Award Date

May 2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Environmental and Occupational Health

First Committee Member

Jay Shen

Second Committee Member

Betty Burston

Third Committee Member

Christopher Cochran

Fourth Committee Member

Neeraj Bhandari

Fifth Committee Member

Christopher Stream

Number of Pages

149

Abstract

Background and Aim. This dissertation examines Medicaid expansion’s effect on breast cancer (BC) screening and treatment disparities in two Medicaid-expanding states (MES) that passed Medicaid expansion (New Jersey and Vermont) relative to two non-expansion states (NES) (Georgia and Wisconsin). It then compares the association of Medicaid expansion to other states that did not undertake this policy on various subgroups, such as minorities by race and ethnicity, income, and age groups. Black women still bear significant BC disparities due to untimely screenings, treatments, and deaths. Therefore, it is critical to investigate how socioeconomic status influences racial/ethnic disparity gaps, given that BC cases continue to rise in America (American Cancer Society, 2022d).Methods. This study provides reliable comparisons across states for healthcare professionals and policymakers, revealing how Medicaid expansion relates to various racial/ethnic subgroups receiving BC care. Thus, the analysis will differentiate these states by matching covariates in all four states that affect BC screening and treatment rates, including educational level, employment status, household income, and healthcare coverage. Thus, the association of Medicaid expansion with other potential influences will be more valid and accurate. 2012 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) compares two MES and two NES. Last, the study applies a modified Andersen Framework Model to conceptualize associations of Medicaid expansion with BC screening and treatment across racial/ethnic groups. Results. The Intervention states show that Medicaid expansion, as a policy by itself, had comparable odds of receiving mammography screenings for both Black and women of other races relative to White women (OR = 0.67, 95% (CI): 0.45–1.01, p < .0552); (OR = 1.13, 95% (CI): 0.77–1.66, p = .5430). Therefore, mammography screenings did not change for all races of women after Medicaid expansion took effect. However, Medicaid expansion had an overall positive impact on BC treatments. Relative to White women, Black women had about eight times higher odds of receiving BC treatments (OR = 8.07, 95% (CI): 1.12–58.36, p = .0386), whereas women of other races had comparable odds of receiving BC treatments (OR = 0.45, 95% (CI): 0.09–2.25, p < .3289). Conclusion. The results indicate no support for Hypothesis 1 (H1) and Hypothesis 2 (H2) since Medicaid expansion did not improve mammography screenings for both Black and other races of women relative to White women. As a result, both Black and other races of women had comparable odds of mammography screening receipt in the past 12 months relative to White women, and the findings do not support (H1) and (H2). However, when looking at the Interaction between Race and Medicaid expansion, Medicaid expansion had a significant influence on BC treatments for Black women. Still, women of other races had comparable odds of receiving BC treatments, and Hypothesis 3 (H3) and Hypothesis 4 (H4) are partially supported.

Keywords

Behavioral Risk Factor Surveillance System; Black Americans; Breast Cancer; Disparities; White Americans; Women of Other Races

Disciplines

Health and Medical Administration | Medicine and Health Sciences | Statistics and Probability

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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