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Cancer Stage Comparison Between Dual Medicare-Medicaid Eligibles Using Medicaid as a Supplemental Health Insurance Program and Low-Income Nonduals

Koroukian, Siran M. PhD; Bakaki, Paul M. MD, MS; Beaird, Heather PhD; Earle, Craig C. MD, MSc; Cooper, Gregory S. MD, MA

Journal of Public Health Management & Practice: November/December 2011 - Volume 17 - Issue 6 - p 479–491
doi: 10.1097/PHH.0b013e31821a3f8c
Original Articles

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.

This study aims 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.

Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (Drs Koroukian, Bakaki, and Cooper); Cancer Aging Program, Case Comprehensive Cancer Center (Dr Koroukian); Summit County Department of Health, Ohio (Dr Beaird, formerly of the Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University); Ontario Institute for Cancer Research and Cancer Care Ontario (Dr Earle); and Department of Internal Medicine, Division of Gastroenterology, University Hospitals Case Medical Center (Dr Cooper).

Correspondence: Siran M. Koroukian, PhD, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106 (skoroukian@case.edu).

This study was supported by a Career Development Grant from the National Cancer Institute (K07 CA096705 to Dr Koroukian).

The authors thank Ms Georgette Haydu of the Ohio Department of Health, which maintains the Ohio Cancer Incidence Surveillance System, and Mr James Gearheart of the Ohio Department of Job and Family Services, which administers the Ohio Medicaid program, for their careful review of the manuscript. The authors also thank Ms Kristen Mikelbank, MA, formerly of the Mandel School of Applied Social Sciences, Case Western Reserve University, currently with the Cleveland Foodbank, for her work in geocoding; and Ms Fang Xu, MS, PhD Candidate, for her earlier work with the present data.

Disclosure: The authors declare no conflict of interest.

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