Podium Session

Poster, Podium & Video Sessions

PD32-05: Prostate Cancer Screening: Effect of Early Medicaid Expansion

Saturday, May 13
4:10 PM - 4:20 PM
Location: BCEC: Room 205BC

Presentation Authors: Jesse Sammon, Emily Serrel*, Portland, ME, Patrick Karabon, Detroit, MI, Gregory Mills, Portland, ME, Mani Menon, Firas Abdollah, Detroit, MI, Quoc-Dien Trinh, Boston, MA

Introduction: The Affordable Care Act of 2010 transformed medical insurance and healthcare access for Americans. A significant component of the ACA, was expansion of Medicaid eligibility for low income individuals. Five states (CA, CT, MN, NJ, WA) & DC expanded Medicaid eligibility prior to the ACA mandate. The effect that improved coverage had on the prevalence of prostate specific antigen (PSA) screening is unknown.

Methods: We compared the rate of self-reported PSA as a function of state Medicaid early expansion (MEE) vs. non-expansion (NE). Data from the 2012 and 2014 Behavioral Risk Factor Surveillance System was used to identify asymptomatic men (aged 40-64) without prostate cancer who reported PSA testing in the past 12 months. Age, race, income, education, insurance, marital status, smoking, access to healthcare provider (HCP), and HCP&[prime]s recommendation to have PSA test were extracted. Income categories were stratified by relationship to federal poverty level (FPL): <138% FPL; 138-400% FPL; >400% FPL. Multivariate logistic regression models were used to evaluate the odds of and rate of change in PSA screening among MEE and NE states.

Results: Among 158,103 survey respondents, the prevalence of PSA screening decreased between 2012 and 2014 (OR 0.87, p<0.001), rates were similar in MEE and NE states (OR 1.02, p=0.8). The decrease was smallest in low-income populations <138% FPL than in higher income populations (OR 0.92, p=0.27; OR 0.88, p=0.002; and OR 0.85, p<0.001 respectively). Men <138% FPL were more likely to undergo PSA screening if living in a MEE than NE state (OR 1.6, p=0.04). In this population of men <138% FPL in MEE states, there was an increase in PSA screening (Figure 1), especially if they were Hispanic or Non-Hispanic black (NHB) males (OR 1.53 and 1.62 respectively, both p<0.001). Though access to HCP and insurance status were lowest among those <138% FPL, these variables did not significantly affect the prevalence of PSA screening.

Conclusions: Regardless of income or expansion of access, self-reported PSA screening declined between 2011 and 2013. This may be in part due to the 2012 United States Preventive Services Task Force recommendation against PSA-based screening. However, Medicaid expansion decreased the disparity between PSA baseline screening rates for low-income populations, particularly among Hispanic and NHB males.

Source Of Funding: None

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