Treatment Disparities for Disabled Medicare Beneficiaries With Stage I Non-Small Cell Lung Cancer
Treatment disparities for disabled Medicare beneficiaries with stage I non-small cell lung cancer.
To compare initial treatment and survival of nonelderly adults with and without disabilities newly diagnosed with non-small cell lung cancer.
Retrospective analyses; population-based cohorts.
Eleven Surveillance, Epidemiology, and End Results cancer registries.
Persons with disability Medicare entitlement (n=1016) and nondisabled persons (n=8425) ages 21 to 64 years when diagnosed with stage I, pathologically confirmed, first primary non-small cell lung cancer between January 1, 1988, and December 31, 1999.
Initial cancer treatments (surgery, radiotherapy), survival (through December 31, 2001). Multivariable logistic regression and Cox proportional hazards regression estimated adjusted associations of disability status with treatments and survival.
Persons with disabilities were much more likely to be male, non-Hispanic black, and not currently married. Although 82.2% of nondisabled persons had surgery, 68.5% of disabled persons received operations. Adjusted relative risks (RRs) of receiving surgery were especially low for persons with respiratory disabilities (adjusted RR=.76; 95% confidence interval [CI], .67-.85), nervous system conditions (adjusted RR=.86; 95% CI, .76-.98), and mental health and/or mental retardation disorders (adjusted RR=.92; 95% CI, .86-.99). Persons with disabilities had significantly higher cancer-specific mortality rates (hazard ratio [HR]=1.37; 95% CI, 1.24-1.51) than persons without disabilities. Observed differences in cancer mortality persisted after adjusting for demographic and tumor characteristics (adjusted relative HR=1.23; 95% CI, 1.10-1.39). Further adjustment for surgery use eliminated statistically significant differences in cancer mortality between persons with and without disabilities across disabling conditions.
Persons with disabilities were much less likely than nondisabled Medicare beneficiaries to receive surgery; statistically significant cancer-specific mortality differences disappeared after accounting for these treatment differences. Future research must explore reasons for these findings and whether survival of disabled Medicare beneficiaries with early-stage, non-small cell lung cancer could improve if surgical treatment disparities were eliminated.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: To explore how underlying disability affects treatments and outcomes of disabled women with breast cancer.
Surveillance, Epidemiology, and End Results program data, linked with Medicare files and Social Security Administration disability group.
Ninety thousand two hundred and forty-three incident cases of early-stage breast cancer under age 65; adjusted relative risks and hazards ratios examined treatments and survival, respectively, for women in four disability groups compared with nondisabled women.
Demographic characteristics, treatments, and survival varied among four disability groups. Compared with nondisabled women, those with mental disorders and neurological conditions had significantly lower adjusted rates of breast conserving surgery and radiation therapy. Survival outcomes also varied by disability type.
Compared with nondisabled women, certain subgroups of women with disabilities are especially likely to experience disparities in care for breast cancer.
Health Services Research 06/2008; 43(5 Pt 1):1752-67. DOI:10.1111/j.1475-6773.2008.00853.x · 2.78 Impact Factor
Available from: stfm.org
Family medicine 11/2008; 40(9):665-7. · 1.17 Impact Factor
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ABSTRACT: A diagnosis of cancer thrusts patients and their loved ones into a sea of emotions, information, and life-altering decisions. A person with a frequently complex disease meets a complex health care system. The circumstances of diagnosis are variable. Some people feel completely healthy and are totally surprised by a positive cancer screening test. Others come to this moment following weeks or months of foreboding in which they either sought or even avoided a diagnosis. © Springer Science+Business Media, LLC 2009. All rights reserved.
Toward the Elimination of Cancer Disparities, 12/2008: pages 299-315;
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