Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

Table 1 Demographic variables, n (%)

	All states (n = 893004)		Expansion states (n = 554101)		Non-expansion states (n = 338903)
	Pre-ACA	Post-ACA	Pre-ACA	Post-ACA	Pre-ACA	Post-ACA
Age (yr)
50-54	144633 (39.15)	125057 (36.68)	89366 (39.16)	78752 (36.63)	55267 (39.13)	46305 (36.78)
55-59	158010 (31.18)	145440 (31.86)	97145 (31.49)	91564 (32.07)	60865 (30.61)	53876 (31.48)
60-64	162680 (29.67)	157184 (31.46)	99078 (29.35)	98196 (31.30)	63602 (30.25)	58988 (31.74)
Gender
Male	189909 (48.59)	183869 (48.49)	117729 (48.72)	116204 (48.69)	72180 (48.35)	67665 (48.13)
Race
Non-Hispanic white	367535 (70.94)	335133 (69.10)	227986 (72.30)	212968 (70.46)	139549 (68.47)	122165 (66.67)
Non-Hispanic black	40005 (11.05)	35498 (11.80)	21748 (9.64)	19925 (10.17)	18257 (13.64)	15573 (14.73)
Other non-Hispanic	17151 (4.95)	16381 (5.23)	11524 (6.16)	11230 (6.60)	5627 (2.73)	5151 (2.78)
Multiracial non-Hispanic	8075 (1.25)	7433 (1.14)	5445 (1.36)	5174 (1.22)	2630 (1.05)	2259 (1.01)
Hispanic	26999 (11.80)	27038 (12.73)	15400 (10.54)	15079 (11.56)	11599 (14.11)	11959 (14.82)
Income
< $25000	108872 (26.91)	90810 (26.19)	62264 (24.56)	53270 (24.04)	46608 (31.27)	37540 (30.07)
Employment status
Employed for wages	229742 (49.78)	214339 (50.54)	143761 (51.16)	137816 (52.12)	85981 (47.27)	76523 (47.70)
Self-employed	51031 (10.74)	48916 (11.28)	31149 (10.79)	30137 (11.23)	19882 (10.65)	18779 (11.37)
Out of work > 1 yr	19335 (5.04)	13208 (3.67)	12399 (5.18)	8569 (3.70)	6936 (4.79)	4639 (3.62)
Out of work < 1 yr	12272 (3.12)	9159 (2.50)	7854 (3.19)	6055 (2.60)	4418 (3.01)	3104 (2.33)
Homemaker	22567 (5.44)	20059 (5.82)	12528 (4.99)	11537 (5.22)	10039 (6.26)	8522 (6.06)
Student	1248 (0.28)	1022 (0.24)	788 (0.28)	692 (0.25)	460 (0.28)	330 (0.12)
Retired	67400 (12.91)	60896 (12.66)	41744 (12.83)	37970 (12.43)	25656 (13.05)	22926 (13.07)
Unable to work	59643 (12.69)	56912 (13.61)	33900 (11.58)	33669 (12.46)	25743 (14.70)	23243 (15.65)
Education
Some high school or less	32774 (13.35)	28992 (13.71)	18155 (15.34)	16686 (12.80)	14619 (15.23)	12306 (12.32)
At least a high school graduate	431169 (86.65)	397159 (86.29)	266416 (84.66)	250815 (87.20)	164753 (84.77)	146344 (87.68)

ACA: Affordable care act.

Table 2 Difference-in-difference analysis of the three colorectal screening strategies (fobt only, sigmoidoscopy only or colonoscopy only) or at least any colorectal screening, n = 893004

Screening modality	Percentage point change		Difference-in- difference estimate	P value
	Expansion states	Non-expansion states
Colonoscopy	16.88 (16.44, 17.32)	14.49 (13.87, 15.11)	2.40 (1.64, 3.15)	< 0.001
Sigmoidoscopy	0.31 (0.20, 0.44)	0.15 (0.001, 0.280)	0.17 (-0.01, 0.35)	0.060
FOBT	2.52 (2.28, 2.76)	1.64 (1.35, 1.94)	0.88 (0.50, 1.26)	< 0.001
CRC screen	18.34 (17.89, 18.80)	15.44 (14.80, 16.08)	2.90 (2.12, 3.69)	< 0.001

Colorectal cancer screen: At least one colorectal screening strategy during the study period. FOBT: Fecal occult blood test; CRC: Colorectal cancer.

Table 3 Difference-in-difference analysis comparing utilization of access to colorectal cancer screening services by income - expansion states versus non-expansion

Annual income	Percentage point change		Difference-in-difference estimate
	Expansion states	Non-expansion states	%	95%CI
< $25000	18.94	14.92	4.02	(2.96, 5.07)
> $25000	19.84	16.65	3.19	(1.70, 4.67)

Table 4 Difference-in-difference analysis comparing utilization of access to colorectal cancer screening in the Medicaid eligible population

Race/ethnicity	Percentage point change		Difference-in- difference estimate
	Expansion states	Non-expansion states	%	95%CI
1Non-Hispanic White	19.92	16.91	3.01	(2.16, 3.85)
1Hispanic	13.74	8.23	5.51	(2.81, 8.20)
Non-Hispanic Black	18.32	16.60	1.72	(-0.83, 4.26)
Non-Hispanic multiracial	17.34	13.20	4.15	(-2.93, 11.22)
Other	12.39	13.93	-1.54	(-6.84, 3.76)
Education level
Some high school or less	14.63	13.42	1.59	(-1.37, 4.55)
1High school grad or more	18.83	15.77	4.26	(3.16, 5.35)

¹Statistically significant.