Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Oluwasegun A Akinyemi; Terhas Asfiha Weldeslase; Mojisola E Fasokun; Eunice Odusanya; Eunice O Mejulu; Ejura Y Salihu; Ngozi T Akueme; Kakra Hughes; Miriam Micheal

doi:10.7759/cureus.52571

Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Cureus. 2024 Jan 19;16(1):e52571. doi: 10.7759/cureus.52571. eCollection 2024 Jan.

Authors

Affiliations

¹ Health Policy and Management, University of Maryland School of Public Health, College Park, USA.
² Surgery, Howard University, Washington DC, USA.
³ Surgery, Howard University College of Medicine, Washington, USA.
⁴ Epidemiology and Public Health, University of Alabama at Birmingham, Birmingham, USA.
⁵ Obstetrics and Gynecology, Howard University College of Medicine, Washington DC, USA.
⁶ Medical School, Western Illinois University, Illinois, USA.
⁷ Department of Health Services Research, University of Wisconsin, Madison, USA.
⁸ Dermatology, University of Medical Sciences (UNIMED), Ondo State, NGA.
⁹ Surgery, Howard University College of Medicine, Washington DC, USA.
¹⁰ Internal Medicine, Howard University College of Medicine, Washingon DC, USA.
¹¹ Internal Medicine, University of Maryland School of Medicine, Baltimore, USA.

Abstract

Introduction: Non-Hodgkin's Lymphoma (NHL) accounts for a substantial number of cancer cases in the United States, with a significant prevalence and mortality rate. The implementation of the Affordable Care Act (ACA) has the potential to impact cancer-specific survival among NHL patients by improving access to healthcare services and treatments.

Objective: This study aims to assess the impact of the implementation of the ACA on cancer-specific survival among patients diagnosed with NHL.

Methodology: In this retrospective analysis, we leveraged data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of the ACA on cancer-specific survival among NHL patients. The study covered the years 2000-2020, divided into pre-ACA (2000-2013) and post-ACA (2017-2020) periods, with a three-year washout (2014-2016). Using a Difference-in-Differences approach, we compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014). We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities.

Results: Among 74,762 patients, 56.2% were in New Jersey (42,005), while 43.8% were in Georgia (32,757). The pre-ACA period included 32,851 patients (51.7% in Georgia and 56.7% in New Jersey), and 27,447 patients were in the post-ACA period (48.3% in Georgia and 43.4% in New Jersey). The post-ACA period exhibited a 34% survival improvement (OR=0.66, 95% CI 0.58-0.75). ACA implementation was associated with a 16% survival boost among NHL patients in New Jersey (OR=0.84, 95% CI 0.74-0.95). Other factors linked to improved survival included surgery (OR=0.86, 95% CI 0.81-0.91), radiotherapy (OR=0.77, 95% CI 0.72-0.82), and married status (OR=0.67, 95% CI 0.64-0.71).

Conclusion: The study underscores the ACA's potential positive impact on cancer-specific survival among NHL patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.

Keywords: affordable care act; cancer-specific survival; difference in difference; health policy; non-hodgkin's lymphoma.