title: Treatment patterns and survival among low-income medicaid patients with head and neck cancer.
abstract: OBJECTIVE
  Medicaid beneficiaries by definition are low income but they are not necessarily a homogeneous group. No study has assessed differences and disparities among Medicaid beneficiaries with head and neck cancers.
  
  
  OBJECTIVE
  To examine predictors of treatment receipt and mortality among Medicaid patients with head and neck cancer.
  
  
  METHODS
  Retrospective cohort study using Medicaid claims linked with cancer registry data for 2 states, California and Georgia, for the years 2002 through 2006.
  
  
  METHODS
  Inpatient and ambulatory care.
  
  
  METHODS
  Medicaid beneficiaries aged 18 to 64 years diagnosed as having head and neck cancer (N = 1308) were included. Descriptive statistics and multivariate regression models analyzed the likelihood of treatment receipt and survival.
  
  
  METHODS
  Receipt of treatment and 12- and 24-month mortality.
  
  
  RESULTS
  Fewer than one-third of Medicaid patients with cancer received a diagnosis at an early stage. Overall, black patients were less likely to get surgical treatment and more likely to die than white patients, even after controlling for demographics, stage at diagnosis, and tumor site. Older age and disability status also increased 12-month mortality. Patients in California, who were alive for at least 12 months, have approximately half the odds of dying within 24 months compared with those in Georgia.
  
  
  CONCLUSIONS
  Concrete steps should be taken to address the significant racial disparities observed in head and neck cancer outcomes among Medicaid beneficiaries. Further research is needed to explore the state-level policies and attributes to examine the startling differences in mortality among the state Medicaid programs analyzed in this study. Pooled comparisons of Medicaid beneficiaries with individuals covered by other types of insurance could mask important disparities among Medicaid beneficiaries, which need to be acknowledged and addressed to improve outcomes for these low-income patients with head and neck cancer.
authors.affiliation: RTI International, Waltham, Massachusetts, USA. ssubramanian@rti.org
authors.forename: Sujha
authors.initials: S
authors.lastname: Subramanian
authors.forename: Amy
authors.initials: A
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D002140:California; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D016208:Databases, Factual; D042241:Early Diagnosis; D005260:Female; D005845:Georgia; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D020380:Needs Assessment; D016017:Odds Ratio; D011203:Poverty; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American