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Xie E, Colditz GA, Lian M, Greever-Rice T, Schmaltz C, Lucht J, Liu Y. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6570595. [PMID: 35583139 PMCID: PMC9113434 DOI: 10.1093/jncics/pkac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Disrupted and delayed Medicaid coverage has been consistently associated with lower rates of cancer screening and early-stage cancer diagnosis compared with continuous coverage. However, the relationships between Medicaid coverage timing, breast cancer treatment delays, and survival are less clear. Methods Using the linked Missouri Cancer Registry-Medicaid claims data, we identified 4583 women diagnosed with breast cancer between 2007 and 2016. We used logistic regression to estimate odds ratios (ORs) of late-stage diagnosis and treatment delays for prediagnosis (>30 days, >90 days, and >1 year before diagnosis) vs peridiagnosis enrollment. Cox proportional hazards models were used to estimate the hazard ratio (HR) of breast cancer-specific mortality for pre- vs postdiagnosis enrollment. Results Patients enrolled in Medicaid more than 30 days before diagnosis were less likely to be diagnosed at a late stage compared with those enrolled in Medicaid peridiagnosis (OR = 0.69, 95% confidence interval [CI] = 0.60 to 0.79). This result persisted using enrollment 90-day (OR = 0.64, 95% CI = 0.56 to 0.74) and 1-year thresholds (OR = 0.55, 95% CI = 0.47 to 0.65). We did not observe a difference in the likelihood of treatment delays between the 2 groups. After adjustment for sociodemographic factors, there was no statistically significant difference in the risk of breast cancer mortality for patients enrolled more than 30 days prediagnosis relative to patients enrolled peridiagnosis (HR = 0.98, 95% CI = 0.83 to 1.14), but a lower risk was observed for patients enrolled prediagnosis when using 90 days (HR = 0.85, 95% CI = 0.72 to 0.999) or 1 year (HR = 0.79, 95% CI = 0.66 to 0.96) as the threshold. Conclusions Women with breast cancer who enroll in Medicaid earlier may benefit from earlier diagnoses, but only longer-term enrollment may have survival benefits.
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Affiliation(s)
- Evaline Xie
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Min Lian
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Chester Schmaltz
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jill Lucht
- Center for Health Policy, University of Missouri, Columbia, MO, USA
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
- Correspondence to: Ying Liu, MD, PhD, 660 South Euclid Ave, Campus Box 8100, St. Louis, MO 63110, USA (e-mail: )
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Yabroff KR, Reeder-Hayes K, Zhao J, Halpern MT, Lopez AM, Bernal-Mizrachi L, Collier AB, Neuner J, Phillips J, Blackstock W, Patel M. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Cancer Inst 2020; 112:671-687. [PMID: 32337585 PMCID: PMC7357319 DOI: 10.1093/jnci/djaa048] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/12/2020] [Accepted: 03/27/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. METHODS We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. RESULTS Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. CONCLUSIONS Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anderson B Collier
- Children’s Cancer Center, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Manali Patel
- Stanford University School of Medicine, Stanford, CA, USA
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Keegan THM, Parsons HM, Chen Y, Maguire FB, Morris CR, Parikh-Patel A, Kizer KW, Wun T. Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. J Natl Cancer Inst 2020; 111:1152-1160. [PMID: 30937440 DOI: 10.1093/jnci/djz039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/01/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.
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Warren JL, Benner S, Stevens J, Enewold L, Huang B, Zhao L, Tilahun N, Bradley CJ. Development and Evaluation of a Process to Link Cancer Patients in the SEER Registries to National Medicaid Enrollment Data. J Natl Cancer Inst Monogr 2020; 2020:89-95. [PMID: 32412075 PMCID: PMC7868030 DOI: 10.1093/jncimonographs/lgz035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/14/2022] Open
Abstract
Cancer patients receiving Medicaid have worse prognosis. Patients in 14 Surveillance, Epidemiology, and End Results (SEER) cancer registries were linked to national Medicaid enrollment files, 2006-2013, to determine enrollment status during the year before and after diagnosis. A deterministic algorithm based on Social Security number, Medicare Health Insurance Claim number, sex, and date of birth was utilized. Results were compared with an independent linkage of Kentucky-based SEER and Medicaid data. A total 559 484 cancer cases were linked to national Medicaid enrollment files, representing 15-17% of persons with cancer yearly. About 60% of these cases were a complete match on all variables. There was 99% agreement on enrollment status compared with the Kentucky linked data. SEER data were successfully linked to national Medicaid enrollment data. NCI will make the linked data available to researchers, allowing for more detailed assessments of the impact Medicaid enrollment has on cancer diagnosis and outcomes.
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Affiliation(s)
- Joan L Warren
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | | | | | - Lindsey Enewold
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Bin Huang
- Department of Biostatistics, College of Public Health, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Lirong Zhao
- Division of Data, Research, and Analytic Methods, Center for Medicare & Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD
| | - Negussie Tilahun
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Cathy J Bradley
- Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, CO
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All-Cause 30-Day Mortality After Surgical Treatment for Head and Neck Squamous Cell Carcinoma in the United States. Am J Clin Oncol 2019; 42:596-601. [DOI: 10.1097/coc.0000000000000557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lebo NL, Khalil D, Balram A, Holland M, Corsten M, Ted McDonald J, Johnson-Obaseki S. Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States. Otolaryngol Head Neck Surg 2019; 161:800-806. [DOI: 10.1177/0194599819856305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identify socioeconomic predictors of stage at diagnosis of laryngeal cancer in the United States. Study Design Retrospective analysis of the North American Association of Central Cancer Registries’ Incidence Data–Cancers in North America Deluxe Analytic File for expanded races. Setting All centers reporting to the US Centers for Disease Control and Prevention’s National Program of Cancer Registries. Subjects and Methods All cases of laryngeal cancer in adult patients from 2005 to 2013 were reviewed. Ordinal logistic regression models were used to evaluate odd ratios (ORs) for socioeconomic indicators potentially predictive of advancing American Joint Committee on Cancer stage at diagnosis. Results A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P < .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P < .001; 95% CI, 0.536-0.609). Once adjusted for regional price and wage disparities, relative income was not a significant predictor of stage at presentation across multiple analyses. Conclusion Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence.
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Affiliation(s)
- Nicole L. Lebo
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Khalil
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Margaret Holland
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
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Koroukian SM, Bakaki PM, Golchin N, Tyler CV, Owusu C, Loue S. Breast Cancer Stage and Treatment Among Ohio Medicaid Beneficiaries With and Without Mental Illness. J Oncol Pract 2014; 11:e50-8. [PMID: 25466705 DOI: 10.1200/jop.2014.000034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a dearth of studies on cancer outcomes in individuals with mental illness. We compared breast cancer outcomes in Medicaid beneficiaries with and without mental illness. METHODS Using records from the 1996 to 2005 Ohio Cancer Incidence Surveillance System (OCISS) and Medicaid files, we identified fee-for-service women age < 65 years diagnosed with incident invasive breast cancer who had enrolled in Medicaid ≥ 3 months before cancer diagnosis (n = 2,177). We retrieved cancer stage, patient demographics, and county of residence from the OCISS. From Medicaid claims data, we identified breast cancer treatment based on procedure codes and mental illness status based on diagnosis codes, prescription drugs dispensed, and service codes. We developed logistic regression models to examine the association between mental illness, cancer stage, and treatment for locoregional disease, adjusting for potential confounders. RESULTS Women with mental illness represented 60.2% of the study population. Adjusting for potential confounders, women with mental illness were less likely than those without mental illness to have unstaged or unknown-stage cancer (adjusted odds ratio [OR], 0.61; 95% CI, 0.44 to 0.86; P = .005) or to be diagnosed with distant-stage cancer (adjusted OR, 0.59; 95% CI, 0.40 to 0.85; P = .005). We observed no difference by mental illness status in receipt of definitive treatment (adjusted OR, 1.04; 95% CI, 0.84 to 1.29; P = .08). CONCLUSION Among Ohio Medicaid beneficiaries, women with mental illness did not experience disparities in breast cancer stage or treatment of locoregional disease. These findings may reflect the equalizing effects of Medicaid through vulnerable individuals' improved access to both physical and mental health care.
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Affiliation(s)
- Siran M Koroukian
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Paul M Bakaki
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Negar Golchin
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Carl V Tyler
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Cynthia Owusu
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Sana Loue
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
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Dawes AJ, Louie R, Nguyen DK, Maggard-Gibbons M, Parikh P, Ettner SL, Ko CY, Zingmond DS. The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers. Health Serv Res 2014; 49:1787-811. [PMID: 25256223 PMCID: PMC4254125 DOI: 10.1111/1475-6773.12237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians. DATA SOURCES California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008. STUDY DESIGN We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables. DATA COLLECTION/EXTRACTION METHODS All incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment. PRINCIPAL FINDINGS Continuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment. CONCLUSIONS Expansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California.
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Affiliation(s)
- Aaron J Dawes
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, 757 Westwood Plaza, B711, Los Angeles, CA 90095
- Robert Wood Johnson Clinical Scholars Program, University of CaliforniaLos Angeles, CAVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - Rachel Louie
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - David K Nguyen
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos AngelesVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - Punam Parikh
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - Susan L Ettner
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health at the University of CaliforniaLos Angeles, CA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos AngelesVA Greater Los Angeles Healthcare SystemLos Angeles, CA
| | - David S Zingmond
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
- Department of Surgery, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
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Nadpara PA, Madhavan SS. Linking Medicare, Medicaid, and cancer registry data to study the burden of cancers in West Virginia. MEDICARE & MEDICAID RESEARCH REVIEW 2012; 2:mmrr2012-002-04-a01. [PMID: 24800152 DOI: 10.5600/mmrr.002.04.a01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Develop the WVCR-Linked dataset by combining the West Virginia Cancer Registry (WVCR) with Medicare, Medicaid, and other data sources. Determine health care utilization, costs, and overall burden of four major cancers among the elderly in a rural and medically underserved state population, and to compare them with national estimates. METHOD We extracted personal identifiers from the West Virginia Cancer Registry (WVCR) data file for individuals ≥ 65 years of age with an incident diagnosis of any cancer between January 1, 2002 and December 31, 2007. We linked the extracted data with Medicare and Medicaid administrative data using deterministic record linkage procedures. We updated missing vital status information by linking the National Death Index (NDI) data file. The updated WVCR-Linked dataset was enriched by links to the U.S. decennial census (2000) file and the Area Resource File. RESULTS We identified 42,333 individuals, of which 41,574 (98.2%) and 6,031 (14.3%) individuals were matched with Medicare and Medicaid administrative data files, respectively. The NDI data added or updated vital status information for 3,295 (7.8%) individuals in the WVCR-Linked dataset. CONCLUSION The WVCR-Linked dataset is a comprehensive dataset offering many opportunities to understand factors related to cancer treatment patterns, costs, and outcomes in a rural and medically underserved elderly Appalachian population. Following our example, non-participant states in the Surveillance, Epidemiology and End Results (SEER) program can build a powerful dataset to identify and target cancer disparities, and to improve cancer-related outcomes for their elderly and dual-eligible citizens.
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Cancer stage comparison between dual Medicare-Medicaid eligibles using Medicaid as a supplemental health insurance program and low-income nonduals. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 17:479-91. [PMID: 21964357 DOI: 10.1097/phh.0b013e31821a3f8c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dual-eligibility status for both Medicare and Medicaid is associated with unfavorable cancer stage outcomes. However, given the reduced financial barriers, duals enrolled in Medicaid prior to cancer diagnosis-or those using Medicaid as a supplemental health insurance program (Dual/SHIP)-may have improved access to preventive services compared with low-income nonduals (LI/nondual), therefore, be more likely to be diagnosed at earlier stages of cancers amenable to screening. OBJECTIVES To compare breast, prostate, and colorectal cancer stage at diagnosis between Duals/SHIP and LI/nonduals, adjusting for sociodemographic variables, comorbidities, and nursing home status. RESEARCH DESIGN Cross-sectional study using a database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Medicaid files, as well as US census data. SUBJECTS Fee-for-service, Ohio residents aged 65 years or older, and diagnosed with incident breast, prostate, or colorectal cancer in 1997-2001. MEASURES (1) Unknown stage/unstaged cancer and (2) distant-stage cancer at diagnosis. RESULTS Duals/SHIP were more likely than LI/nonduals to have unknown stage/unstaged breast cancer (adjusted odds ratio: 1.43, 95% Confidence Interval (CI): 1.02-2.0; P = .035). However, this difference was not seen in prostate or colorectal cancer. In prostate cancer patients, but not in breast or colorectal cancer patients, Dual/SHIP status was associated with distant-stage disease (adjusted odds ratio: 1.74, 95% CI: 1.12-2.70; P = .014). In colorectal cancer patients, dual status was not associated with cancer stage. CONCLUSION The findings show no benefit associated with Medicaid as SHIP. Rather, they indicate that for the most part, cancer stage is comparable between Duals/SHIP and LI/nonduals.
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11
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Schapmire TJ, Head BA, Faul AC. Just give me hope: lived experiences of Medicaid patients with advanced cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2012; 8:29-52. [PMID: 22424383 DOI: 10.1080/15524256.2012.650672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this phenomenological exploration was to describe the lived experiences of persons diagnosed with advanced cancer who receive Medicaid. Themes emerged from the transcribed interviews of 10 participants in accordance with the cancer trajectory. Before diagnosis, participants were uninsured or underinsured and had more severe symptoms prior to late diagnosis. Upon diagnosis, they desired hopeful, respectful communication and experienced strong emotional reactions. There was also an abrupt change in the use of health care resources. During cancer treatment, they experienced social isolation from family and friends while receiving strong psychosocial support from the health care team. Throughout the cancer trajectory, they focused on living, reclaiming normalcy, and expressed resiliency and spirituality. Findings support the need to recognize the "fighting spirit" of patients regardless of prognosis or socioeconomic status; the impact of hopeful, respectful communication; and the value of oncology social work assistance when navigating the cancer experience. Lack of health care coverage prior to severe symptoms prevented earlier diagnosis and contributed to poor physical outcomes. Medicaid eligibility enabled these patients to receive quality health care and focus on living beyond cancer.
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Affiliation(s)
- Tara J Schapmire
- School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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12
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Koroukian SM, Bakaki PM, Raghavan D. Survival disparities by Medicaid status: an analysis of 8 cancers. Cancer 2011; 118:4271-9. [PMID: 22213271 DOI: 10.1002/cncr.27380] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/08/2011] [Accepted: 11/10/2011] [Indexed: 11/08/2022]
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.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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13
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Palliative care case management: increasing access to community-based palliative care for Medicaid recipients. Prof Case Manag 2011; 15:206-17. [PMID: 20631596 DOI: 10.1097/ncm.0b013e3181d18a9e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this pilot project was to integrate palliative care principles and practices into the day-to-day operations of a Medicaid managed care provider. This was accomplished through the following five activities: (1) employment of an experienced palliative care nurse and social worker to serve as expert role models and consultants to the case management staff; (2) development of a palliative care training curriculum for case managers; (3) provision and evaluation of the training; (4) identification of appropriate patients, provision of palliative care case management (PCCM), and tracking of outcomes; and (5) development of a resource/reference manual for case managers. PRIMARY PRACTICE SETTING The project involved a managed care organization providing Medicaid services to patients residing in both urban and rural settings. FINDINGS/CONCLUSIONS Expert staff was hired and modeled effective PCCM. This, as well as the training program, had significant influence on both the palliative care knowledge and attitudes of existing case managers. Involved patients demonstrated improved symptom management and satisfaction with care. Patient scenarios demonstrated desirable outcomes in healthcare utilization, and timely, appropriate hospice referrals were realized. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Integrating PCCM into the practices of a provider of Medicaid managed care can result in positive patient outcomes, improved utilization of healthcare services, and related savings for the managed care provider. Such a program can increase access to community-based palliative care for Medicaid recipients with life-threatening illnesses. PCCM can address the multiple needs of younger patients with serious illness who are not yet ready to forego curative efforts.
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Boscoe FP, Schrag D, Chen K, Roohan PJ, Schymura MJ. Building capacity to assess cancer care in the Medicaid population in New York State. Health Serv Res 2010; 46:805-20. [PMID: 21158856 DOI: 10.1111/j.1475-6773.2010.01221.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To link data from a central cancer registry with Medicaid enrollment and claims files in order to assess cancer care in an economically disadvantaged population. DATA SOURCES Over 500,000 cancer patients diagnosed between 2002 and 2006 reported to the New York State Cancer Registry were linked with New York State Medicaid enrollment and claims records. STUDY DESIGN A probabilistic linkage was performed between the two data sources. The resulting Medicaid and non-Medicaid populations were compared in terms of demographics and stage at diagnosis. DATA COLLECTION METHODS Existing databases were used. PRINCIPAL FINDINGS One-quarter of cancer patients were enrolled in Medicaid at or near the time of cancer diagnosis. The Medicaid cohort was younger, more likely to be an ethnic minority, foreign born, never married, live in either an inner-city or remote rural area, and have a higher stage at diagnosis. CONCLUSIONS The linked dataset will permit detailed analysis of cancer treatment and cancer treatment disparities among historically understudied groups. The linkage has also resulted in improvements in Cancer Registry quality through the identification of errors and missing values. The linkage did present technical challenges in the form of immense file sizes not easily adaptable to desktop computers.
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Affiliation(s)
- Francis P Boscoe
- New York State Cancer Registry, 150 Broadway, Menands, NY 12204, USA.
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Koroukian SM, Dahman B, Copeland G, Bradley CJ. The utility of the state buy-in variable in the Medicare denominator file to identify dually eligible Medicare-Medicaid beneficiaries: a validation study. Health Serv Res 2009; 45:265-82. [PMID: 19840136 DOI: 10.1111/j.1475-6773.2009.01051.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the adequacy of the state buy-in variable (SBI) in the Medicare denominator file to identify dually eligible patients. DATA SOURCE/STUDY SETTINGS: We used linked Medicare and Medicaid data from Michigan and Ohio for elders diagnosed with incident breast, prostate, or colorectal cancer between 1996 and 2001. STUDY DESIGN Using the Medicaid enrollment file as the "gold standard," we assessed the number of duals from Medicare files in cross-sectional and longitudinal analyses. DATA COLLECTION/EXTRACTION METHODS Data for the study population were linked with Medicare and Medicaid files using patient identifiers. PRINCIPAL FINDINGS Sensitivity was low (74.2 percent, 95 percent confidence interval [CI]: 72.7, 75.6 and 80.8 percent, 79.7, 81.9, in Michigan and Ohio, respectively). PPV was above 95 percent in Michigan and 88.8 percent in Ohio. Both sensitivity and PPV varied between and within the states. Both in Michigan and in Ohio, we observed limited agreement on the length of enrollment in Medicaid between the two data sources. CONCLUSIONS Except to examine disparities by dual status at a very broad level, the SBI variable alone may be inadequate to identify duals. The findings call for improvements in Medicare and Medicaid information management systems and for uniformity in database linking strategies.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA.
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Peek ME, Han JH. Compliance and Self-Reported Barriers to Follow-Up of Abnormal Screening Mammograms Among Women Utilizing a County Mobile Mammography Van. Health Care Women Int 2009; 30:857-70. [DOI: 10.1080/07399330903066350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lien précarité – durée et complexité des séjours hospitaliers en secteur de court séjour. Rev Epidemiol Sante Publique 2009; 57:205-11. [DOI: 10.1016/j.respe.2009.02.208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 01/14/2009] [Accepted: 02/16/2009] [Indexed: 11/17/2022] Open
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Virnig BA, Baxter NN, Habermann EB, Feldman RD, Bradley CJ. A matter of race: early-versus late-stage cancer diagnosis. Health Aff (Millwood) 2009; 28:160-8. [PMID: 19124866 PMCID: PMC2766845 DOI: 10.1377/hlthaff.28.1.160] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the stage at which cancer is diagnosed and survival rates between African Americans and whites, for thirty-four solid tumors, using the population-based Surveillance Epidemiology and End Results (SEER) database. Whites were diagnosed at earlier stages than African Americans for thirty-one of the thirty-four tumor sites. Whites were significantly more likely than blacks to survive five years for twenty-six tumor sites; no cancer site had significantly superior survival among African Americans. These differences cannot be explained by screening behavior or risk factors; they point instead to the need for broad-based strategies to remedy racial inequality in cancer survival.
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Affiliation(s)
- Beth A Virnig
- Health Policy and Management, University of Minnesota in Minneapolis, USA.
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Quach T, Nguyen KD, Doan-Billings PA, Okahara L, Fan C, Reynolds P. A preliminary survey of Vietnamese nail salon workers in Alameda County, California. J Community Health 2008; 33:336-43. [PMID: 18478317 DOI: 10.1007/s10900-008-9107-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In recent decades, the nail salon industry has been one of the fastest growing in the U.S. California has over 300,000 workers licensed to perform nail care services. Though little is known about their health, these workers routinely handle cosmetic products containing carcinogens and endocrine disruptors that may increase a woman's breast cancer risk. Additionally, an estimated 59-80% of California nail salons are run by Vietnamese women who face socio-cultural barriers that may compromise their workplace safety and health care access. In a pilot project designed to characterize Vietnamese nail salon workers in Alameda County, California in order to inform future health interventions and reduce occupational exposures, we conducted face-to-face surveys with a convenience sample of 201 Vietnamese nail salon workers at 74 salons. Of the workers surveyed, a majority reported that they are concerned about their health from exposure to workplace chemicals. Additionally, a sizeable proportion reported having experienced some health problem after they began working in the industry, particularly acute health problems that may be associated with solvent exposure (e.g. skin and eye irritation, breathing difficulties and headaches). Our findings highlight a critical need for further investigation into the breast cancer risk of nail salon workers, underscored by the workers' routine use of carcinogenic and endocrine-disrupting chemicals, their prevalent health concerns about such chemicals, and their high level of acute health problems. Moreover, the predominance of Vietnamese immigrant women in this workforce makes it an important target group for further research and health interventions.
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Affiliation(s)
- Thu Quach
- Northern California Cancer Center, 2001 Center Street, Suite 700, Berkeley, CA 94704, USA.
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Medicaid re-enrollment policies and children's risk of hospitalizations for ambulatory care sensitive conditions. Med Care 2008; 46:1049-54. [PMID: 18815526 DOI: 10.1097/mlr.0b013e318185ce24] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many poor children rotate through the Medicaid program with periods of being uninsured. OBJECTIVE To determine health and cost consequences of a Medicaid policy change that extended the Medicaid eligibility redetermination period for children in California from 3 to 12 months. RESEARCH DESIGN A pre/postevaluation with a comparison group of a natural experiment. SUBJECTS All California children ages 1-17 years who received a minimum of 1 month of Medicaid coverage in 1999-2000 (3,288,171) and/or 2001-2002 (3,230,120). MEASURES The percentage of children with continuous Medicaid coverage and the hospitalization rate and costs for ambulatory care sensitive conditions in each time period. RESULTS In the 2 years before the policy change, 49% of children had continuous Medicaid coverage compared with 62% in the 2 years afterward (P < 0.0001). After adjusting for demographic and programmatic differences in the population of children in each time period, the relative hazard of a hospitalization for an ambulatory care sensitive condition for a child with at least 1 month of Medicaid coverage decreased to 0.74 (P < 0.0001) after the extension of the Medicaid enrollment period. There was dollars 17 million less in estimated hospitalization costs for ambulatory care sensitive conditions with less frequent eligibility redetermination that partially offset the estimated dollars 150 million in additional costs to Medicaid for providing more continuous coverage. CONCLUSIONS Reducing the frequency of eligibility redetermination for children in Medicaid was associated with higher costs to the program but more continuity of insurance coverage, improvements in health, and lower hospital spending.
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Pollitt RA, Clarke CA, Shema SJ, Swetter SM. California Medicaid enrollment and melanoma stage at diagnosis: a population-based study. Am J Prev Med 2008; 35:7-13. [PMID: 18482824 PMCID: PMC4350993 DOI: 10.1016/j.amepre.2008.03.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/21/2008] [Accepted: 03/11/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population. METHODS California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis. RESULTS Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment. CONCLUSIONS Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.
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Affiliation(s)
- Ricardo A Pollitt
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California 94305, USA
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Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY. Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer 2007; 110:403-11. [PMID: 17562557 DOI: 10.1002/cncr.22786] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals without medical insurance or with limited insurance are less likely than those with broader insurance coverage to receive preventive services and to seek timely medical care. The authors examined the associations of insurance status with stage at diagnosis among women with breast cancer. METHODS This study included women age >/=40 years who were diagnosed with invasive breast cancer from 1998 to 2003 and who were reported to the National Cancer Data Base. Multivariable logistic regression analyses were used to examine the associations of insurance status with more advanced-stage breast cancer at diagnosis while controlling for other patient characteristics. RESULTS Among the 533,715 women with breast cancer who were included in the current analysis, the proportions with advanced-stage (III/IV) cancer at diagnosis ranged from 8% among privately insured patients to 18% among uninsured patients and 19% among Medicaid patients; differences in the proportions of women with advanced-stage cancer were statistically significant (P < .0001). Regression analyses indicated that, compared with privately insured patients, uninsured patients and Medicaid patients had a greater likelihood of diagnosis at stage II (odds ratio [OR], approximately approximately 1.5) or at stages III/IV (OR, 2.4) versus stage I (P < .001). Black and Hispanic patients also were significantly more likely than white patients to be diagnosed at a more advanced stage (P < .001). CONCLUSIONS The results from this study provided strong evidence that patients without health insurance or with Medicaid coverage, as well as black and Hispanic patients, were more likely to present with advanced-stage breast cancer. These results are consistent with other reports that have documented less use of preventive services, including mammography, among uninsured women and delays in diagnosis and treatment for black and Hispanic women.
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Affiliation(s)
- Michael T Halpern
- Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia, USA.
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Koroukian SM, Xu F, Dor A, Cooper GS. Colorectal cancer screening in the elderly population: disparities by dual Medicare-Medicaid enrollment status. Health Serv Res 2007; 41:2136-54. [PMID: 17116113 PMCID: PMC1955310 DOI: 10.1111/j.1475-6773.2006.00585.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess the disparities in colorectal cancer (CRC) screening between elderly dual Medicare-Medicaid enrollees (or duals), the most vulnerable subgroup of the Medicare population, and nonduals. DATA SOURCES/STUDY SETTING The 1999 Medicare Denominator File, the Medicare Outpatient Standard Analytic Files, and Physician Supplier Part B files. In addition, the 1998 Area Resource File was used as a source for county-level attributes. DATA COLLECTION/EXTRACTION METHODS CRC screening procedures for 1999-fecal occult blood test (FOBT), flexible sigmoidoscopy (FLEX), colonoscopy with FOBT and/or FLEX (COL-WFF), and colonoscopy only (COL-ONLY)-were extracted from claim records, using diagnostic and procedure codes. Duals (n = 2.5 million) and nonduals (n = 20.2 million) receiving their care through the fee-for-service system were identified from the Denominator file. Hierarchical logistic regression analysis was conducted to adjust for individual- and county-level characteristics. PRINCIPAL FINDINGS Compared with nonduals, duals were disproportionately represented by female, older-old, and minority individuals (respectively 74.4 versus 58.5 percent; 19.3 versus 10.8 percent; 35.7 versus 8.0 percent), and CRC screening was significantly lower in duals than in nonduals (5.1 versus 12.2 percent for FOBT adjusted odds ratio [AOR]: 0.48, 95 percent confidence interval [CI]: 0.45-0.51); 0.7 versus 1.9 percent for FLEX, (AOR: 0.55, 95 percent CI: 0.49-0.61); 0.4 versus 0.8 percent for COL-WFF (AOR: 0.60, 95 percent CI: 0.54-0.67); and 1.8 versus 2.5 percent for COL-ONLY (AOR: 0.85, 95 percent CI: 0.80-0.89); p < .001 for all comparisons. CONCLUSIONS Duals are significantly less likely than nonduals to undergo CRC screening, even after adjusting for individual- and county-level covariates. Future studies should evaluate the contribution of comorbidity and low socioeconomic status to these disparities.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945, USA
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O'Malley CD, Shema SJ, Clarke LS, Clarke CA, Perkins CI. Medicaid status and stage at diagnosis of cervical cancer. Am J Public Health 2006; 96:2179-85. [PMID: 17077390 PMCID: PMC1698154 DOI: 10.2105/ajph.2005.072553] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid. METHODS Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status. RESULTS Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk. CONCLUSIONS Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.
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Chan JK, Gomez SL, O'Malley CD, Perkins CI, Clarke CA. Validity of Cancer Registry Medicaid Status Against Enrollment Files. Med Care 2006; 44:952-5. [PMID: 17001267 DOI: 10.1097/01.mlr.0000220830.46929.43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor access to or inadequate health insurance contributes to disparities in cancer incidence and mortality. Cancer registry "payer source" data is collected by many cancer registries in the United States and has been used to compare cancer outcomes across insurance types. OBJECTIVES We evaluated the validity of cancer registry data on patient Medicaid status against enrollment data from Medi-Cal, California's Medicaid program. METHODS Data from the statewide California Cancer Registry for persons under age 65 years diagnosed with 1) any cancer in 1998 and 1999 or 2) with invasive cervical cancer between 1996 and 1999 were obtained and linked probabilistically to Medi-Cal enrollment files. We compared registry Medicaid status, determined from payer source information, against linkage results and used crosstabulations to calculate sensitivity, specificity, and positive predictive value. These measures were compared across different hospital and patient characteristics and cancer types. RESULTS Cancer registry Medicaid status data had poor sensitivity (48%), good specificity (98%), and moderate positive predictive value (77%). Measures of validity did not vary substantially by cancer type, stage, patient age, sex, vital status, race/ethnicity, socioeconomic status, or diagnosing hospital size. Registry data undercounted the number of Medicaid patients by 52% and incorrectly assigned Medicaid as a payer to approximately 2% of patients. CONCLUSIONS As a result of the poor validity of cancer registry Medicaid status data, caution should be used when interpreting cancer outcomes by insurance type calculated from registry payer source data. Linkage of registry data to Medicaid enrollment files represents a more accurate means of identifying Medicaid insurance status.
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Affiliation(s)
- Jo Kay Chan
- Northern California Cancer Center, Fremont, CA 94538-2334, USA.
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Glaser SL, Clarke CA, Gomez SL, O'Malley CD, Purdie DM, West DW. Cancer Surveillance Research: a Vital Subdiscipline of Cancer Epidemiology. Cancer Causes Control 2005; 16:1009-19. [PMID: 16184466 DOI: 10.1007/s10552-005-4501-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 03/23/2005] [Indexed: 10/25/2022]
Abstract
Public health surveillance systems relevant to cancer, centered around population-based cancer registration, have produced extensive, high-quality data for evaluating the cancer burden. However, these resources are underutilized by the epidemiology community due, we postulate, to under-appreciation of their scope and of the methods and software for using them. To remedy these misperceptions, this paper defines cancer surveillance research, reviews selected prior contributions, describes current resources, and presents challenges to and recommendations for advancing the field. Cancer surveillance research, in which systematically collected patient and population data are analyzed to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time, has produced not only cancer statistics and etiologic hypotheses but also information for public health education and for cancer prevention and control. Data on cancer patients are now available for all US states and, within SEER, since 1973, and have been enhanced by linkage to other population-based resources. Appropriate statistical methods and sophisticated interactive analytic software are readily available. Yet, publication of papers, funding opportunities, and professional training for cancer surveillance research remain inadequate. Improvement is necessary in these realms to permit cancer surveillance research to realize its potential in resolving the growing cancer burden.
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Affiliation(s)
- Sally L Glaser
- Northern California Cancer Center, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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Davidson PL, Bastani R, Nakazono TT, Carreon DC. Role of community risk factors and resources on breast carcinoma stage at diagnosis. Cancer 2005; 103:922-30. [PMID: 15651072 DOI: 10.1002/cncr.20852] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study investigated the individual and community determinants of breast carcinoma stage at diagnosis (BCSAD) using multiple data sources merged with cancer registry data. The literature review yielded 5 studies that analyzed cancer registry data merged with community-level variables (1995-2004). METHODS Community variables constructed for the current study reflected social and economic risk factors, physician supply, and health maintenance organization penetration. Multivariate logistic regression was used to identify the significant predictors of increasingly progressive BCSAD. RESULTS Disparities remained for black and Hispanic females in California, who were least likely to be diagnosed early compared with their white counterparts. Younger (< 40 years) and middle-aged (40-64 years) females were less likely to be diagnosed with early BCSAD, compared with older females (> or = 65 years). Utilizing services at hospitals serving a lower volume of patients with breast carcinoma was associated with later BCSAD. After controlling for individual-level factors, community-level variables constructed at the census block group and county level were tested. If a woman resided in a neighborhood with greater percentages of female-headed households, persons living below the poverty level, less educated people, and more recent immigrants, then her chances of being diagnosed at an earlier stage were diminished. If, conversely, she resided in a neighborhood with greater percentages of females > or = 65 years (a proxy for Medicare coverage), her access to medical care and the probability of earlier BCSAD increased. County-level insurance rates and residing in counties where greater percentages of women ever had a mammogram were associated with in situ and early-stage diagnosis. Similarly, the supply of primary care physicians and radiologists was associated positively with earlier BCSAD. CONCLUSIONS Results confirmed community-level predictors of socioeconomic and delivery system context matter, although the individual-level predictors showed a stronger effect. Nevertheless, analysis of community variables is promising for guiding and evaluating the effects of health policy and developing community and delivery system interventions for earlier detection and treatment of breast carcinoma.
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Affiliation(s)
- Pamela L Davidson
- Department of Health Services, University of California at Los Angeles, Los Angeles, California 90092-1772, USA.
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Koroukian SM. Screening mammography was used more, and more frequently, by longer than shorter term Medicaid enrollees. J Clin Epidemiol 2004; 57:824-31. [PMID: 15485735 DOI: 10.1016/j.jclinepi.2004.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Recent studies have shown that timing and length of enrollment (LOE) in Medicaid in relation to cancer diagnosis are associated with stage of breast cancer among Medicaid beneficiaries. Whether LOE in Medicaid is also associated with the use of screening mammography (USM) is unclear, however. The objective was to determine whether USM among Medicaid beneficiaries is associated with LOE in Medicaid. STUDY DESIGN AND SETTING The study used Ohio Medicaid enrollment and claims files, and a cohort approach to estimate USM during the 8-year study period. USM was assessed through (a) the proportion of women receiving screening mammography, and (b) the frequency of screening mammography exams. This study used women 40-64 years of age enrolled in Ohio Medicaid during 1992-1999 (n=140,592). RESULTS The proportion of women receiving screening mammography increased significantly with each additional year of LOE [adjusted odds ratio (AOR): 1.59, 95% confidence interval (95% CI): 1.57-1.60], and was higher among women presenting comorbid conditions (AOR: 3.05; 95% CI: 2.90-3.20). The mean number of annual mammography exams increased from 0.08 among women with LOE < or = 12 months, to 0.26 among women with LOE > or = 7 years. CONCLUSION Both LOE and comorbid conditions are independently, significantly, and positively associated with USM, although their interactive effect relative to USM needs to be studied further. These findings have important implications in the methods employed to study use of cancer screening and other preventive services by Medicaid beneficiaries, as well as in Medicaid policy analysis and program management.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4945, USA.
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Affiliation(s)
- Michael J Pentecost
- Department of Radiology, Georgetown University Medical Center, Washington, DC 10007-2197, USA.
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Roos LL, Soodeen RA, Bond R, Burchill C. Working more productively: tools for administrative data. Health Serv Res 2003; 38:1339-57. [PMID: 14596394 PMCID: PMC1360950 DOI: 10.1111/1475-6773.00180] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This paper describes a web-based resource (http://www.umanitoba.ca/centres/mchp/concept/) that contains a series of tools for working with administrative data. This work in knowledge management represents an effort to document, find, and transfer concepts and techniques, both within the local research group and to a more broadly defined user community. Concepts and associated computer programs are made as "modular" as possible to facilitate easy transfer from one project to another. STUDY SETTING/DATA SOURCES Tools to work with a registry, longitudinal administrative data, and special files (survey and clinical) from the Province of Manitoba, Canada in the 1990-2003 period. DATA COLLECTION Literature review and analyses of web site utilization were used to generate the findings. PRINCIPAL FINDINGS The Internet-based Concept Dictionary and SAS macros developed in Manitoba are being used in a growing number of research centers. Nearly 32,000 hits from more than 10,200 hosts in a recent month demonstrate broad interest in the Concept Dictionary. CONCLUSIONS The tools, taken together, make up a knowledge repository and research production system that aid local work and have great potential internationally. Modular software provides considerable efficiency. The merging of documentation and researcher-to-researcher dissemination keeps costs manageable.
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Affiliation(s)
- Leslie L Roos
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Abstract
BACKGROUND Medicaid insurance promotes screening for early stage cancers. However, previous research suggests that Medicaid recipients are at risk for late stage disease. OBJECTIVE To identify differences in stage of diagnosis between cancer patients enrolled in Medicaid before versus after their disease was identified, as well as differences in diagnostic stage between Medicaid enrollees and other patients. DESIGN Analyses of a linked database including information from the 1996 and 1997 Michigan Cancer Registry and Medicaid enrollment files. PATIENTS All persons ages 25 to 64 diagnosed with incident cases of breast, cervical, colorectal, or lung cancer (n = 5852). Patients enrolled in Medicaid before their cancer diagnosis and those enrolled in the same month or after their diagnosis were identified. MAIN OUTCOME MEASURE Early (in situ, local) versus late (regional, distant, invasive/unknown) cancer stage at diagnosis was modeled using multivariate logistic regression. RESULTS In each site of disease with the exception of breast, persons who enrolled in Medicaid after a cancer diagnosis were approximately 2 to 3 times more likely to have late stage disease compared with persons who were enrolled in Medicaid before the month of diagnosis. Odds ratios (OR) and 95% confidence intervals (C.I.) were: 1.28 (95% C.I. = 0.95, 1.67) for breast cancer, 2.96 (95% C.I. = 1.85, 4.75) for cervical cancer, 2.08 (95% C.I. = 1.30, 3.33) for colorectal cancer, and 3.40 (95% C.I. = 2.13, 5.43) for lung cancer. Relative to non-Medicaid enrollees, Medicaid enrollees were 2 to 5 times more likely to be diagnosed with late stage disease. CONCLUSIONS 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.
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Affiliation(s)
- Cathy J Bradley
- Department of Medicine, Michigan State University, East Lansing 48824, USA.
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