title: Gynecologic cancer outcomes in the elderly poor: A population-based study.
abstract: BACKGROUND
  Adults aged ≥65 years who are dually enrolled in Medicare and Medicaid are an at-risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown.
  
  
  METHODS
  The current study was a population-based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar/vaginal cancers (2003-2009), with linked enrollment in Medicare and state Medicaid. Outcomes of all-cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves.
  
  
  RESULTS
  Of 4522 women aged ≥65 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar/vaginal (8%) cancers. Dual enrollees had increased all-cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19-1.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02-1.47]; ovarian: aHR, 1.25 [95% CI, 1.05-1.49]; cervical: aHR, 1.34 [95% CI, 0.96-1.87]; and vulvar/vaginal: aHR, 1.93 [95% CI, 1.36-2.72]). Increased odds of advanced-stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06-1.79). Stratified survival curves demonstrated the strongest disparities among women with early-stage uterine and early-stage vulvar/vaginal cancers.
  
  
  CONCLUSIONS
  Women aged ≥65 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all-cause mortality after diagnosis with a gynecologic cancer compared with the non-dually enrolled Medicare population. Women with early-stage uterine and vulvar/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.|Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Kemi M
authors.initials: KM
authors.lastname: Doll
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Ke
authors.initials: K
authors.lastname: Meng
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Basch
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Brewster
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063026:Dual Medicare Medicaid Eligibility; D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008483:Medical Assistance / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis
keywords: Medicaid; Medicare; aged; female genital neoplasms; outcomes research