title: Cancer disparities in the context of Medicaid insurance: a comparison of survival for acute myeloid leukemia and Hodgkin's lymphoma by Medicaid enrollment.
abstract: BACKGROUND
  Because poverty is difficult to measure, its association with outcomes for serious illnesses such as hematologic cancers remains largely uncharacterized. Using Medicaid enrollment as a proxy for poverty, we aimed to assess potential disparities in survival after a diagnosis of acute myeloid leukemia (AML) or Hodgkin's lymphoma (HL) in a nonelderly population.
  
  
  METHODS
  We used records from the New York (NY) and California (CA) state cancer registries linked to Medicaid enrollment records for these states to identify Medicaid enrolled and nonenrolled patients aged 21-64 years with incident diagnoses of AML or HL in 2002-2006. We compared overall survival for the two groups using Kaplan-Meier curves and Cox proportional hazards analyses adjusted for sociodemographic and clinical factors.
  
  
  RESULTS
  For HL, the adjusted risk for death for Medicaid enrolled compared with nonenrolled patients was 1.98 (95% confidence interval [CI], 1.47-2.68) in NY and 1.89 (95% CI, 1.43-2.49) in CA. In contrast, for AML, Medicaid enrollment had no effect on survival (adjusted hazard ratio, 1.00; 95% CI, 0.84-1.19 in NY and hazard ratio, 1.02; 95% CI, 0.89-1.16 in CA). These results persisted despite adjusting for race/ethnicity and other factors.
  
  
  CONCLUSIONS
  Poverty does not affect survival for AML patients but does appear to be associated with survival for HL patients, who, in contrast to AML patients, require complex outpatient treatment. Challenges for the poor in adhering to treatment regimens for HL could explain this disparity and merit further study.
authors.affiliation: Department of Medical Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Yung
authors.forename: Kun
authors.initials: K
authors.lastname: Chen
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
authors.forename: Foster C
authors.initials: FC
authors.lastname: Gesten
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Roohan
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe
authors.forename: Amber H
authors.initials: AH
authors.lastname: Sinclair
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schymura
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D002140:California; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006689:Hodgkin Disease / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007341:Insurance; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009518:New York; D011203:Poverty; D012042:Registries; D014481:United States / Q000453:epidemiology