Siran M. Koroukian,1,2 Paul M. Bakaki,1 Cynthia Owusu,3 Craig C. Earle,4 Gregory S. Cooper1,2,3
1Case Western Reserve University 2Case Comprehensive Cancer Center 3University Hospitals Case Medical Center 4Ontario Institute for Cancer Research and Cancer Care
Background: Because of reduced financial barriers, dual Medicare-Medicaid enrollment of low-income Medicare beneficiaries may be associated with receipt of definitive cancer treatment and favorable survival outcomes. Methods: We used a database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Medicaid files, death certificates, and U.S. Census data. The study population included community-dwelling Medicare fee-for-service beneficiaries, age 66 years or older, with low incomes, residing in Ohio, and diagnosed with incident loco-regional breast (n=838), colorectal (n=784), or prostate cancer (n=946) in years 1997–2001. We identified as “duals” Medicare beneficiaries who were enrolled in Medicaid at least three months prior to cancer diagnosis. Multivariable logistic regression and survival models were developed to analyze the association between dual status and (1) receipt of definitive treatment; and (2) overall and disease-specific survival, after adjusting for tumor stage and patient covariates. Results: Dual status was associated with a significantly lower likelihood to receive definitive treatment among colorectal cancer patients (Adjusted Odds Ratio: 0.60, 95% Confidence Interval, or CI, [0.38, 0.95]), but not among breast or prostate cancer patients. Furthermore, dual status was associated with decreased overall survival among prostate cancer patients (Adjusted Hazard Ratio, or AHR, 1.45, 95% CI [1.05, 2.02]), and decreased disease-specific survival among colorectal cancer patients (AHR: 1.52 [1.05, 2.19]). Conclusion: Enrollment of low-income Medicare beneficiaries in Medicaid is not associated with favorable treatment patterns or survival outcomes. Differences in health and functional status between community-dwelling duals and non-duals might help explain the observed disparities.
Keywords: Dually Eligible; Low-Income Medicare-Medicaid Beneficiaries; Cancer-Related Outcomes; Breast Cancer; Colorectal Cancer; Prostate Cancer; Cancer treatment; Linked Databases