The <scp>B</scp>reast and <scp>C</scp>ervical <scp>C</scp>ancer <scp>E</scp>arly <scp>D</scp>etection <scp>P</scp>rogram, <scp>M</scp>edicaid, and breast cancer outcomes among Ohio's underserved women

Koroukian, Siran M.; Bakaki, Paul M.; Htoo, Phyo T.; Xiao, Han; Schluchter, Mark D.; Owusu, Cynthia; Cooper, Gregory S.; Rose, Johnie; Flocke, Susan A.

doi:10.1002/cncr.30720

Cited by 17 publications

(33 citation statements)

References 42 publications

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“…Previous studies have shown that prediagnosis enrollees have more favorable cancer survival outcomes compared with peridiagnosis/postdiagnosis enrollees, perhaps reflecting the better access to care for prediagnosis enrollees. 40,41 In addition, prediagnosis enrollees may be more likely to present for care in the face of early cancer symptoms.…”

Section: Discussionmentioning

confidence: 99%

The effect of Medicaid expansion among adults from low‐income communities on stage at diagnosis in those with screening‐amenable cancers

Kim

Koroukian²,

Statler

et al. 2020

Cancer

Self Cite

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Background Several states have opted to expand Medicaid under the Patient Protection and Affordable Care Act (ACA), which offers insurance coverage to low‐income individuals up to 138% of the federal poverty level. This expansion of Medicaid to a medically vulnerable population potentially can reduce cancer outcome disparities, especially among patients with screening‐amenable cancers. The objective of the current study was to estimate the effect of Medicaid expansion on the percentage of adults from low‐income communities with screening‐amenable cancers who present with metastatic disease. Methods Using state cancer registry data linked with block group–level income data, a total of 12,760 individuals aged 30 to 64 years who were diagnosed with incident invasive breast (female), cervical, colorectal, or lung cancer from 2011 through 2016 and who were uninsured or had Medicaid insurance at the time of diagnosis were identified. This sample was probability weighted based on income to reflect potential Medicaid eligibility under the ACA's Medicaid expansion. A multivariable logistic model then was fitted to examine the independent association between the exposure (pre‐expansion [years 2011‐2013] vs postexpansion [years 2014‐2016]) and the outcome (metastatic vs nonmetastatic disease at the time of diagnosis). Results After adjusting for potential confounders, individuals who were diagnosed postexpansion were found to have 15% lower odds of having metastatic disease compared with those who were diagnosed pre‐expansion (adjusted odds ratio, 0.85; 95% confidence interval, 0.77‐0.93). As a control, a separate analysis that focused on individuals with private insurance who resided in high‐income communities found nonsignificant postexpansion (vs pre‐expansion) changes in the outcome (adjusted odds ratio, 1.02; 95% confidence interval, 0.96‐1.09). Conclusions Medicaid expansion is associated with a narrowing of a critical cancer outcome disparity in adults from low‐income communities.

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Section: Discussionmentioning

confidence: 99%

The effect of Medicaid expansion among adults from low‐income communities on stage at diagnosis in those with screening‐amenable cancers

Kim

Koroukian²,

Statler

et al. 2020

Cancer

Self Cite

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show abstract

“…Among the 13 studies that examined coverage disruptions and stage of disease at diagnosis, details for study populations, settings, measures of coverage disruptions and outcomes, comparison groups, and key findings are listed in Table 3 (33,34,40,41,(43)(44)(45)(46)(47)(48)(49)(50)(51). Each of these studies examined timing of Medicaid enrollment in a single state, including California, Michigan, New Jersey, North Carolina, Ohio, or Washington.…”

Section: Stage Of Disease At Diagnosismentioning

confidence: 99%

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

Yabroff

Reeder‐Hayes

Zhao

et al. 2020

JNCI: Journal of the National Cancer Institute

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Abstract Background Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival. Methods We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively. Results Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions. Conclusions Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes.

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“…In addition, the linked data set benefits cancer registries by identifying potentially missed cancer cases and providing missing race data. For example, studies have been performed using the data set to compare stage of disease at the time of diagnosis with screening histories among women with cancer …”

Section: Cancer Control Programsmentioning

confidence: 99%

“…For example, studies have been performed using the data set to compare stage of disease at the time of diagnosis with screening histories among women with cancer. [34][35][36]…”

Section: National Breast and Cervical Cancer Early Detection Programmentioning

confidence: 99%

The history and use of cancer registry data by public health cancer control programs in the United States

White

Babcock

Hayes

et al. 2017

Cancer

101

105

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Because cancer registry data provide a census of cancer cases, registry data can be used to: 1) define and monitor cancer incidence at the local, state, and national levels; 2) investigate patterns of cancer treatment; and 3) evaluate the effectiveness of public health efforts to prevent cancer cases and improve cancer survival. The purpose of this article is to provide a broad overview of the history of cancer surveillance programs in the United States, and illustrate the expanding ways in which cancer surveillance data are being made available and contributing to cancer control programs. The article describes the building of the cancer registry infrastructure and the successful coordination of efforts among the 2 federal agencies that support cancer registry programs, the Centers for Disease Control and Prevention and the National Cancer Institute, and the North American Association of Central Cancer Registries. The major US cancer control programs also are described, including the National Comprehensive Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, and the Colorectal Cancer Control Program. This overview illustrates how cancer registry data can inform public health actions to reduce disparities in cancer outcomes and may be instructional for a variety of cancer control professionals in the United States and in other countries.

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The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women

Abstract: Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society.

Cited by 17 publications

References 42 publications

The effect of Medicaid expansion among adults from low‐income communities on stage at diagnosis in those with screening‐amenable cancers

The effect of Medicaid expansion among adults from low‐income communities on stage at diagnosis in those with screening‐amenable cancers

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

The history and use of cancer registry data by public health cancer control programs in the United States

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