Abstract
Introduction: Enactment of the Affordable Care Act (ACA) in 2010 has expanded coverage for millions of Americans. However, the efficacy of this landmark legislation on cancer patients has yet to be quantified. We studied colorectal cancer (CRC) patients in Maricopa Integrated Health System (MIHS), a safety-net hospital in Phoenix, AZ, from 2010-Quarter 2, 2014 and compared them to patients who benefited from the ACA expansion in Quarter 3, 2014-2017 to analyze if a difference in staging was present. Methods: All CRC patients who were staged between 2010-2017 at MIHS or staged at an outside facility but received care through MIHS were queried. Age, race, ethnicity, sex, marital status, insurance type, zip code of current address, prior CRC screening, and staging at diagnosis were collected. Median household income was estimated based on patients zip code. Year of diagnosis was estimated using the American Community Survey from the US Census Bureau. Logistic regression analyses were performed to assess differences in staging at diagnosis pre-ACA and post-ACA. Results: A total of 75 patients were queried: 43 patients were diagnosed before the enactment of the ACA and 32 after ACA. The average age of these patients was 60.1 years and 56% were male. Among the pre-ACA group, 16 patients were enrolled in Medicaid while 8 were enrolled in Medicare. Among the post-ACA group, 5 were enrolled in Medicaid and 7 were enrolled in Medicare. When stratifying the data by ethnicity, a z-test of each stage demonstrated a greater proportion of pre-ACA Hispanic patients presented at stage 4 (P=0.01) while a greater proportion of post-ACA Hispanic patients presented at stage 3 (P=0.04). Conclusion: The analysis demonstrated a statistically significant decrease in the proportion of stage 4 colorectal cancer diagnoses in post-ACA Hispanic patients, representing a decrease in metastatic disease in this population. However, overall there was no statistically significant decrease in the likelihood of presenting at a later stage for all patients regardless their ethnicity. Follow up studies could examine larger sample sizes, or populations with different ethnic mixes.