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Access to the Indian health service care system is not associated with early enrollment in medicaid for American Indian and Alaska Natives with cancer.

https://arctichealth.org/en/permalink/ahliterature259101
Source
Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):362-4
Publication Type
Article
Date
Feb-2014
Author
Andrea N Burnett-Hartman
Mark E Bensink
Kristin Berry
David G Mummy
Victoria Warren-Mears
Carol Korenbrot
Scott D Ramsey
Source
Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):362-4
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alaska
Female
Health Services Accessibility - statistics & numerical data
Health services needs and demand
Humans
Indians, North American - statistics & numerical data
Male
Medicaid - statistics & numerical data
Middle Aged
United States
United States Indian Health Service - statistics & numerical data
Young Adult
Abstract
For uninsured American Indians and Alaskan Natives (AIAN) diagnosed with cancer, prompt enrollment in Medicaid may speed access to treatment and improve survival. We hypothesized that AIANs who were eligible for the Indian Health Service Care System (IHSCS) at cancer diagnosis may be enrolled in Medicaid sooner than other AIANs.
Using Washington, Oregon, and California State Cancer Registries, we identified AIANs with a primary diagnosis of lung, breast, colorectal, cervical, ovarian, stomach, or prostate cancer between 2001 and 2007. Among AIANs enrolled in Medicaid within 365 days of a cancer diagnosis, we linked cancer registry records with Medicaid enrollment data and used a multivariate logistic regression model to compare the odds of delayed Medicaid enrollment between those with (n = 223) and without (n = 177) IHSCS eligibility.
Among AIANs who enrolled in Medicaid during the year following their cancer diagnosis, approximately 32% enrolled >1 month following diagnosis. Comparing those without IHSCS eligibility to those with IHSCS eligibility, the adjusted odds ratio (OR) for moderately late Medicaid enrollment (between 1 and 6 months after diagnosis) relative to early Medicaid enrollment (=1 month after diagnosis) was 1.10 [95% confidence interval (CI), 0.62-1.95] and for very late Medicaid enrollment (>6 months to 12 months after diagnosis), OR was 1.14 (CI, 0.54-2.43).
IHSCS eligibility at the time of diagnosis does not seem to facilitate early Medicaid enrollment.
Because cancer survival rates in AIANs are among the lowest of any racial group, additional research is needed to identify factors that improve access to care in AIANs.
PubMed ID
24296857 View in PubMed
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Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives.

https://arctichealth.org/en/permalink/ahliterature271321
Source
Cancer Epidemiol Biomarkers Prev. 2015 Jul;24(7):1138-43
Publication Type
Article
Date
Jul-2015
Author
Stacey Shiovitz
Aasthaa Bansal
Andrea N Burnett-Hartman
Andrew Karnopp
Scott V Adams
Victoria Warren-Mears
Scott D Ramsey
Source
Cancer Epidemiol Biomarkers Prev. 2015 Jul;24(7):1138-43
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Aged
Alaska - ethnology
Female
Hospice Care - methods
Humans
Incidence
Indians, North American
Male
Neoplasm Metastasis - therapy
Neoplasms - ethnology
Population Surveillance
Registries
United States - epidemiology
Abstract
Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer.
The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care.
AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83-1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61-0.99).
Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted.
Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.
Notes
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PubMed ID
25987547 View in PubMed
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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
Cites: Gynecol Oncol. 2015 Dec;139(3):500-5 PMID 26498912
Cites: Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):362-4 PMID 24296857
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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

Lung cancer histology, stage, treatment, and survival in American Indians and Alaska Natives and whites.

https://arctichealth.org/en/permalink/ahliterature96490
Source
Cancer. 2010 Jul 1;
Publication Type
Article
Date
Jul-1-2010
Author
Megan Dann Fesinmeyer
Bernardo Goulart
David K Blough
Dedra Buchwald
Scott D Ramsey
Author Affiliation
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Source
Cancer. 2010 Jul 1;
Date
Jul-1-2010
Language
English
Publication Type
Article
Abstract
BACKGROUND:: Studies of lung cancer disparities between American Indians and Alaska Natives (AIANs) and whites have yielded mixed results. To the authors' knowledge, no studies to date have investigated whether race-based differences in histology could explain survival disparities. METHODS:: Data were obtained on AIANs and whites with lung cancer from the 17 population-based cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) program from 1973 to 2006. Logistic regression was used to determine whether race and other covariates were associated with histology, stage at diagnosis, and receipt of surgery. Cox regression was used to determine the risk of death associated with race, after adjusting for histology, stage, and other covariates. RESULTS:: Histology, but not race, was found to be associated with stage at diagnosis, and both race and stage were found to be associated with histology. AIANs were less likely to receive surgery than whites, after adjusting for patient and tumor characteristics. Survival improved for both AIANs and whites after 2000, compared with the 1973 through 1999 period, but survival was consistently shorter for AIANs. The association between AIAN race and decreased survival was strongest in the later time period. CONCLUSIONS:: Lung cancer histology appears to be associated with tumor characteristics, treatment, and survival. AIAN race is associated with tumor histology, receipt of surgery, and survival. In the future, studies with access to smoking data, patient comorbidity information, and health systems-level data will be able to identify factors responsible for the disparities observed in these analyses. Cancer 2010. (c) 2010 American Cancer Society.
PubMed ID
20597131 View in PubMed
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Resource utilization, cost, and health status impacts of coronary stent versus "optimal" percutaneous coronary angioplasty: results from the OPUS-I trial.

https://arctichealth.org/en/permalink/ahliterature188506
Source
J Interv Cardiol. 2002 Aug;15(4):249-55
Publication Type
Article
Date
Aug-2002
Author
Nancy Neil
Scott D Ramsey
David J Cohen
Nathan R Every
John A Spertus
W Douglas Weaver
Author Affiliation
Virginia Mason Medical Center, University of Washington School of Public Health, Seattle, Washington. nancy.neil@vmmc.org
Source
J Interv Cardiol. 2002 Aug;15(4):249-55
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary - economics - utilization
Blood Vessel Prosthesis Implantation - economics
Canada - epidemiology
Coronary Disease - economics - therapy
Coronary Vessels - pathology - surgery
Costs and Cost Analysis
Female
Follow-Up Studies
Hospitalization - economics
Humans
Length of Stay
Male
Middle Aged
Prospective Studies
Quality of Life
Stents - economics - utilization
Time Factors
Treatment Outcome
United States - epidemiology
Abstract
In the OPUS-I trial, primary coronary stent implantation reduced 6-month composite incidence of death, myocardial infarction, cardiac surgery, or target vessel revascularization relative to a strategy of initial PTCA with provisional stenting in patients undergoing single vessel coronary angioplasty. The purpose of this research was to compare the economic and health status impacts of each treatment strategy. Resource utilization data were collected for the 479 patients randomized in OPUS-I. Itemized cost estimates were derived from primary hospital charge data gathered in previous multicenter trials evaluating coronary stents, and adjusted to approximate 1997 Medicare-based costs for a cardiac population. Health status at 6 months was assessed using the Seattle Angina Questionnaire (SAQ). Initial procedure related costs for patients treated with a primary stent strategy were higher than those treated with optimal PTCA/provisional stent ($5,389 vs $4,339, P
PubMed ID
12238418 View in PubMed
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