title: California Medicaid enrollment and melanoma stage at diagnosis: a population-based study.
abstract: BACKGROUND
  Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population.
  
  
  METHODS
  California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis.
  
  
  RESULTS
  Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment.
  
  
  CONCLUSIONS
  Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.
authors.affiliation: Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Pollitt
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Shema
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008545:Melanoma / Q000208:ethnology / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D012878:Skin Neoplasms / Q000208:ethnology / Q000473:pathology*; D012923:Social Class; D014481:United States