Cancer stage comparison between dual Medicare-Medicaid eligibles using Medicaid as a supplemental health insurance program and low-income nonduals.

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.

Complexity of care needs and unstaged cancer in elders: a population-based study.

BACKGROUND: Little is known about the contribution of older patients' complexity of care needs (COCN) to unstaged cancer, or incomplete evaluation of the extent of disease. We aimed at examining the association between the patients' COCN at baseline and unstaged cancer. METHODS: The study used linked databases consisting of the Ohio Cancer Incidence Surveillance System (OCISS), Medicare and Medicaid enrollment files, the home health care Outcome and Assessment Information Set (OASIS), and the Long Term Care Minimum Data Set (MDS). The study population included patients 65 years of age or older diagnosed with incident breast (n=4,404), prostate (n=5,334), or colorectal cancer (n=4,822) in year 2000. The outcome of interest was unstaged cancer. Patients were identified with high COCN if they were admitted to a nursing home, with moderate COCN if they received home health services, and with low COCN if they were neither admitted to a nursing home nor received home health services, at baseline, or in the 6 months prior to cancer diagnosis. We employed logistic regression analyses to evaluate the independent association between COCN and unstaged cancer after adjusting for patient demographics and socioeconomic attributes. RESULTS: The proportion of unstaged cases increased significantly with older age, by Medicaid status, and by COCN at baseline. Compared with patients with low COCN, those with higher complexity were four to five times as likely to have unstaged cancer. CONCLUSION: The occurrence of unstaged cancer follows a systematic pattern of increase by age, Medicaid status, and COCN at baseline.

Analysis of injury- and violence-related fatalities in the Ohio Medicaid population: identifying opportunities for prevention.

BACKGROUND: To identify the leading causes of injury- and violence-related deaths in demographic subgroups of the population in Ohio, by Medicaid status. METHODS: We used linked Ohio Medicaid and death certificate files, 1992 to 1998, and obtained the probability (p) of dying from a specific mechanism of injury--given death from injury--by Medicaid status, using multinomial multivariable logistic regression analysis. Probabilities were rank-ordered to identify the leading causes of death in each subgroup. RESULTS: The leading cause of injury-related deaths was homicide among Medicaid decedents in the age groups 0 to 4, 15 to 24, and 25 to 44 (p = 0.283, 0.380, and 0.269, respectively), and motor vehicle crashes among nonMedicaid decedents aged 5 to 14, 15 to 24, 25 to 44, and 45 to 74 (p = 0.448, 0.462, 0.293, and 0.293, respectively). Accidental falls ranked first among the elderly (p = 0.593 and 0.414, respectively in Medicaid and nonMedicaid decedents). Suicide and accidental exposure to smoke, fire, and flames also ranked high among the leading causes of injury-related deaths in many population subgroups. CONCLUSIONS: Findings from this study, pointing to the vulnerability of population subgroups to certain mechanisms of injury, can be used to formulate targeted prevention strategies.

End-of-life expenditures by Ohio Medicaid beneficiaries dying of cancer.

We evaluate the extent to which the Ohio Medicaid Program serves as a safety net to terminally ill cancer patients, and the costs associated with providing care to this patient population. Over a 10-year period, Ohio Medicaid served nearly 45,000 beneficiaries dying of cancer, and spent more than $1 billion in medical care expenditures in their last year of life. Eighty percent of the expenditures were incurred by 67 percent of the decedents who had been enrolled in Medicaid for at least 1 year before death, implying an opportunity for the Medicaid Program to ensure timely transition to palliative care and hospice.