Cancer stage at diagnosis and survival among persons with Social Security Disability Insurance on Medicare.
OBJECTIVE
To examine stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with cancer under age 65 and compare their experiences with those of other persons diagnosed under age 65.


METHODS
Surveillance, Epidemiology, and End Results (SEER) Program data and SEER-Medicare linked data for 1988-1999. SEER-11 Program includes 11 population-based tumor registries collecting information on all incident cancers in catchment areas. Tumor registry and Medicare data are linked for persons enrolled in Medicare.


METHODS
307,595 incident cases of non-small cell lung (51,963), colorectal (52,092), breast (142,281), and prostate (61,259) cancer diagnosed in persons under age 65 from 1988 to 1999. Persons who qualified for Social Security Disability Insurance and had Medicare (SSDI/Medicare) were identified from Medicare enrollment files. Ordinal polychotomous logistic regression and Cox proportional hazards regression were used to estimate adjusted associations between disability status and later-stage diagnoses and mortality (all-cause and cancer-specific).


RESULTS
Persons with SSDI/Medicare had lower rates of Stages III/IV diagnoses than others for lung (63.3 versus 69.5 percent) and prostate (25.5 versus 30.8 percent) cancers, but not for breast or colorectal cancers. After adjustment, they remained less likely to be diagnosed at later stages for lung and prostate cancers. Nevertheless, persons with SSDI/Medicare experienced higher all-cause mortality for each cancer. Cancer-specific mortality was higher among persons with SSDI/Medicare for breast and colorectal cancer patients.


CONCLUSIONS
Disabled Medicare beneficiaries are diagnosed with cancer at similar or earlier stages than others. However, they experience higher rates of cancer-related mortality when diagnosed at the same stage of breast and colorectal cancer.
McCarthy
Ellen P
EP
Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/RO-139, Boston, MA 02215, USA.
Ngo
Long H
LH
Chirikos
Thomas N
TN
Roetzheim
Richard G
RG
Li
Donglin
D
Drews
Reed E
RE
Iezzoni
Lisa I
LI
D000328:Adult; D000368:Aged; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D017533:Marital Status; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D044469:Racial Groups; D018426:SEER Program; D012943:Social Security / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States