Medicaid expansion and timely colorectal cancer treatment initiation among young adults in Virginia.

Abstract

e15679 Background: Colorectal cancer (CRC) remains a leading cause of cancer mortality in the United States, and incidence is rising among younger adults. Treatment within 30 days of CRC diagnosis is associated with higher survival; however, younger survivors, particularly those insured by Medicaid, may face barriers to timely care. We evaluated the association between insurance type and timely receipt of care (TRC) among younger survivors in Virginia. Methods: We conducted a retrospective cohort study using Virginia all-payer claims data (2016–2023). CRC survivors aged 18–54 enrolled in Medicaid or commercial insurance at diagnosis and initial treatment were identified. Survivors with continuous enrollment from diagnosis through 30 days post-diagnosis were included; individuals with any Medicare enrollment or death within 30 days were excluded. Bivariate comparisons (chi-square, t-tests) assessed unadjusted associations between insurance and TRC. Multivariable logistic regression assessed the association between insurance and TRC (treatment ≤30 days) adjusting for demographic and clinical factors (Charlson Comorbidity Index [CCI]). Results: Among 5,211 CRC survivors aged 18–54, most had commercial insurance (74.1% vs 25.3% Medicaid) and resided in urban areas (87.1%). One-half (50.3%) initiated CRC treatment; time to treatment did not differ by payer (mean 71.1 vs 75.9 days, p = 0.593; median 27 vs 26 days, p = 0.866). Overall, 27.4% initiated treatment within 30 days. In adjusted models, Medicaid insurance was associated with 24% lower odds of TRC compared with commercial coverage (aOR 0.76, 95% CI 0.64–0.92; p = 0.004). Adults aged < 40 had higher odds of TRC than those aged 50–54 (aOR 1.27, 95% CI 1.06–1.53); adults aged 40–49 also had higher odds (aOR 1.20, 95% CI 1.04–1.38). Higher comorbidity burden was associated with TRC (aOR 1.18, 95% CI 1.16–1.20). Survivors in large rural areas had lower odds of TRC than urban residents (aOR 0.55, 95% CI 0.38–0.78; p = 0.001). Conclusions: Among insured CRC survivors aged 18–54 in Virginia, Medicaid insurance was associated with lower odds of treatment within 30 days compared with commercial coverage. Younger age and higher comorbidity were associated with timely care. Adjusted odds ratios for timely CRC treatment initiation within 30 days among CRC survivors aged 18–54 (N=5,211). Covariates Adjusted OR 95% CI p-value Medicaid vs Commercial 0.762 0.635–0.918 0.0039 Age group 40–49 vs 50–54 1.199 1.042–1.379 0.0115 <40 vs 50–54 1.271 1.060–1.525 0.0097 Rurality Large rural vs Urban 0.549 0.384–0.784 0.001 Small rural vs Urban 0.868 0.653–1.145 0.3229 Isolated vs Urban 1.058 0.743–1.516 0.7567 CCI (per 1-unit increase) 1.178 1.156–1.200 <0.0001 Note: Models are also adjusted for race, sex, ethnicity; Estimates are not shown due to missingness >10%.