Disparities in Oral Cancer Diagnosis and Outcomes: Role of Medicaid Dental Coverage and Dental Utilization - Modified Project Summary/Abstract Section This proposal aims to examine differences in oropharyngeal cancer (OPC) outcomes among Medicaid-enrolled adults, focusing on the effects of Medicaid dental coverage policies and dental care utilization. We hypothesize that Medicaid beneficiaries with OPCs in states offering preventive dental coverage, as well as those who regularly visit the dentist, will be more likely to be diagnosed at an early stage and have better survival rates. The study will use a combination of clinical, surveillance, and administrative data. First, we will characterize differences in early-stage diagnosis and 5-year survival rates for OPCs based on race-ethnicity, sex, and rurality, using the SEER-Medicaid dataset, a nationally representative cancer registry linked with Medicaid enrollment data from 1999-2019. Next, we will assess the impact of state Medicaid dental coverage policies on OPC outcomes, using a quasi-experimental difference-in-difference design. This analysis will determine whether Medicaid beneficiaries in states with dental benefits are more likely to be diagnosed early and have better survival outcomes compared to those in states without such coverage. We will also explore whether these benefits reduce health disparities in OPC outcomes. Finally, we will investigate how dental care utilization patterns—regular preventive care, sporadic acute care, or no care—affect stage at diagnosis and survival rates, using data from the OneFlorida+ clinical research network, which integrates electronic health and dental records, Medicaid claims, and cancer registry data. This analysis will provide insights into how dental care patterns influence OPC outcomes among Medicaid enrollees. Our study is the first to comprehensively examine the role of Medicaid dental policies and utilization in OPC outcomes, using linked datasets from clinical, surveillance, and Medicaid claims sources. The findings will inform policy decisions regarding the provision of preventive dental services in Medicaid to improve cancer outcomes for vulnerable populations. This research aligns with the NIDCR's strategic priority to advance early detection of oral cancers and supports the Healthy People 2030 goal of increasing early-stage cancer diagnoses. The knowledge gained will contribute to effective healthcare policies and interventions for populations disproportionately affected by OPC.
