung cancer stat bite. https:\/\/www.cdc.gov\/united-states-cancer-statistics\/publications\/lung-cancer-stat-bite.html. Accessed October 1 2025."},{"key":"e_1_3_5_5_2","unstructured":"NIH NCI. Annual report to the nation part 2: patient economic burden of cancer care more than $21 billion in the United States in 2019. https:\/\/www.cancer.gov\/news-events\/press-releases\/2021\/annual-report-nation-part-2-economic-burden. Accessed October 1 2025."},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35128"},{"key":"e_1_3_5_7_2","unstructured":"ESMO ESFMO. Lung cancer treatment research enters a new era. https:\/\/www.esmo.org\/newsroom\/press-and-media-hub\/esmo-media-releases\/lung-cancer-treatment-research-enters-a-new-era. Accessed November 1 2025."},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0377"},{"key":"e_1_3_5_9_2","unstructured":"American Cancer Society. NELSON trial confirms mortality benefit of lung cancer screening. https:\/\/pressroom.cancer.org\/NELSON2020. Accessed November 1 2025."},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000002952"},{"key":"e_1_3_5_11_2","unstructured":"National Cancer Institute Surveillance Epidemiology and End Results Program. SEER databases in SEER*Stat. Accessed March 5 2025."},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgae022"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.24366"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.52571"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.916167"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31296"},{"key":"e_1_3_5_17_2","unstructured":"American Cancer Society. Medicaid expansion improves post-surgery survival among adults with non-small cell lung cancer new study shows. https:\/\/pressroom.cancer.org\/releases?item=1293. Accessed November 1 2025."},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2024.7041"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32740"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4087"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/or.2024.1427441"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251339526","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251339526","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251339526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:37:43Z","timestamp":1777379863000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251339526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":20,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1177\/00031348251339526"],"URL":"https:\/\/doi.org\/10.1177\/00031348251339526","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,13]]}}}