Cancer, Medicaid enrollment, and survival disparities

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Abstract
BACKGROUND The current article examined survival for adults < 65 years old diagnosed with breast, colorectal, or lung carcinoma who were either Medicaid insured at the time of diagnosis, Medicaid insured after diagnosis, or non‐Medicaid insured. METHODS The authors hypothesized that subjects enrolling in Medicaid after they were diagnosed with cancer would explain disparate survival outcomes between Medicaid and non–Medicaid‐insured subjects. The authors used the Michigan Tumor Registry, a population‐based cancer registry covering the State of Michigan, to identify subjects who were diagnosed with the cancer sites of interest (n = 13,740). The primary outcome was all cause mortality over an 8‐year time period. RESULTS Subjects who enrolled in Medicaid after diagnosis with cancer had much lower 8‐year survival rates relative to Medicaid‐enrolled and non‐Medicaid subjects. These reductions in survival were partly due to a high proportion of lung carcinoma and late‐stage cancers within the sample of subjects who enrolled in Medicaid after diagnosis. The likelihood of death was two to three times greater for subjects enrolled in Medicaid relative to subjects who were not enrolled in Medicaid once the analysis was stratified by cancer site and stage. CONCLUSIONS Disparities in cancer survival were apparent between subjects enrolled in Medicaid and subjects not enrolled in Medicaid. From a policy perspective, cancer survival in the Medicaid population cannot be improved as long as 40% of the population enrolls in Medicaid after diagnosis with late‐stage disease. Cancer 2005. © 2005 American Cancer Society.