Breast Cancer Stage and Treatment Among Ohio Medicaid Beneficiaries With and Without Mental Illness

Koroukian, Siran M.; Bakaki, Paul M.; Golchin, Negar; Tyler, Carl V.; Owusu, Cynthia; Loue, Sana

doi:10.1200/jop.2014.000034

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…Our findings are consistent with increased unadjusted rates of advanced disease reported in previous population studies, [15][16][17][18][19] suggesting that previous findings are not merely due to differences in demographics or screening participation. Our findings contrast with those of Koroukian et al, 23 who found a lower adjusted risk of advanced disease in women accessing MH services. The authors of that study speculated that their findings may have reflected the use of a comparison group who had significant health and social problems (women accessing US Medicaid services for non-MH conditions).…”

Section: Discussioncontrasting

confidence: 99%

“…17 However, these studies have not adjusted for factors such as age, socioeconomic disadvantage, or rural residence that may influence both screening participation 20 and degree of spread, [20][21][22] and also covary with mental health conditions. Only one study 23 has compared breast cancer stage in women with mental illness after adjusting for these factors, unexpectedly finding that women using US Medicaid MH services had a lower adjusted rate of distant stage cancer (hazard ratio, 0.59) than women who had received other Medicaid services. To our knowledge, no study has examined both breast cancer screening participation rates and degree of cancer spread at diagnosis in women with MH conditions to assess directly how screening participation contributes to possible differences in cancer stage at presentation and hence subsequent differences in mortality.…”

Section: Introductionmentioning

confidence: 99%

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Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study

Sara,

Lambeth,

Burgess

et al. 2023

Cancer

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BackgroundWomen living with mental health conditions may not have shared in improvements in breast cancer screening and care. No studies have directly examined the link between reduced screening participation and breast cancer spread in women using mental health (MH) services.MethodsPopulation‐wide linkage of a population cancer register, BreastScreen register, and mental health service data set in women aged 50 to 74 years in New South Wales, Australia, from 2008 to 2017. Incident invasive breast cancers were identified. Predictors of degree of spread (local, regional, metastatic) at diagnosis were examined using partial proportional odds regression, adjusting for age, socioeconomic status, rurality, and patterns of screening participation.ResultsA total of 29 966 incident cancers were identified and included 686 (2.4%) in women with MH service before cancer diagnoses. More than half of MH service users had regional or metastatic spread at diagnosis (adjusted odds ratio, 1.63; 95% CI, 1.41‐1.89). MH service users had lower screening participation; however, advanced cancer was more common even when adjusting for screening status (adjusted odds ratio, 1.53; 95% CI, 1.32‐1.77). Advanced cancer was more common in women with severe or persistent MH conditions.ConclusionsLow screening participation rates explain only small part of the risk of more advanced breast cancer in women who use MH services. More study is needed to understand possible mechanisms contributing to more advanced breast cancer in women living with MH conditions. Health systems need strategies to ensure that women living with MH conditions enjoy population gains in breast cancer outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study

Sara,

Lambeth,

Burgess

et al. 2023

Cancer

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“…The role of mental health is gaining greater prominence in outcomes research; and increasingly, recent studies are investigating cancer-related outcomes (1,2), including cancer screening, stage at diagnosis, receipt of treatment, and survival, in the presence of comorbid mental conditions. Prior studies have documented excess cancer mortality in people with mental illness (3,4).…”

mentioning

confidence: 99%

Increased cancer-specific mortality in individuals developing mental disorders after cancer diagnosis: biomedical factors versus psychosocial support

Koroukian

Sajatovic

2017

Ann. Transl. Med.

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“…We used data from the Ohio Cancer Incidence Surveillance System (OCISS) and Ohio Medicaid enrollment data, which we linked using a deterministic linkage algorithm based on the patient's social security number, first and last name, date of birth, and sex. [17][18][19][20]29 Further contextual data were derived from the 2013-2017 American Community Survey data from the US Census (income, education, and percent uninsured at the census tract level; urbanicity/rurality of patients' county of residence) and the Health Resources Service Administration to identify Health Professional Shortage Areas (HPSAs).…”

Section: Data and Study Samplementioning

confidence: 99%

Post–Affordable Care Act Improvements in Cancer Stage Among Ohio Medicaid Beneficiaries Resulted From an Increase in Stable Coverage

et al. 2022

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Background: The mechanisms underlying improvements in early-stage cancer at diagnosis following Medicaid expansion remain unknown. We hypothesized that Medicaid expansion allowed for low-income adults to enroll in Medicaid before cancer diagnosis, thus increasing the number of stably-enrolled relative to those who enroll in Medicaid only after diagnosis (emergently-enrolled). Methods: Using data from the 2011–2017 Ohio Cancer Incidence Surveillance System and Medicaid enrollment files, we identified individuals diagnosed with incident invasive breast (n=4850), cervical (n=1023), and colorectal (n=3363) cancer. We conducted causal mediation analysis to estimate the direct effect of pre- (vs. post-) expansion on being diagnosed with early-stage (-vs. regional-stage and distant-stage) disease, and indirect (mediation) effect through being in the stably- (vs. emergently-) enrolled group, controlling for individual-level and area-level characteristics. Results: The percentage of stably-enrolled patients increased from 63.3% to 73.9% post-expansion, while that of the emergently-enrolled decreased from 36.7% to 26.1%. The percentage of patients with early-stage diagnosis remained 1.3–2.9 times higher among the stably-than the emergently-enrolled group, both pre-expansion and post-expansion. Results from the causal mediation analysis showed that there was an indirect effect of Medicaid expansion through being in the stably- (vs. emergently-) enrolled group [risk ratios with 95% confidence interval: 1.018 (1.010–1.027) for breast cancer, 1.115 (1.064–1.167) for cervical cancer, and 1.090 (1.062–1.118) for colorectal cancer. Conclusion: We provide the first evidence that post-expansion improvements in cancer stage were caused by an increased reliance on Medicaid as a source of stable insurance coverage.

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Breast Cancer Stage and Treatment Among Ohio Medicaid Beneficiaries With and Without Mental Illness

Cited by 7 publications

References 38 publications

Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study

Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study

Increased cancer-specific mortality in individuals developing mental disorders after cancer diagnosis: biomedical factors versus psychosocial support

Post–Affordable Care Act Improvements in Cancer Stage Among Ohio Medicaid Beneficiaries Resulted From an Increase in Stable Coverage

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