Survival disparities by Medicaid status

An analysis of 8 cancers

Authors

  • Siran M. Koroukian PhD,

    Corresponding author
    1. Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
    2. Cancer Aging Program, Case Comprehensive Cancer Center, Cleveland, Ohio
    • Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4945

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    • Fax: (216) 368-3970

  • Paul M. Bakaki MD, MS,

    1. Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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  • Derek Raghavan MD, PhD

    1. Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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  • Derek Raghavan's current address: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.

  • Results were presented in part at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities, September 30 to October 3, 2010; Miami, Florida.

Abstract

BACKGROUND:

A study was undertaken to compare survival and 5-year mortality by Medicaid status in adults diagnosed with 8 select cancers.

METHODS:

Linking records from the Ohio Cancer Incidence Surveillance System (OCISS) with Ohio Medicaid enrollment data, the authors identified Medicaid and non-Medicaid patients aged 15 to 54 years and diagnosed with the following incident cancers in the years 1996-2002: cancer of the testis; Hodgkin and non-Hodgkin lymphoma; early stage melanoma, colon, lung, and bladder cancer; and pediatric malignancies (n = 12,703). Medicaid beneficiaries were placed in the pre-diagnosis group if they were enrolled in Medicaid at least 3 months before cancer diagnosis, and in the peri/post-diagnosis group if they enrolled in Medicaid upon or after being diagnosed with cancer. The authors also linked the OCISS with death certificates and data from the US Census. By using Cox and logistic regression analysis, they examined the association between Medicaid status and survival and 5-year mortality, respectively, after adjusting for patient covariates.

RESULTS:

Nearly 11% of the study population were Medicaid beneficiaries. Of those, 45% were classified in the peri/post-diagnosis group. Consistent with higher mortality, findings from the Cox regression model indicated that compared with non-Medicaid, patients in the Medicaid pre-diagnosis and peri/post-diagnosis groups experienced unfavorable survival outcomes (adjusted hazard ratio [AHR], 1.52; 95% confidence interval [CI], 1.27-1.82 and AHR, 2.01; 95% CI, 1.70-2.38, respectively).

CONCLUSIONS:

Medicaid status was associated with unfavorable survival, even after adjusting for confounders. The findings reflect the vulnerability of Medicaid beneficiaries and possible inadequacies in the process of care. Cancer 2012. © 2011 American Cancer Society.

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