Cancer
Rural-Urban Differences In Timing of Medicaid Enrollment Among Cancer Patients: An Analysis of SEER-Medicaid Anjelica Elizondo* Anjelica Eliondo Dr. Gabriel Benavidez
Background: Previous work has shown that among Medicaid enrollees, those enrolled prior to their cancer diagnosis, compared to after, have better cancer outcomes (i.e. stage at diagnosis and survival). No research has examined whether there are rural/urban disparities in early vs late Medicaid enrollment among cancer patients.
Methods: Data came from the Surveillance Epidemiology and End Results program Medicaid linked dataset. We classified patients as being enrolled either prior to or after their cancer diagnosis. A mixed effects multivariable logistic regression model was used to examine the relationship between county of residence rurality and Medicaid enrollment timing. A state level random intercept was included in the model to account for state-to-state variation.
Results: For breast (n= 44853), colorectal (n= 21908), and lung (n= 35666) cancer patients approximately, 13.0%, 16.0%, and 20.0% lived in a rural county, respectively. For each cancer type, compared to their urban counterparts, rural patients had significantly higher odds of enrolling in Medicaid after diagnosis. Odds of being enrolled in Medicaid after diagnosis were 1.08 (95% CI: 1.01, 1.16), 1.15 (95% CI: 1.05, 1.25), and 1.20 (95% CI: 1.13, 1.28) times higher for rural breast, colorectal, and lung cancer patients than urban patients, respectively. Additionally, a significant (p<.001) state-to-state variation is explained by our random intercept for each cancer type.
Conclusions: For breast, colorectal, and lung cancer patients who are enrolled in Medicaid, those who live in rural areas have significantly greater odds of being enrolled after their cancer diagnosis as compared to being enrolled prior to their diagnosis. Research has shown early Medicaid enrollment is associated with earlier diagnosis, which may subsequently contribute to improved survival outcomes. Initiatives to increase Medicaid enrollment of rural residents may aid in beneficial outcomes for those diagnosed with cancer.