Impact of Medicaid Enrollment Timing on Tumor Stage at Diagnosis and Survival in Breast, Colorectal, and Lung Cancer

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Abstract
Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific survival for breast, colorectal, and lung cancers. Methods: We analyzed SEER-Medicaid linked data for 276,755 breast, 104,784 colorectal, and 101,058 lung cancer patients < 65 years of age. Patients were categorized as non-Medicaid enrollees, pre-diagnosis enrollees (≥12 months before), or post-diagnosis enrollees (≤12 months after). Multivariable logistic regression estimated odds ratios of late-stage diagnosis, and cause-specific Cox proportional hazards models were used to assess cancer-specific survival, adjusting for demographic and socioeconomic factors. Results: Compared to non-Medicaid enrollees, post-diagnosis enrollees had the highest odds of late-stage diagnosis (breast cancer: OR: 3.41; colorectal cancer: OR: 3.78; lung cancer: OR: 1.87). Pre-diagnosis enrollees also had increased odds, but the association was weaker than post-diagnosis enrollees. Cancer-specific mortality was higher for both pre- and post-diagnosis enrollees compared to non-Medicaid enrollees for each cancer examined across tumor stage at diagnosis. Among Medicaid enrollees, those enrolled post-diagnosis had higher cancer-specific mortality than those enrolled pre-diagnosis for localized-stage colorectal (HR: 1.82) and lung cancer (HR: 1.30). In contrast, those enrolled post-diagnosis had lower mortality than those enrolled pre diagnosis for distant-stage breast cancer (HR: 0.91). Conclusions: Compared with cancer patients not insured by Medicaid, post-diagnosis Medicaid enrollment was associated with a greater likelihood of late-stage cancer and worse cancer-specific survival across each cancer type examined. Future research is warranted to examine the role of Medicaid enrollment timing in cancer care to better understand its impact on cancer outcomes.
Funding Information
  • University of South Carolina
  • National Institutes of Health (NIH) National Institute of General Medical Science (T32-GM081740)

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