Disp-14. the association between medicaid enrollment continuity and childhood, adolescent, and young adult brain tumor survival

Abstract BACKGROUND Disparities in younger cancer patient survival between individuals with Medicaid and private insurance have been reported. To further understand this association for brain tumor survival, we used Surveillance, Epidemiology, and End RESULTS (SEER)-Medicaid-linked data to test two hypotheses: 1) those enrolled in Medicaid have lower brain tumor survival than those not enrolled, and 2) those with discontinuous enrollment in Medicaid around the time of diagnosis have lower survival than those with continuous enrollment. METHODS SEER-Medicaid linked data on individuals diagnosed with a first malignant primary brain cancer between 0 to 39 years from 2006 to 2013 were obtained with follow-up through 2018. Medicaid enrollment was classified as continuous (enrolled six months before through six months after diagnosis) and discontinuous (enrolled non-continuously in the twelve months surrounding the diagnosis month). We used Kaplan-Meier (KM) curves and Cox Proportional Hazards (PH) regression models with SEs clustered on state to evaluate survival differences in association with Medicaid enrollment timing after adjusting for age, race/ethnicity, and a measure of census tract poverty. RESULTS Our analytic dataset included 10,110 children, adolescents, and young adults, including 3,148 brain tumor deaths. Consistently lower survival probabilities over time were observed for those enrolled in Medicaid, particularly those with discontinuous enrollment for both age groups. Higher hazards of death were observed for those enrolled in Medicaid vs. not enrolled (HR0-19 =1.66 95% CI 1.41-1.95; HR20-39=1.38, 95% CI 1.27-1.51) and with discontinuous vs. continuous in Medicaid enrollment (HR0-19 =1.60, 95% CI 1.43-1.81; HR20-39=2.03, 95% CI 1.75-2.36). CONCLUSIONS These results indicate Medicaid enrollment continuity has an impact on the risk of death, with discontinuous enrollment associated with an over two times higher risk of death for young brain tumor patients. These results further support the critical need for consistent health insurance coverage for children, adolescents, and young adults.