S521 Impact of Medicaid Expansion on Racial Disparities in Colorectal Cancer Screening: A CDC State-Level Comparison (2014-2023)

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. Conclusion: 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.