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Survival disparities by Medicaid status: an analysis of 8 cancers

. 2012 Sep 1;118(17):4271-9. doi: 10.1002/cncr.27380. Epub 2011 Dec 27. Survival disparities by Medicaid status: an analysis of 8 cancers

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Survival disparities by Medicaid status: an analysis of 8 cancers

Siran M Koroukian et al. Cancer. 2012.

. 2012 Sep 1;118(17):4271-9. doi: 10.1002/cncr.27380. Epub 2011 Dec 27. Affiliation

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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.

Copyright © 2011 American Cancer Society.

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Figures

Figure 1. Disease-Specific Survival of by Medicaid…

Figure 1. Disease-Specific Survival of by Medicaid Status – All Cancer Sites Combined

KM All…

Figure 1. Disease-Specific Survival of by Medicaid Status – All Cancer Sites Combined

KM All Log-Rank = 323.2, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

Figure 2. Disease-Specific Survival of by Medicaid…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder…

Figure 2. Disease-Specific Survival of by Medicaid Status – Cancer Site Specific

Figure 2A Bladder Log-Rank = 15.3, p = 0.0005 Figure 2B Colon Log-Rank = 47.2, p < .0001 Figure 2C Hodgkin’s Lymphoma Log-Rank = 13.1, p = 0.0014 Figure 2D Non Hodgkin’s Lymphoma Log-Rank = 24.2, p < .0001 Figure 2E Lung Log-Rank = 14.1, p = 0.0009 Figure 2F Melanoma Log-Rank = 55.7, p < .0001 Figure 2G Pediatric Malignancies Log-Rank = 3.1, p = 0.2139 Figure 2H Testicular Log-Rank = 138.7, p < .0001

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