Sunday , August 1 2021

Relationship between the Affordable Care Act in terms of insurance status, cancer stage and overall survival in kidney cancer patients

( During this year’s virtual annual meeting of the Society of Urologic Oncology (SUO) on the best presentations of kidney cancer posters (SUO), Dr. Javier-Desloges sought to determine whether the insurance extensions implemented under the Patient Protection Act and Affordability (ACA) have been associated with changes in insurance status, stage of diagnosis and overall survival in patients with RCC.

First, it stressed that the 2020 poverty line is $ 12,389, so in the expansion states of Medicaid, people would qualify if they had an income of less than $ 17,236 (138% of the poverty line), while that threshold was $ 4,996 in non-expansion states. (40% of the poverty line).

The authors used the National Cancer Database to identify patients aged 40 to 64 years who were diagnosed with renal cell carcinoma between 2010 and 2016. They categorized patients based on whether their patients participated in the timely Medicaid expansion or not. .


Patients living in the late and early stages of Medicaid expansion were excluded. The stratification analysis was performed by tumor stage (grade 1/2 vs 3/4) and by income level (low, medium and high according to federal poverty guidelines). Stage trend analysis was used to assess stage migration, and difference-in-difference modeling was used to compare the reduction in the number of people uninsured and the diagnosis of advanced disease.

The authors identified 78,099 patients for whom they performed the analysis. The authors found that ACA implementation was associated with an increase in the number of patients with renal cell carcinoma (RCC) covered, with an absolute percentage change of 4% in expansion states and 2.1% in non-expansion states.


In the adjusted difference in differences analysis, the uninsured status indicators decreased to a much greater extent in the expansion states (1.14%, p <0.001). The largest increase was recorded in the states of expansion among people with low incomes (11%), compared with those with medium (4.2%) and high (4.0%) incomes.


Among low (4%) and middle income (1.6%) patients, the expansion of Medicaid was associated with a higher proportion of patients with ACA localized renal cell carcinoma.


In the Cox overall survival model, ACA implementation was associated with a reduction in the increased risk of mortality observed in low-income patients.

The authors conclude that the implementation of ACA was associated with increased insurance for RCC patients and staged migration to a localized disease.

Presented by: Juan F. Javier-Desloges, MD, Urology Resident, Yale School of Medicine, Yale University, New Haven, Connecticut

By Christopher JD Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the Society of Urologic Oncology 2020 Annual Meeting – December 2-5, 2020 – Washington, DC

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