Abstract SS1-09: Medicaid expansion associated with earlier stage and improved reconstruction rates in low income breast cancer patients

Introduction: Substantial delays in time to initiation of treatment (TTT) following diagnosis of breast cancer (BC) can inflict a toll on quality of life and can decrease cancer-specific survival. Among low-income, non-elderly Ohio women having newly-diagnosed breast cancer with local or regional spread, we examined TTT and other measures where income-related disparities have been documented, comparing 2011-2013 (pre-Medicaid-expansion) vs. 2014-2016 (post-expansion). Our primary hypothesis was that TTT would decrease following 2014 Medicaid expansion.Methods: Using data from the Northeast Ohio Cancer Assessment and Surveillance Engine (NEO-CASE), a multilevel data infrastructure linking Ohio cancer registry data with community data, we identified 30-64 year-old women with new diagnosis of invasive, non-metastatic BC who were uninsured or on Medicaid when diagnosed. TTT was defined as days from diagnosis to first BC treatment with any modality. We excluded women with TTT=0 (likely coding error). The main exposure was pre- or post-Medicaid expansion period defined as 2011-2013 or 2014-2016, respectively. We examined additional key demographic and treatment variables before and after expansion and in multivariate analysis of TTT. We used a previously-described probability-weighting approach based on neighborhood median income to approximate excluding women with incomes above 138% of Federal Poverty Level. As a control analysis, we compared pre- and post-expansion TTT among privately insured women, probability weighted to select for higher income individuals.Results: Our study population included 1177 and 1143 women diagnosed with BC pre- and post-expansion, respectively. Demographic characteristics were similar, though mean age increased by 1.2 years (p Citation Format: Johnie Rose, Weichuan Dong, Uriel Kim, Samilia Obeng-Gyasi, Siran Koroukian. Medicaid expansion associated with earlier stage and improved reconstruction rates in low income breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS1-09.