Diagnosis of advanced cancer among elderly medicare and medicaid patients
Diagnosis of advanced cancer among elderly medicare and medicaid patients
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DOI：
10.1097/01.mlr.0000256970.19359.2a
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发表时间：
2007-05-01
期刊：
影响因子：
3
通讯作者：
Virnig, Beth A.
中科院分区：
文献类型：
--
作者：
Bradley, Cathy J.;Given, Charles W.;Virnig, Beth A.
背景：医疗补助与晚期癌症诊断有关，这是预后不良的主要指标。目的：我们检查了66岁及以上患者的医疗补助登记和癌症诊断。医疗补助登记的定义为确诊前12个月以上登记，确诊前12个月登记，确诊后登记。研究对象：医疗补助和医疗保险管理数据与密歇根州肿瘤登记中心合并，从1997至2000年间首次诊断为前列腺癌、肺癌、乳腺癌或结直肠癌的46,109名患者中抽取样本。结果：在确诊前12个月参加Medicaid<的患者在死亡当月被诊断为乳腺癌(优势比[OR]=2.70；95%可信区间[95%CI]=1.22-5.99)和肺癌(OR=2.18；95%CI=1.45-3.29)的风险比仅参加Medicaid<；的患者高。同样，有医疗补助登记史的患者被诊断为浸润性、但未知的乳腺癌、肺癌和前列腺癌的风险很高。与仅参加医疗保险的患者相比，参加医疗补助的患者患晚期结直肠癌(OR=1.30；95%CI=1.01-1.67)、乳腺癌(OR=2.12；95%CI=1.60-2.82)和肺癌(OR=1.33；95%CI=1.02-1.75)的风险更高。在医疗补助人群中，死亡时的癌症诊断和具有侵袭性但未知阶段的癌症诊断的比例很高，但这些诊断的适当性尚不清楚。晚期癌症往往会促使医疗补助计划的加入。
Background: Medicaid is implicated in late-stage cancer diagnoses, which is the primary indicator of a poor prognosis.Objective: We examined Medicaid enrollment and cancer diagnosis in patients ages 66 years and older. Medicaid enrollment was defined as enrolled 12+ months before diagnosis, enrolled < 12 months before diagnosis, and enrolled after diagnosis.Subjects: Medicaid and Medicare administrative data were merged with the Michigan Tumor Registry to extract a sample of 46,109 patients with a first primary diagnosis of prostate, lung, breast, or colorectal cancer between 1997 and 2000. Measures were: (1) diagnosed during the same month as death; (2) invasive, but unknown stage; and (3) regional or distant stage disease.Results: Patients enrolled in Medicaid < 12 months before diagnosis were at greater risk of breast (odds ratio [OR] = 2.70; 95% confidence interval [95% CI] = 1.22-5.99) and lung (OR = 2.18; 95% Cl = 1.45-3.29) cancer diagnosis in the month of death than Medicare only patients. Similarly, patients with a history of Medicaid enrollment had a high risk of diagnosis with invasive, but unknown breast, lung, and prostate cancer stage. Patients enrolled in Medicaid following diagnosis had a higher risk of late stage colorectal (OR = 1.30; 95% CI = 1.01-1.67), breast (OR = 2.12; 95% CI = 1.60-2.82), and lung (OR = 1.33; 95% CI = 1.02-1.75) cancer relative to Medicare only patients.Conclusions: There is a preponderance. of cancer diagnosis at death and cancer diagnosis with invasive but unknown stage in the Medicaid population, but the appropriateness of these diagnoses is unclear. Late-stage cancer tends to precipitate Medicaid enrollment.