Introduction: The 2014 Medicaid expansion has improved access to insurance for low-income people. Although liver cancer (LC) is the third leading cause of cancer death, the burden of LC in the Medicaid population post expansion is not well understood. Hence, the aim of this study is to provide an update focusing on LC incidence and mortality by using nationally representative data to support population health management and resource planning.
Methods: This is a retrospective study using RWD Insights, a US national all payers’ claims database which covers ~87% of the insured population. Medicaid-insured patients (≥18 years) with ≥ 1 inpatient claim or ≥ 2 outpatient claims (≥ 30 days apart) with ICD-CM cancer diagnosis codes were identified from 01/01/2015–12/31/2020. The index date was the first date of cancer diagnosis. All patients had medical benefits 12 months pre- (baseline) and post-index date (follow-up). Patients with an incident LC diagnosis were included for the analysis. Incidence, baseline patient characteristics, and mortality were assessed.
Results: A total of 9,776 incident LC patients were identified; 36.6% were identified with metastases at diagnosis. Most LC patients were male (60.4%) and diagnosed between 50 and 69 years (75.0%). The states with the highest LC incidence included California, New York, Ohio, Pennsylvania, and Michigan. LC incidence increased significantly starting at the age of 50 (table). While the annual LC incidence rate was relatively stable from 2015-2019 (16/100,000, versus 9/100,000 in the general population (CDC)), the incidence rate decreased in 2020 (11/100,000). Additionally, the proportion of patients with metastasis at diagnosis more than doubled from 21% in 2015 to 44% in 2020. Compared to the 6,197 non-metastatic LC patients, the 3,579 metastatic LC patients were more likely to be younger (56.0 vs 57.8), female (48.8% vs. 34.4%), and black (16.9% vs. 15.4%) (all P< 0.05). An overwhelmingly high mortality rate in the 12-month follow-up period was observed in patients with metastases compared to non-metastatic patients (40.5% vs. 0.03%, P%< 0.0001).
Discussion: There is a high burden of LC in Medicaid-insured patients with a more than doubling of the proportion of advanced stage disease in recent years. This disproportionately affects younger, female, and black populations and highlights the call for increased focus on early LC detection.
Yihang Liu: Grail, LLC – I am a paid employee of STATinMED Research which is a paid consultant to Grail, LLC.
Parul Gupta: Grail, LLC – I am a paid employee of STATinMED Research which is a paid consultant to Grail, LLC.
Gideon Aweh: Grail, LLC – I am a paid employee of STATinMED Research which is a paid consultant to Grail, LLC.
Karen Chung: Baxter Healthcare – Stock-publicly held company(excluding mutual/index funds). Bayer Pharmaceuticals – Stock-publicly held company(excluding mutual/index funds). Bristol-Myers Squibb – Stock-publicly held company(excluding mutual/index funds). Gilead – Stock-publicly held company(excluding mutual/index funds). Grail, LLC – Employee. Illumina – Stock-publicly held company(excluding mutual/index funds).
Jordan J.. Karlitz, MD, FACG1, Yihang Liu, MD, MS, MA2, Parul Gupta, PhD2, Gideon Aweh, MS2, Karen C.. Chung, PharmD, MS3. P3863 - Burden of Liver Cancer Among Medicaid-Insured Patients: A Retrospective Analysis of a National All-Payer Claims Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
