Treatment patterns and survival among low-income medicaid patients with head and neck cancer.

IMPORTANCE Medicaid beneficiaries by definition are low income but they are not necessarily a homogeneous group. No study has assessed differences and disparities among Medicaid beneficiaries with head and neck cancers. OBJECTIVE To examine predictors of treatment receipt and mortality among Medicaid patients with head and neck cancer. DESIGN Retrospective cohort study using Medicaid claims linked with cancer registry data for 2 states, California and Georgia, for the years 2002 through 2006. SETTING Inpatient and ambulatory care. PARTICIPANTS Medicaid beneficiaries aged 18 to 64 years diagnosed as having head and neck cancer (N = 1308) were included. Descriptive statistics and multivariate regression models analyzed the likelihood of treatment receipt and survival. MAIN OUTCOMES AND MEASURES Receipt of treatment and 12- and 24-month mortality. RESULTS Fewer than one-third of Medicaid patients with cancer received a diagnosis at an early stage. Overall, black patients were less likely to get surgical treatment and more likely to die than white patients, even after controlling for demographics, stage at diagnosis, and tumor site. Older age and disability status also increased 12-month mortality. Patients in California, who were alive for at least 12 months, have approximately half the odds of dying within 24 months compared with those in Georgia. CONCLUSIONS AND RELEVANCE Concrete steps should be taken to address the significant racial disparities observed in head and neck cancer outcomes among Medicaid beneficiaries. Further research is needed to explore the state-level policies and attributes to examine the startling differences in mortality among the state Medicaid programs analyzed in this study. Pooled comparisons of Medicaid beneficiaries with individuals covered by other types of insurance could mask important disparities among Medicaid beneficiaries, which need to be acknowledged and addressed to improve outcomes for these low-income patients with head and neck cancer.