Thursday , January 20 2022

The Association Between the Affordable Care Act on Insurance Status, Cancer Stage, and Overall Survival in Patients with Renal Cancer


( At a session of the Best Kidney Cancer Poster Presentations at this year’s Society of Urology Oncology (SUO) virtual annual meeting, Dr. Javier-Desloges determined whether insurance expansion was implemented through the Patient Protection and Affordable Care Act (ACA) related to changes in the status of insurance coverage, diagnosis stage and overall survival of patients with renal cell carcinoma.

First, he emphasized that the poverty line in 2020 is $ 12,389, therefore, in the Medicaid expansion states, individuals would qualify if they had an income of less than $ 17,236 (138% of the poverty line) while this threshold was $ 4,996 in non-expanding states. (40% of the poverty line).

The authors used the National Cancer Database to identify patients between the ages of 40 and 64 who were diagnosed with renal cell carcinoma between 2010 and 2016. They categorized patients on the basis of whether or not their patients participated in time for Medicaid expansion. .


Patients living in late and early Medicaid expansion states were excluded. The analysis was performed following stratification by tumor stage (Stage 1/2 versus 3/4) and by income level (low, middle and high according to Federal Poverty Guidelines). Platform trend analysis was used to assess for stage migration and difference-in-difference modeling was used to compare reductions in uninsured and diagnosed advanced disease.

The authors identified 78,099 patients in whom they analyzed. The authors found that ACA activation was associated with an increase in insured renal cell carcinoma (RCC) patients, with an absolute percentage change of 4% in expansion states and 2.1% in non-expanding states.


In a modified difference-in-difference analysis, uninsured status rates decreased to a significantly higher degree in expansion states (1.14%, p <0.001). The largest increases in expansionist states were among low-income individuals (11%), compared to middle (4.2%) and high-income (4.0%) individuals.


Among low-income (4%) and middle-income (1.6%) patients, Medicaid expansion was associated with a higher proportion of patients with localized renal cell carcinoma following ACA implementation.


In a Cox model of overall survival, ACA activation was associated with a reduction in the increased risk of mortality seen among low-income patients.

The authors conclude that ACA implementation is associated with increased patient insurance with RCC and platform migration toward local disease.

Presented by: Juan F. Javier-Desloges, MD, Urology Resident, Yale School of Medicine, Yale University, New Haven, Connecticut

Written by: Christopher JD Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the Society of Urology Oncology 2020 Annual Meeting – December 2-5, 2020 – Washington, DC

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