Cancer, Medicaid enrollment, and survival disparities

Abstract

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.

Complexity of care needs and unstaged cancer in elders: A population-based study

“…As noted earlier, the review of the literature points to a lack of consistency among researchers relative to whether to exclude unstaged cases from the analysis [18,19,20], to group unstaged cases with latestaged cancers [21,22], or even to analyze unstaged cases in a separate stage category [11,14,23,24]. SEER reports survival rates for unstaged cases that are somewhat more favorable than for those with distant stage cancer, but less favorable than for those with regional stage cancer [3,4,5], and a previous study has documented differences in survival patterns among unstaged cases when analysis was performed in age-specific strata [11].…”

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

“…15,34,35,[42][43][44][45][46][47] Eight of these found that uninsured or Medicaid patients had worse health outcomes than privately insured patients. 15,35,[42][43][44][45][46][47] Of these, three were based on data from single states. Roetzheim et al, 35 15 Okunade et al 47 analyzed state-level data from 1990 to 1997 from a variety of sources, including the BRFSS; NCI's SEER registry; and the US Bureau of the Census.…”

Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

“…3 Studies examining health care outcomes related to insurance also find disparate outcomes; patients with inadequate insurance are more likely to have perforated appendicitis 4 and are more likely to die of cancer. 5 Intricate interrelationships among risk factors and a host of potential confounders make it difficult for researchers to attribute differences in outcomes to specific racial or insurance bias.…”