Presentation Authors: Scott R Hawken MD MS*, Parth K Modi MD MS, Lindsey A Herrel MD MS, Ann Arbor, MI
Introduction: In 2010, the Affordable Care Act (ACA) dependent coverage expansion (DCE) took effect, allowing 19-25 year olds to remain on their parent&[prime]s health insurance and potentially improving access to care. Taking advantage of this natural experiment, we sought to examine whether the ACA DCE resulted in a measureable impact in testicular cancer stage at diagnosis.
Methods: We used data from National Cancer Database to identify men diagnosed with testicular cancer aged 19-25. To evaluate the impact of DCE, we compared this group to men aged 26-34. We examined pre- and post-ACA time periods (2006-2009 vs 2011-2015, respectively), with 2010 treated as a washout period. Our primary outcome was cancer stage at diagnosis, classified as &[Prime]Early&[Prime] (Stage 1) vs &[Prime]Late&[Prime] (Stage 2-3). A difference-in-differences analysis was performed to isolate the impact of the DCE. A secondary outcome was insurance status and its association with cancer stage.
Results: 11,175 men aged 19-25 and 19,976 aged 26-34 met study criteria. Difference-in-differences analysis revealed a significant interaction between the 19-25 age group and the post-DCE time period (OR 0.47, 95% CI: 0.44-0.50, p=0.047, FIGURE). This suggests that, relative to background trends, men eligible for DCE had lower than expected odds of late stage disease. Among those aged 19-25, rates of private insurance increased from 65.7% to 66.8%, Medicaid from 10.9% to 13.8%, and the uninsured rate decreased from 17.0% to 13.3% pre vs post-DCE (p < 0.001). Among those aged 26-34, private insurance rates decreased from 73.3% to 68.5%, Medicaid increased from 8.0% to 12.6%, and the uninsured rate increased from 12.2% to 12.7% (p < 0.001 for each). Overall, men on Medicaid were most likely to present with late stage disease, followed by uninsured men and those with private insurance at 46.1%, 34.5% and 26.3% respectively (P < 0.001).
Conclusions: Implementation of DCE resulted in a protective effect against the increasing odds of presenting with late stage testicular cancer seen among those who were not eligible. These findings support the importance of insurance coverage in improving testis cancer outcomes.