Impact of Medicaid Expansion Status and Race on Metastatic Disease at Diagnosis in Patients with Melanoma

Jesus C. Fabregas, Benjamin T. Carter, Jose Lutzky, William Russell Robinson, Jeannine M. Brant

Research output: Contribution to journalArticlepeer-review


Background: Black patients are diagnosed with melanoma at a later stage, as compared with their white counterparts. It is unknown if Medicaid expansion might ameliorate this disparity. Methods: Using data from the 2016 National Cancer Database, we conducted a retrospective cohort study. The primary objective was to evaluate whether being diagnosed with melanoma at a Medicaid Expansion State (MES) and black race are associated with a late diagnosis of melanoma. Main exposure: Being diagnosed in a MES. Secondary exposure: Race. Main outcome: Odds of Stage IV vs Stages 0-III at diagnosis. Univariate, multivariate logistic regression, and propensity score analyses were conducted to evaluate the potential associations. Sub-group analysis was conducted according to age < 65 or ≥ 65 years. Results: A total of 216,604 patients were included, 40–90 years of age, X¯ 64 years [SD 12.47]. In univariate analysis, patients diagnosed in MES were 15% less likely (95% CI, 0.81–0.88) to be diagnosed with Stage IV melanoma. Black race (vs white) had 3.04 increased odds (95% CI, 2.56–3.60) of late diagnosis. In multivariate analysis, adjusting for socio-economic confounders, patients < 65 years of age were 13% less likely (95% CI, 0.82–0.92) to be diagnosed with Stage IV melanoma. By propensity score analysis, the strength of the associations remained. Black race (vs white) was associated with higher odds (95% CI, 1.91–3.08) of being diagnosed with Stage IV disease. For black patients < 65 years, being diagnosed in a state without Medicaid expansion had 2.55 higher odds (95% CI, 1.93–3.38) of being diagnosed with Stage IV melanoma, which decreased to 2.11 odds (95% CI, 1.34–3.33) in MES. The interaction between race and MES was statistically significant (P = 0.008). Conclusions: This study suggests that patients are less likely to be diagnosed with Stage IV melanoma in MES. This beneficial effect is more pronounced among Black minorities.

Original languageEnglish (US)
JournalJournal of Racial and Ethnic Health Disparities
StateAccepted/In press - 2021
Externally publishedYes


  • Disparities
  • Ethics
  • Insurance
  • Melanoma
  • Staging diagnosis

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health


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