Impact of the Affordable Care Act on Cervical Cancer Trends in New Orleans [32H]. (May 2020) - Masri, Amal
Abstract : INTRODUCTION: To examine trends among women diagnosed with cervical carcinoma in New Orleans before and after the Affordable Care Act's (ACA's) Medicaid expansion was implemented in Louisiana in January 2016. Age at diagnosis, time since last doctor's visit, progression free survival (PFS), and overall survival (OS) were analyzed between racial groups. METHODS: Subjects with Medicaid coverage diagnosed with cervical cancer at an urban medical center between 2005-2019 were identified via hospital databases. Data were reviewed retrospectively and analyzed using SPSS. RESULTS: 451 subjects (310 black, 103 Caucasian, 38 Hispanic) were identified: 375 pre-ACA (2005-2016) and 76 post-ACA (2016-2019). All comparisons pre- vs post-ACA and results not statistically significant unless specified. Cumulative analysis: age 49.9 vs 53.0 years (P<.001), doctor's visit 18.7 vs 16.4 months (P<.001), PFS 52.5 vs 71.2 months (P<.001), and OS 57.6 vs 72.9 months (P<.001). Black: age 49.8 vs 49.0 years; doctor's visit 19.2 vs 15.3 months; PFS 45.2 vs 36.9 months; OS 49.8 vs 39.5 months. White: age 51.9 vs 53.8 years; doctor's visit 14.9 vs 11.0 months; PFS 50.4 vs 75.7 months (P<.006); OS 56.6 vs 77.3 months (P<.01). Hispanic: age 50.2 vs 42.4 years (P<.001), doctor's visit 23.0 vs 19.5 months; PFS 54.5 vs 72.4 months; OS 59.0 vs 75 months. CONCLUSION: The ACA's Medicaid expansion was associated with decreased time since last doctor's visit and increased PFS and OS, notably in Hispanics and Caucasians. Hispanic women were diagnosed at earlier ages post-ACA which likely influenced early treatment and favorable prognoses. Conversely black women had decreased PFS and OS post-ACA which approached statistical significance, and they had the lowest PFS and OS pre-and post-ACA of all groups. This suggests access to care is not the only factor influencing cervical cancer outcomes in this disproportionately affected group.