title: Diagnosis of advanced cancer among elderly Medicare and Medicaid patients.
abstract: 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.
  
  
  METHODS
  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% CI = 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.
authors: Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia 23298-0203, USA. cjbradley@vcu.edu
authors: Cathy J
authors: CJ
authors: Bradley
authors: Charles W
authors: CW
authors: Given
authors: Bassam
authors: B
authors: Dahman
authors: Zhehui
authors: Z
authors: Luo
authors: Beth A
authors: BA
authors: Virnig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008824:Michigan / Q000453:epidemiology; D009367:Neoplasm Staging; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology