The linkage of Medicaid and SEER data provides more in-depth information on low-income women than has been available in past studies. In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable breast cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.

BACKGROUND Concern has been raised over the disproportionate cancer mortality among minority and low‐income persons. The current study examined differences in disease stage at the time of diagnosis and subsequent survival for patients who are medically indigent compared with the rest of the population of cancer patients in Michigan. METHODS The authors linked three Michigan statewide data bases: the Cancer Registry, Medicaid enrollment files, and death certificates. The analysis focused on female breast, cervix, lung, prostate, and colon carcinoma, and differences were analyzed in the incidence, disease stage at the time of diagnosis, and survival between younger women and older women who were either insured or not insured by Medicaid. To estimate the risk of late stage diagnosis and death, the authors used logistic regression, controlling for age, race, and Medicaid enrollment. Ordered logit models also were used as a refinement of disease stage prediction. RESULTS Medically indigent persons had a disproportionately larger share of cancer. Persons age < 65 years who were insured by Medicaid had the greatest risk of late stage diagnosis and death across all five disease sites analyzed. African‐American women had a greater risk of death from breast carcinoma compared with other women independent of Medicaid status. No interaction effects were found between age, race, and/or gender and Medicaid enrollment. CONCLUSIONS The results of this study showed that the disparities in cancer outcomes may be greater than previously thought and are consistent across disease sites. If advancements made in cancer control are to be shared by the low‐income population, then improvements clearly are needed in cancer prevention, early detection, and treatment for the poor. Cancer 2001;91:178–88. © 2001 American Cancer Society.

BACKGROUND The current article examined survival for adults < 65 years old diagnosed with breast, colorectal, or lung carcinoma who were either Medicaid insured at the time of diagnosis, Medicaid insured after diagnosis, or non‐Medicaid insured. METHODS The authors hypothesized that subjects enrolling in Medicaid after they were diagnosed with cancer would explain disparate survival outcomes between Medicaid and non–Medicaid‐insured subjects. The authors used the Michigan Tumor Registry, a population‐based cancer registry covering the State of Michigan, to identify subjects who were diagnosed with the cancer sites of interest (n = 13,740). The primary outcome was all cause mortality over an 8‐year time period. RESULTS Subjects who enrolled in Medicaid after diagnosis with cancer had much lower 8‐year survival rates relative to Medicaid‐enrolled and non‐Medicaid subjects. These reductions in survival were partly due to a high proportion of lung carcinoma and late‐stage cancers within the sample of subjects who enrolled in Medicaid after diagnosis. The likelihood of death was two to three times greater for subjects enrolled in Medicaid relative to subjects who were not enrolled in Medicaid once the analysis was stratified by cancer site and stage. CONCLUSIONS Disparities in cancer survival were apparent between subjects enrolled in Medicaid and subjects not enrolled in Medicaid. From a policy perspective, cancer survival in the Medicaid population cannot be improved as long as 40% of the population enrolls in Medicaid after diagnosis with late‐stage disease. Cancer 2005. © 2005 American Cancer Society.

Cancer patients enrolled in Medicaid after their diagnosis were disproportionately likely to have late stage disease relative to patients previously enrolled in Medicaid or non-Medicaid enrollees.

Our study underscores the importance of cervical cancer screening programs targeted at low-income women.