Association between Medicaid Expansion and 5-Year Survival among Individuals Diagnosed with Cancer
Bibliographic record
Abstract
Medicaid expansion is associated with improvements in access to early detection and treatment services, and 2-year overall survival (OS) among individuals with cancer. However, the association with improvements in longer-term survival remains understudied. A difference-in-differences (DD) approach was used to examine changes in 5-year cause-specific survival and OS following Medicaid expansion. A total of 1,423,983 cancer cases diagnosed between 2007 and 2008 and 2014 and 2015 among adults 18 to 59 years of age residing in 26 expansion and 12 non-expansion states were included. Improvements in cause-specific survival were significantly greater in expansion states among individuals residing in rural [DD: 2.55 percentage point (ppt); 95% confidence interval (CI), 0.23-4.86] and high-poverty communities (DD: 1.54 ppt; 95% CI, 0.30-2.77), non-Hispanic White individuals (DD: 0.37 ppt; 95% CI, 0.05-0.70), and those with pancreatic (DD: 2.60 ppt; 95% CI, 0.86-4.34), lung (DD: 1.32 ppt; 95% CI, 0.30-2.34), and colorectal cancers (DD: 1.31 ppt; 95% CI, 0.26-2.37). Results were similar for OS. These findings underscore the importance of Medicaid expansion in mitigating disparities in survival outcomes. SIGNIFICANCE: Improvements in 5-year cause-specific survival and OS were greater in Medicaid expansion than non-expansion states among individuals residing in rural and high-poverty communities and among individuals diagnosed with cancers that generally have a worse prognosis, emphasizing the importance of Medicaid expansion in mitigating disparities in survival outcomes. See related commentary by Paskett, p. 2404.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".