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Cancer Stage in American Indians and Alaska Natives Enrolled in Medicaid.

https://arctichealth.org/en/permalink/ahliterature289339
Source
Am J Prev Med. 2016 Sep; 51(3):368-72
Publication Type
Journal Article
Date
Sep-2016
Author
Scott V Adams
Andrea N Burnett-Hartman
Andrew Karnopp
Aasthaa Bansal
Stacey A Cohen
Victoria Warren-Mears
Scott D Ramsey
Author Affiliation
Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Electronic address: sadams@fredhutch.org.
Source
Am J Prev Med. 2016 Sep; 51(3):368-72
Date
Sep-2016
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Alaska Natives - statistics & numerical data
California - epidemiology
Female
Humans
Incidence
Indians, North American - statistics & numerical data
Male
Medicaid
Middle Aged
Neoplasm Staging
Neoplasms - epidemiology - ethnology
Oregon - epidemiology
Population Surveillance
Registries
United States
Washington - epidemiology
Abstract
Nationally, a greater proportion of American Indians and Alaska Natives (AI/ANs) are diagnosed with advanced-stage cancers compared with non-Hispanic whites. The reasons for observed differences in stage at diagnosis between AI/ANs and non-Hispanic whites remain unclear.
Medicaid, Indian Health Service Care Systems, and state cancer registry data for California, Oregon, and Washington (2001-2008, analyzed in 2014-2015) were linked to identify AI/ANs and non-Hispanic whites diagnosed with invasive breast, cervical, colorectal, lung, or prostate cancer. Logistic regression was used to estimate ORs and 95% CIs for distant disease versus local or regional disease, in AI/ANs compared with non-Hispanic white case patients.
A similar proportion of AI/AN (31.2%) and non-Hispanic white (35.5%) patients were diagnosed with distant-stage cancer in this population (AOR=1.03, 95% CI=0.88, 1.20). No significant differences in stage at diagnosis were found for any individual cancer site. Among AI/ANs, Indian Health Service Care Systems eligibility was not associated with stage at diagnosis.
In contrast to the general population of the U.S., among Medicaid enrollees, AI/AN race is not associated with later stage at diagnosis. Cancer survival disparities associated with AI/AN race that have been observed in the broader population may be driven by factors associated with income and health insurance that are also associated with race, as income and insurance status are more homogenous within the Medicaid population than within the broader population.
Notes
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PubMed ID
27020318 View in PubMed
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Cancer Treatment Delays in American Indians and Alaska Natives Enrolled in Medicare.

https://arctichealth.org/en/permalink/ahliterature290092
Source
J Health Care Poor Underserved. 2017; 28(1):350-361
Publication Type
Journal Article
Date
2017
Author
Scott V Adams
Aasthaa Bansal
Andrea N Burnett-Hartman
Stacey A Cohen
Andrew Karnopp
Victoria Warren-Mears
Scott D Ramsey
Source
J Health Care Poor Underserved. 2017; 28(1):350-361
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Age Factors
Age of Onset
Aged
Aged, 80 and over
Alaska - epidemiology
Alaska Natives - statistics & numerical data
Breast Neoplasms - ethnology - therapy
Colorectal Neoplasms - ethnology - therapy
Comorbidity
European Continental Ancestry Group - statistics & numerical data
Female
Humans
Indians, North American - statistics & numerical data
Lung Neoplasms - ethnology - therapy
Male
Medicare - statistics & numerical data
Neoplasm Grading
Neoplasms - ethnology - therapy
Prostatic Neoplasms - ethnology - therapy
Residence Characteristics
SEER Program
Sex
Socioeconomic Factors
Time-to-Treatment - statistics & numerical data
United States
United States Indian Health Service - statistics & numerical data
Abstract
To assess whether timing of initial post-diagnosis cancer care differs between American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) patients, we accessed SEER-Medicare data for breast, colorectal, lung, and prostate cancers (2001-2007). Medicare claims data were examined for initiation of cancer-directed treatment. Overall, AI/ANs experienced longer median times to starting treatment than NHWs (45 and 39 days, p < .001) and lower rates of treatment initiation (HR[95%CI]: 0.86[0.79-0.93]). Differences were largest for prostate (HR: 0.80[0.71-0.89]) and smallest for breast cancer (HR: 0.96[0.83-1.11]). American Indians / Alaska Natives also had elevated odds of greater than 10 weeks between diagnosis and treatment compared with NHWs (OR[95% CI]: 1.37[1.16-1.63]), especially for prostate cancer (OR: 1.41[1.14-1.76]). Adjustment for comorbidity and socio-demographic factors attenuated associations except for prostate cancer. In this insured population, we observed evidence that AI/ANs start cancer therapy later than NHWs. The modest magnitude of delays suggests that they are unlikely to be a determinant of survival disparities.
PubMed ID
28239006 View in PubMed
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Indian Health Service Care System and Cancer Stage in American Indians and Alaska Natives.

https://arctichealth.org/en/permalink/ahliterature290198
Source
J Health Care Poor Underserved. 2018; 29(1):245-252
Publication Type
Journal Article
Date
2018
Author
Andrea N Burnett-Hartman
Scott V Adams
Aasthaa Bansal
Jean A McDougall
Stacey A Cohen
Andrew Karnopp
Victoria Warren-Mears
Scott D Ramsey
Source
J Health Care Poor Underserved. 2018; 29(1):245-252
Date
2018
Language
English
Publication Type
Journal Article
Abstract
We aimed to determine whether the association between late-stage cancer and American Indian/Alaska Native (AI/AN) race differed by enrollment in the Indian Health Service Care System (IHSCS).
We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to compare the odds of late-stage breast, colorectal, lung, or prostate cancer between non-Hispanic Whites (NHWs) (n=285,993) and AI/ANs with (n=581) and without (n=543) IHSCS enrollment.
For AI/ANs without IHSCS enrollment, the odds of late-stage disease were higher in AI/ANs compared with NHWs for breast (OR=3.17, 95%CI: 1.82-5.53) and for prostate (OR=2.59, 95%CI:1.55-4.32) cancer, but not for colorectal or lung cancers. Among AI/ANs with IHSCS enrollment, there was not a significant association between late-stage disease and AI/AN race for any of the four cancers evaluated.
Our results suggest that enrollment in the IHSCS reduced the disparity between AI/ANs and NHWs with respect to late-stage cancer diagnoses.
PubMed ID
29503298 View in PubMed
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Indian Health Service Care System and Cancer Stage in American Indians and Alaska Natives.

https://arctichealth.org/en/permalink/ahliterature299923
Source
J Health Care Poor Underserved. 2018; 29(1):245-252
Publication Type
Journal Article
Date
2018
Author
Andrea N Burnett-Hartman
Scott V Adams
Aasthaa Bansal
Jean A McDougall
Stacey A Cohen
Andrew Karnopp
Victoria Warren-Mears
Scott D Ramsey
Source
J Health Care Poor Underserved. 2018; 29(1):245-252
Date
2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alaska Natives - statistics & numerical data
European Continental Ancestry Group - statistics & numerical data
Female
Health Status Disparities
Humans
Indians, North American - statistics & numerical data
Male
Medicare
Neoplasm Staging
Neoplasms - ethnology - pathology
United States
United States Indian Health Service - statistics & numerical data
Abstract
We aimed to determine whether the association between late-stage cancer and American Indian/Alaska Native (AI/AN) race differed by enrollment in the Indian Health Service Care System (IHSCS).
We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to compare the odds of late-stage breast, colorectal, lung, or prostate cancer between non-Hispanic Whites (NHWs) (n=285,993) and AI/ANs with (n=581) and without (n=543) IHSCS enrollment.
For AI/ANs without IHSCS enrollment, the odds of late-stage disease were higher in AI/ANs compared with NHWs for breast (OR=3.17, 95%CI: 1.82-5.53) and for prostate (OR=2.59, 95%CI:1.55-4.32) cancer, but not for colorectal or lung cancers. Among AI/ANs with IHSCS enrollment, there was not a significant association between late-stage disease and AI/AN race for any of the four cancers evaluated.
Our results suggest that enrollment in the IHSCS reduced the disparity between AI/ANs and NHWs with respect to late-stage cancer diagnoses.
PubMed ID
29503298 View in PubMed
Less detail