Beyond Insurance Status: The Impact of Medicaid Expansion on the Diagnosis of Hepatocellular Carcinoma

HPB ◽  
2022 ◽  
Author(s):  
Marianna V. Papageorge ◽  
Alison P. Woods ◽  
Susanna W.L. de Geus ◽  
Sing Chau Ng ◽  
Michael K. Paasche-Orlow ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Insurance Status ◽  
Medicaid Expansion ◽  
The Impact

scholarly journals Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482095661
Author(s):  
Bryce D. Beutler ◽  
Mark B. Ulanja ◽  
Rohee Krishan ◽  
Vijay Aluru ◽  
Munachismo L. Ndukwu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Native American ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Private Insurance ◽  
Insurance Status ◽  
The Impact ◽  
To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

Sociodemographic characteristics as predictors of outcomes in hepatocellular carcinoma: A retrospective cohort study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 503-503
Author(s):  
Bryce David Beutler ◽  
Mark Bilinyi Ulanja ◽  
Vijay Aluru ◽  
Nageshwara Gullapalli
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Household Income ◽  
Retrospective Cohort ◽  
Insurance Status ◽  
Socioeconomic Class ◽  
The Impact ◽  
To Receive

503 Background: It has been established that race, insurance status, and socioeconomic class play an important role in predicting health care outcomes. However, the impact of these factors has yet to be investigated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the SEER program (2007-2015) to identify patients with resectable HCC (N = 28518). Exposures of interest were race (Asian [AS], Black [BL], Native American/Alaska Native [NA/AN], or White [WH]), insurance status (Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]), and median household income. Endpoints included: (1) likelihood of surgical recommendation and (2) overall survival. Multinomial logistic regression for relative risk ratio (RRR) and Cox models were used to identify pertinent associations. Results: Race, insurance status, and socioeconomic class had statistically significant effects on the likelihood of surgical recommendation and overall survival. AS were more likely to receive a recommendation for hepatic resection (RRR = 1.60; 95% CI: 1.42 – 1.80; Reference Race: BL) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73 – 0.82) as compared to members of other ethnic groups; there was no difference in these endpoints between BL, NA/AN, or WH individuals. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Individuals with a household income in the highest quintile were less likely to receive a surgical recommendation than those in the lower quintiles, but nevertheless demonstrated prolonged survival. Conclusions: Race, insurance status, and socioeconomic class have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation. [Table: see text]

scholarly journals Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act

2018 ◽  
Vol 14 (2) ◽  
pp. e92-e102 ◽  
Author(s):  
Haley A. Moss ◽  
Laura J. Havrilesky ◽  
S. Yousuf Zafar ◽  
Gita Suneja ◽  
Junzo Chino
Keyword(s):  
Breast Cancer ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Insurance Status ◽  
Medicaid Expansion ◽  
Before And After ◽  
Medicaid Eligibility ◽  
The Affordable Care Act ◽  
Insurance Rates ◽  
The Impact

Purpose: The Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among patients newly diagnosed with colon, lung, or breast cancer. Methods: Using the SEER database, patients younger than age 65 years diagnosed with colon, lung, or breast cancer between 2008 and 2014 were identified. Insurance rates were examined before versus after passage of the ACA (2011) and before (2011 to 2013) versus after (2014) Medicaid expansion in nine expansion states and five nonexpansion states. Difference-in-differences models were used to estimate the differential impact of ACA in expansion compared with nonexpansion states. Results: A total of 414,085 patients with known insurance status were diagnosed with colon, lung, or breast cancer between 2008 and 2014. For all cancer types, there was a significant increase in patients enrolled in Medicaid after 2011 in expansion states. Between 2011 to 2013 and 2014, in patients living in states with Medicaid expansion, the uninsured rates decreased by ≥ 50% among patients with a new diagnosis of lung and colon cancer (6.5% in 2011 to 2013 to 3.1% in 2014 and 6.8% in 2011 to 2013 to 3.4% in 2014, respectively; P < .001); the uninsured rate decreased to a lesser degree for patients with breast cancer (2.7% in 2011 to 2013 to 1.6% in 2014; P < .001). This decrease in the rate of uninsured patients was absent in patients living in nonexpansion states. Conclusion: The ACA resulted in expanded insurance coverage for patients diagnosed with colon, lung, and breast cancer. However, the impact was only observed in states that increased their Medicaid eligibility.

scholarly journals Beyond Insurance Status: Impact of Medicaid Expansion on the Diagnosis of Hepatocellular Carcinoma

2021 ◽  
Vol 233 (5) ◽  
pp. S147
Author(s):  
Marianna V. Papageorge ◽  
Alison P. Woods ◽  
Susanna W.L. de Geus ◽  
Sing Chau Ng ◽  
David B. McAneny ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Insurance Status ◽  
Medicaid Expansion

Mechanisms of liver damage in COVID-19

2020 ◽  
Vol 1 (19) ◽  
pp. 39-46
Author(s):  
T. V. Pinchuk ◽  
N. V. Orlova ◽  
T. G. Suranova ◽  
T. I. Bonkalo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Risk Factor ◽  
Liver Disease ◽  
Liver Function ◽  
Liver Damage ◽  
The World ◽  
Coronavirus Infection ◽  
The Impact ◽  
Analyze Data

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19. The ongoing COVID-19 pandemic poses a major challenge to health systems around the world. There is still little information on how infection affects liver function and the significance of pre-existing liver disease as a risk factor for infection and severe COVID-19. In addition, some drugs used to treat the new coronavirus infection are hepatotoxic. In this article, we analyze data on the impact of COVID-19 on liver function, as well as on the course and outcome of COVID-19 in patients with liver disease, including hepatocellular carcinoma, or those on immunosuppressive therapy after liver transplantation.

Disparities in the Impact of Medicaid Expansion on Adults in Poverty

2019 ◽  
Author(s):  
Brandon W. Yan ◽  
Frank A. Sloan ◽  
Chien-Wen Tseng ◽  
John Boscardin ◽  
R. Adams Dudley
Keyword(s):  
Medicaid Expansion ◽  
The Impact

scholarly journals Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth A. Brown ◽  
Brandi M. White ◽  
Walter J. Jones ◽  
Mulugeta Gebregziabher ◽  
Kit N. Simpson
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Medicaid Expansion ◽  
Time Series Approach ◽  
Access To Primary Care ◽  
The Impact

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals The impact of FGF19/FGFR4 signaling inhibition in antitumor activity of multi-kinase inhibitors in hepatocellular carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroaki Kanzaki ◽  
Tetsuhiro Chiba ◽  
Junjie Ao ◽  
Keisuke Koroki ◽  
Kengo Kanayama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Molecular Mechanisms ◽  
Kinase Inhibitors ◽  
Progression Free Survival ◽  
Erk Signaling ◽  
Enzyme Linked Immunosorbent Assay ◽  
Antitumor Effects ◽  
The Impact

AbstractFGF19/FGFR4 autocrine signaling is one of the main targets for multi-kinase inhibitors (MKIs). However, the molecular mechanisms underlying FGF19/FGFR4 signaling in the antitumor effects to MKIs in hepatocellular carcinoma (HCC) remain unclear. In this study, the impact of FGFR4/ERK signaling inhibition on HCC following MKI treatment was analyzed in vitro and in vivo assays. Serum FGF19 in HCC patients treated using MKIs, such as sorafenib (n = 173) and lenvatinib (n = 40), was measured by enzyme-linked immunosorbent assay. Lenvatinib strongly inhibited the phosphorylation of FRS2 and ERK, the downstream signaling molecules of FGFR4, compared with sorafenib and regorafenib. Additional use of a selective FGFR4 inhibitor with sorafenib further suppressed FGFR4/ERK signaling and synergistically inhibited HCC cell growth in culture and xenograft subcutaneous tumors. Although serum FGF19high (n = 68) patients treated using sorafenib exhibited a significantly shorter progression-free survival and overall survival than FGF19low (n = 105) patients, there were no significant differences between FGF19high (n = 21) and FGF19low (n = 19) patients treated using lenvatinib. In conclusion, robust inhibition of FGF19/FGFR4 is of importance for the exertion of antitumor effects of MKIs. Serum FGF19 levels may function as a predictive marker for drug response and survival in HCC patients treated using sorafenib.

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