Affordable Care Act Improved Stage at Diagnosis of Lymphoma in AYAs in California

After implementation of the Affordable Care Act (ACA) in California, adolescents and young adults (AYAs) diagnosed with lymphomas had increased Medicaid coverage and access to care, and were less likely to present with stage IV disease, according to a new study.

However, despite these improvements in health insurance, the study showed that racial/ethnic and socioeconomic survival disparities persisted.

The study looked at associations between ACA insurance coverage, stage at diagnosis, and survival among AYAs with lymphoma in California. The researchers used data from the California Cancer Registry linked to Medicaid enrollment files for AYAs diagnosed with primary non-Hodgkin lymphoma or Hodgkin lymphoma.

The proportion of AYAs that were uninsured/Medicaid enrolled decreased from 13.4% before ACA to 9.7% after full ACA implementation. However, continuous Medicaid increased from 9.3% to 29.6% during the same period (P<0.001).

After implementation of ACA, AYAs with non-Hodgkin lymphoma were 16% less likely to be diagnosed with stage IV disease. AYAs were 42% more likely to receive care at National Cancer Institute-Designated Cancer Centers and had a 46% decreased likelihood of death.

Despite these improvements in insurance coverage and stage at diagnosis, several disparities remained. For example, Black, Hispanic, and Asian/Pacific Islander patients with Hodgkin lymphoma had 40% higher odds of stage IV diagnosis than White patients. Black patients had a lower likelihood of receiving care at an NCI-designated cancer centers. In addition, those AYAs that had private insurance had better survival than those with public insurance.

“Our study contributes to the growing literature showing positive health outcomes following the ACA implementation, which has substantially increased health insurance coverage for low-income AYAs in the US,” the researchers wrote. “However, the persistent socioeconomic and racial/ethnic disparities we identified underscore the ongoing need for strategies aimed to decrease disparities in outcomes among AYAs with lymphoma.”