P0473 - Impact of Medicaid Expansion on Racial Disparities in Colorectal Cancer Screening: A CDC State-Level Comparison (2014-2023)

Laiba Javed, MBBS¹, Usman Bin Hameed, MD², Zohaib Ahmed, MBBS¹, Hammad Jehangir, MBBS¹, Aimen Saeed, MBBS¹, Areej Javeid, MBBS³, Mian Abdul Musawir, MBBS¹, Fasih Khalil Ur Rehman, MBBS¹, Nisa Kapoor, MBBS¹, Muhammad Khubaib Javaid, MBBS¹, Muhammad Areeb Ul Haq, ¹, Hunaina Aman, MBBS¹, Suhayya Batool, MBBS¹, Hakim Wazir, MBBS⁴, Ayesha Sharif, MD⁵
1Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 2Corewell Health William Beaumont University Hospital, Royal Oak, MI; 3Allama Iqbal Medical College, Lahore, Lahore, Punjab, Pakistan; 4Gajju Khan Medical College,Swabi Pakistan Medicine department, Shahmansor, Swabi, North-West Frontier, Pakistan; 5William Beaumont hospital, Royal Oak, MI

Introduction: Medicaid provides essential healthcare coverage for low-income populations. This study compares colorectal cancer (CRC) mortality and racial disparities across states with and without Medicaid expansion.

Methods: We conducted a retrospective, population-based study using

CDC WONDER mortality data (2014-2023) for U.S. adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Variables included year of death, age, sex, race/ethnicity, urbanization, and census region.

Joinpoint regression analysis was performed using the Joinpoint Regression Program Version 5.0 to assess mortality trends in Medicaid expansion states and non-Medicaid expansion states and estimate the Annual Percent

Change (APC).

Results: From 2014-2023, 98,576 CRC deaths occurred in Medicaid-expanded states and 49,940 in non-expanded states. Expansion states had lower AAMRs. Among 25-34-year-olds, the AAMR was 0.75 (95% CI: 0.64-0.85) in expanded states vs. 0.80 (95% CI: 0.65-0.97) in non-expanded states, suggesting early detection barriers in the latter. The Northeast, with full expansion, showed the lowest and most stable mortality (7.16; 95% CI: 6.87-7.46), while the South had the highest: 9.63 (95% CI: 9.13-10.16) in expanded and 9.38 (95% CI: 9.10-9.66) in non-expanded states. Black individuals had the highest AAMRs: 13.39 (95% CI: 12.21-14.16) in non-expanded vs. 11.85 (95% CI: 11.22-12.51) in expanded states. Male and female AAMRs were consistently higher in non-expanded states. Urban areas in expanded states remained stable (7.43 in 2014 to 7.71 in 2020); rural areas rose from 8.84 (95% CI: 8.26-8.42) to 9.62 (95% CI: 9.11-10.12). In non-expanded states, urban AAMRs rose then declined, while rural AAMRs increased from 11.21 (95% CI: 10.43-11.95) in 2014 to 11.83 (95% CI: 11.05-12.60) in 2020.

Discussion: AAMRs varied by age, race, sex, expansion status, and urbanization. Medicaid expansion was associated with reduced CRC mortality and disparities, particularly in the Black population. However, targeted public health interventions are needed to further reduce CRC mortality in high-burden populations.


Figure: Age-Adjusted Mortality Rates by Age Group and Gender


Figure: Age-Adjusted Mortality Rates by Ethnicity, Region, and Care Setting

Disclosures:
Laiba Javed indicated no relevant financial relationships.
Usman Bin Hameed indicated no relevant financial relationships.
Zohaib Ahmed indicated no relevant financial relationships.
Hammad Jehangir indicated no relevant financial relationships.
Aimen Saeed indicated no relevant financial relationships.
Areej Javeid indicated no relevant financial relationships.
Mian Abdul Musawir indicated no relevant financial relationships.
Fasih Khalil Ur Rehman indicated no relevant financial relationships.
Nisa Kapoor indicated no relevant financial relationships.
Muhammad Khubaib Javaid indicated no relevant financial relationships.
Muhammad Areeb Ul Haq indicated no relevant financial relationships.
Hunaina Aman indicated no relevant financial relationships.
Suhayya Batool indicated no relevant financial relationships.
Hakim Wazir indicated no relevant financial relationships.
Ayesha Sharif indicated no relevant financial relationships.

Laiba Javed, MBBS¹, Usman Bin Hameed, MD², Zohaib Ahmed, MBBS¹, Hammad Jehangir, MBBS¹, Aimen Saeed, MBBS¹, Areej Javeid, MBBS³, Mian Abdul Musawir, MBBS¹, Fasih Khalil Ur Rehman, MBBS¹, Nisa Kapoor, MBBS¹, Muhammad Khubaib Javaid, MBBS¹, Muhammad Areeb Ul Haq, ¹, Hunaina Aman, MBBS¹, Suhayya Batool, MBBS¹, Hakim Wazir, MBBS⁴, Ayesha Sharif, MD⁵. P0473 - Impact of Medicaid Expansion on Racial Disparities in Colorectal Cancer Screening: A CDC State-Level Comparison (2014-2023), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.