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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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American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program.

https://arctichealth.org/en/permalink/ahliterature289968
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Publication Type
Journal Article
Date
Apr-2017
Author
Carol Grimes
Jenine Dankovchik
Megan Cahn
Victoria Warren-Mears
Author Affiliation
Northwest Portland Area Indian Health Board, 918 NE Rosa Parks Way, Portland, OR, 97211, USA.
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Date
Apr-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Alaska Natives - psychology
Attitude to Health - ethnology
Cultural Competency
Female
Humans
Idaho
Indians, North American - psychology
Interviews as Topic
Male
Middle Aged
Models, organizational
Neoplasms - ethnology - psychology
Oregon
Patient Navigation - methods - organization & administration - standards
Patient Satisfaction - ethnology
Qualitative Research
Young Adult
Abstract
Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Notes
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PubMed ID
27838858 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
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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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Disparities in life expectancy of pacific northwest American Indians and Alaska natives: analysis of linkage-corrected life tables.

https://arctichealth.org/en/permalink/ahliterature261058
Source
Public Health Rep. 2015 Jan-Feb;130(1):71-80
Publication Type
Article
Author
Jenine Dankovchik
Megan J Hoopes
Victoria Warren-Mears
Elizabeth Knaster
Source
Public Health Rep. 2015 Jan-Feb;130(1):71-80
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Child
Child, Preschool
Continental Population Groups - statistics & numerical data
Death Certificates
European Continental Ancestry Group - statistics & numerical data
Female
Humans
Indians, North American - statistics & numerical data
Infant
Inuits - statistics & numerical data
Life Expectancy - ethnology
Life tables
Male
Middle Aged
Northwestern United States - epidemiology
Sex Distribution
Young Adult
Abstract
American Indians and Alaska Natives (AI/ANs) experience a high burden of mortality and other disparities compared with the general population. Life tables are an important population health indicator; however, federal agencies have not produced life tables for AI/ANs, largely due to racial misclassification on death certificates. Our objective was to correct this misclassification and create life tables for AI/ANs who resided in the Pacific Northwest region of the U.S., making comparisons with the general population.
To correct racial misclassification, we conducted probabilistic record linkages between death certificates from three Northwest states-Idaho, Oregon, and Washington State-issued during 2008-2010, and AI/AN patient registration records. We calculated mortality rates and generated period life tables for AI/ANs and non-Hispanic white (NHW) Americans.
Overall life expectancy at birth for Northwest AI/ANs was 72.8 years, which was 6.9 years lower than that of NHW Americans. Male AI/ANs had a lower life expectancy (70.9 years) than female AI/ANs (74.6 years). The disparity in life expectancy between AI/ANs and their NHW counterparts was higher for females (with AI/ANs living 7.3 years fewer than NHW females) than for males (with AI/ANs living 6.7 years fewer than NHW males). The greatest disparity in mortality rates was seen among young adults.
Data linkage with a registry of known AI/ANs allowed us to generate accurate life tables that had not previously been available for this population and revealed disparities in both life expectancy at birth and survival across the life span. These results represent an important tool to help AI/AN communities as they monitor their health and promote efforts to eliminate health disparities.
PubMed ID
25552757 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
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Using Record Linkage to Improve Race Data Quality for American Indians and Alaska Natives in Two Pacific Northwest State Hospital Discharge Databases.

https://arctichealth.org/en/permalink/ahliterature266858
Source
Health Serv Res. 2015 Aug;50 Suppl 1:1390-402
Publication Type
Article
Date
Aug-2015
Author
Kristyn M Bigback
Megan Hoopes
Jenine Dankovchik
Elizabeth Knaster
Victoria Warren-Mears
Sujata Joshi
Thomas Weiser
Source
Health Serv Res. 2015 Aug;50 Suppl 1:1390-402
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Algorithms
Female
Health Services Research
Humans
Indians, North American - statistics & numerical data
Inuits - statistics & numerical data
Male
Medical Record Linkage
Oregon
Patient Discharge
Quality Improvement
Registries
Washington
Abstract
To evaluate and adjust for American Indian and Alaska Native (AI/AN) racial misclassification in two hospital discharge datasets in the Pacific Northwest.
Oregon (2010-2011) and Washington (2011) hospital discharge datasets were linked with the Northwest Tribal Registry (NTR), a registry of AI/AN individuals who accessed services at Indian health facilities in the Northwest.
Record linkage was used to match state hospital records to the NTR. A state record was considered misclassified if it matched the NTR and was coded as non-AI/AN or missing race data. Effect of misclassification was evaluated by comparing prelinkage and postlinkage, age-adjusted hospital discharge rates.
Researchers used Link Plus 2.0 software (Atlanta, GA, USA) for linkages and SAS 9.4 (Cary, NC, USA) for statistical analyses.
In Oregon, 55.4 percent of matching records were misclassified (66.5 percent miscoded white, and 22.1 percent were missing race information). In Washington, 44.9 percent of matching records were misclassified (61.8 percent miscoded white, and 32.7 percent were missing race information). Linkage increased ascertainment of AI/AN hospitalizations by 31.8 percent in Oregon and 33.9 percent in Washington. Linkage increased the rate ratio (RR) for AI/AN hospitalizations in comparison to non-Hispanic whites (NHW) from 0.81 to 1.07 in Oregon, and from 1.21 to 1.62 in Washington.
Correction of race in hospital discharge datasets through linkage with a reference file of known AI/AN individuals is an important first step before analytic research on AI/AN health care in the Pacific Northwest can be accomplished with administrative datasets.
Notes
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PubMed ID
26133568 View in PubMed
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9 records – page 1 of 1.