Treatment disparities for disabled medicare beneficiaries with stage I non-small cell lung cancer.

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.18). 05/2008; 89(4):595-601. DOI: 10.1016/j.apmr.2007.09.042
Source: PubMed

ABSTRACT 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.
Not applicable.
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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Disability is increasing among middle-aged adults, and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31-64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n=13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.
    Journal of Aging & Social Policy 07/2014; · 0.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: National survey data indicate the number of individuals reporting a disability is rising. Those with disabilities experience a large number of barriers to health promotion and disease prevention programming. However, only a limited number of studies have used nationally representative data to examine the health status of individuals with disabilities in comparison to those without disabilities. We used the Medical Expenditures Panel Survey (MEPS) to examine whether disability is associated with higher prevalence rates for common chronic diseases, lower use of preventive care and higher health care expenditures. Our research hypothesis was that nationally, adults with either physical disability or cognitive limitations experience significant health disparities in comparison to those with no disability. We conducted a retrospective analysis comparing the health of adults (18 and over) with physical disabilities or cognitive limitations to individuals with no disability using data from the 2006 full year consolidated data file from the Medical Expenditures Panel Survey (MEPS). We used chi-squared tests, t-tests, and logistic regression to evaluate the association. Individuals with physical disabilities or cognitive limitations had significantly higher prevalence rates for 7 chronic diseases than persons with no disabilities. The disability groups were also significantly less likely than the no disability group to receive 3 types of preventive care. These data suggest that adults with disabilities and chronic conditions receive significantly fewer preventive services and have poorer health status than individuals without disabilities who have the same health conditions. This indicates a need for public health interventions that address the unique characteristics of adults with disabilities, many of whom are at risk for high cost, debilitating conditions that may not have as severe an effect on other population segments.
    Disability and Health Journal 04/2011; 4(2):59-67. · 1.50 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fifty-four million people in the United States are now living with disabilities. That number will grow substantially in the next thirty years, as the "baby-boom" generation ages and many of today's children and young adults mature and experience complications related to overweight and obesity. This reality poses a major challenge to the health care and policy communities. People with disabilities confront disadvantages from social and environmental determinants of health, including lower educational levels, lower incomes, and higher unemployment, than people without disabilities. Those with disabilities are also much more likely to report being in fair or poor health; to use tobacco; to forgo physical activity; and to be overweight or obese. People with disabilities also experience health care disparities, such as lower rates of screening and more difficulty accessing services, compared to people without disabilities. Eliminating these multifaceted disadvantages among people with disabilities should be a critical national priority.
    Health Affairs 10/2011; 30(10):1947-54. · 4.64 Impact Factor