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Diagnosis of Advanced Cancer among Elderly Medicare and Medicaid Patients

Cathy J. Bradley, Charles W. Given, Bassam Dahman, Zhehui Luo and Beth A. Virnig
Medical Care
Vol. 45, No. 5 (May, 2007), pp. 410-419
Stable URL: http://www.jstor.org/stable/40221442
Page Count: 10
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Diagnosis of Advanced Cancer among Elderly Medicare and Medicaid Patients
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Abstract

Background: Medicaid is implicated in late-stage cancer diagnoses, which is the primary indicator of a poor prognosis. Objective: We examined Medicaid enrollment and cancer diagnosis in patients ages 66 years and older. Medicaid enrollment was defined as enrolled 12+ months before diagnosis, enrolled < 12 months before diagnosis, and enrolled after diagnosis. Subjects: Medicaid and Medicare administrative data were merged with the Michigan Tumor Registry to extract a sample of 46,109 patients with a first primary diagnosis of prostate, lung, breast, or colorectal cancer between 1997 and 2000. Measures were: (1) diagnosed during the same month as death; (2) invasive, but unknown stage; and (3) regional or distant stage disease. Results: Patients enrolled in Medicaid < 12 months before diagnosis were at greater risk of breast (odds ratio [OR] = 2.70; 95% confidence interval [95% CI] = 1.22-5.99) and lung (OR = 2.18; 95% CI = 1.45-3.29) cancer diagnosis in the month of death than Medicare only patients. Similarly, patients with a history of Medicaid enrollment had a high risk of diagnosis with invasive, but unknown breast, lung, and prostate cancer stage. Patients enrolled in Medicaid following diagnosis had a higher risk of late stage colorectal (OR = 1.30; 95% CI = 1.01-1.67), breast (OR = 2.12; 95% CI = 1.60-2.82), and lung (OR = 1.33; 95% CI = 1.02-1.75) cancer relative to Medicare only patients. Conclusions: There is a preponderance of cancer diagnosis at death and cancer diagnosis with invasive but unknown stage in the Medicaid population, but the appropriateness of these diagnoses is unclear. Late-stage cancer tends to precipitate Medicaid enrollment.

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