Disparities in cancer diagnosis and survival

BACKGROUND. Concern has been raised over the disproportionate cancer mortal ity among minority and low-income persons. The current study examined diffe rences in disease stage at the time of diagnosis and subsequent survival fo r patients who are medically indigent compared with the rest of the populat ion of cancer patients in Michigan. METHODS. The authors linked three Michigan statewide data bases: the Cancer Registry, Medicaid enrollment files, and death certificates. The analysis focused on female breast, cervix, lung, prostate, and colon carcinoma, and differences were analyzed in the incidence, disease stage at the time of di agnosis, and survival between younger women and older women who were either insured or not insured by Medicaid. To estimate the risk of late stage dia gnosis and death, the authors used logistic regression, controlling for age , race, and Medicaid enrollment. Ordered logit models also were used as a r efinement of disease stage prediction. RESULTS. Medically indigent persons had a disproportionately larger share o f cancer. Persons age < 65 years who were insured by Medicaid had the great est risk of late stage diagnosis and death across all five disease sites an alyzed. African-American women had a greater risk of death from breast carc inoma compared with other women independent of Medicaid status. No interact ion effects were found between age, race, and/or gender and Medicaid enroll ment. CONCLUSIONS. The results of this study showed that the disparities in cance r outcomes may be greater than previously thought and are consistent across disease sites. If advancements made in cancer control are to be shared by the low-income population, then improvements clearly are needed in cancer p revention, early detection, and treatment for the poor. Cancer 2001;91:178- 88. (C) 2001 American Cancer Society.