{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:46Z","timestamp":1788847726562,"version":"build-2803163510"},"reference-count":22,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"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":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medicaid expansion under the Affordable Care Act has been associated with improved colorectal cancer (CRC) outcomes, predominantly attributed to earlier diagnosis and stage migration. However, it remains unclear whether survival benefits vary across disease stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate cancer-specific survival (CSS) after Medicaid expansion across disease stages among working-age adults with CRC, comparing the expansion state of California with the non-expansion state of Texas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data (2007-2021) for patients aged 18-64\u00a0years with primary CRC. A difference-in-differences design compared pre-ACA (2007-2013) and post-ACA (2015-2021) periods between California and Texas. CSS was modeled using Cox proportional hazards regression adjusting for demographics, tumor characteristics, and treatments. Analyses were stratified by disease stage (localized, regional, distant) and race\/ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 122,543 patients, CSS improved after Medicaid expansion in California relative to Texas. Stage-stratified difference-in-differences models showed a modest reduction in cancer-specific mortality for localized disease 0.985 (0.974-0.996), a larger reduction for regional disease 0.941 (0.900-0.983), and the greatest reduction for distant metastatic disease 0.689 (0.525-0.903). Improvements were consistent across racial\/ethnic groups, with the largest relative reduction among non-Hispanic Black patients 0.855 (0.763-0.958).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medicaid expansion was associated with stage-dependent improvements in CRC survival, with the most pronounced benefit for patients with metastatic disease. These findings suggest that enhanced access to systemic therapy, multidisciplinary care, and financial protection may yield survival gains beyond those mediated by stage shift alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261465402","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:43:52Z","timestamp":1782459832000},"page":"2558-2564","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Medicaid Expansion and Stage-Specific Colorectal Cancer Survival"],"prefix":"10.1177","volume":"92","author":[{"given":"Oluwasegun","family":"Akinyemi","sequence":"first","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5627-9655","authenticated-orcid":false,"given":"Kaelyn","family":"Gordon","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojisola","family":"Fasokun","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"Nnorom","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Edward","family":"Cornwell","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kakra","family":"Hughes","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Nembhard","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_4_3_2","volume-title":"Cancer stat facts: colorectal cancer","author":"NIH NCI, S","unstructured":"NIH NCI, S. Cancer stat facts: colorectal cancer. NIH. https:\/\/seer.cancer.gov\/statfacts\/html\/colorect.html. Accessed 2 5 2025."},{"key":"e_1_3_4_4_2","volume-title":"Medicaid expansion to the new adult group","author":"MACPAC MaCaAC","unstructured":"MACPAC MaCaAC. Medicaid expansion to the new adult group. MACPAC. https:\/\/www.macpac.gov\/subtopic\/medicaid-expansion\/. Accessed 1 7 2025."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr1916091"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","unstructured":"Schwehr NA Giovann H Lacey. Impacts of the affordable care act medicaid expansion in California. 2021. doi:10.5070\/P2cjpp13154573.","DOI":"10.5070\/P2cjpp13154573"},{"key":"e_1_3_4_7_2","unstructured":"Graves S. Federal threats hindered California\u2019s progress in further advancing health care reform last year \u2014 what will 2019 bring? California budget and policy center. https:\/\/calbudgetcenter.org\/resources\/federal-threats-hindered-californias-progress-in-further-advancing-health-care-reform-last-year-what-will-2019-bring\/. Accessed 1 7 2025."},{"key":"e_1_3_4_8_2","volume-title":"The Texas Tribune","author":"Melhado W","unstructured":"Melhado W. The percentage of uninsured Texans in 2022 dropped to the lowest in a decade. In: The Texas Tribune. https:\/\/www.texastribune.org\/2023\/09\/14\/census-bureau-texas-healthcare-insurance\/. 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