title: The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.
abstract: OBJECTIVE
  To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians.
  
  
  METHODS
  California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008.
  
  
  METHODS
  We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables.
  
  
  METHODS
  All incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment.
  
  
  RESULTS
  Continuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment.
  
  
  CONCLUSIONS
  Expansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA; Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Dawes
authors.forename: Rachel
authors.initials: R
authors.lastname: Louie
authors.forename: David K
authors.initials: DK
authors.lastname: Nguyen
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.forename: Punam
authors.initials: P
authors.lastname: Parikh
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: David S
authors.initials: DS
authors.lastname: Zingmond
mesh_terms: D002140:California; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States
keywords: Medicaid; access to care; cancer; surgery; survival