Cancer Stage at Diagnosis and Survival among Persons with Social Security Disability Insurance on Medicare

Authors

  • Ellen P. McCarthy,

    1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/RO-139, Boston, MA 02215,
    Search for more papers by this author
    • Address correspondence to Ellen P. McCarthy, Ph.D., M.P.H., Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/RO-139, Boston, MA 02215. Long H. Ngo, Ph.D., is with the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. Thomas N. Chirikos, Ph.D., is with the H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Cancer Prevention & Control, Tampa, FL 33612. Richard G. Roetzheim, M.D., M.S.P.H., is with the Department of Family Medicine and the H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL. Donglin Li, M.D., M.P.H., is with the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Reed E. Drews, M.D., is with the Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. Lisa I. Iezzoni, M.D., M.Sc., is with the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.

  • Long H. Ngo,

    1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA,
    Search for more papers by this author
  • Thomas N. Chirikos,

    1. H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Cancer Prevention & Control, Tampa, FL 33612,
    Search for more papers by this author
  • Richard G. Roetzheim,

    1. Department of Family Medicine and the H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL,
    Search for more papers by this author
  • Donglin Li,

    1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA,
    Search for more papers by this author
  • Reed E. Drews,

    1. Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
    Search for more papers by this author
  • Lisa I. Iezzoni

    1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA,
    Search for more papers by this author

Abstract

Objective. To examine stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with cancer under age 65 and compare their experiences with those of other persons diagnosed under age 65.

Data Sources. Surveillance, Epidemiology, and End Results (SEER) Program data and SEER-Medicare linked data for 1988–1999. SEER-11 Program includes 11 population-based tumor registries collecting information on all incident cancers in catchment areas. Tumor registry and Medicare data are linked for persons enrolled in Medicare.

Study Design. 307,595 incident cases of non-small cell lung (51,963), colorectal (52,092), breast (142,281), and prostate (61,259) cancer diagnosed in persons under age 65 from 1988 to 1999. Persons who qualified for Social Security Disability Insurance and had Medicare (SSDI/Medicare) were identified from Medicare enrollment files. Ordinal polychotomous logistic regression and Cox proportional hazards regression were used to estimate adjusted associations between disability status and later-stage diagnoses and mortality (all-cause and cancer-specific).

Principal Findings. Persons with SSDI/Medicare had lower rates of Stages III/IV diagnoses than others for lung (63.3 versus 69.5 percent) and prostate (25.5 versus 30.8 percent) cancers, but not for breast or colorectal cancers. After adjustment, they remained less likely to be diagnosed at later stages for lung and prostate cancers. Nevertheless, persons with SSDI/Medicare experienced higher all-cause mortality for each cancer. Cancer-specific mortality was higher among persons with SSDI/Medicare for breast and colorectal cancer patients.

Conclusions. Disabled Medicare beneficiaries are diagnosed with cancer at similar or earlier stages than others. However, they experience higher rates of cancer-related mortality when diagnosed at the same stage of breast and colorectal cancer.

Ancillary