California Medicaid Enrollment and Melanoma Stage at Diagnosis: A Population-Based Study
published online 16 May 2008.
Background
Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population.
Methods
California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998–1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis.
Results
Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment.
Conclusions
Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.
aDepartment of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California
bStanford Comprehensive Cancer Center, Stanford, California
cDepartment of Health Research and Policy, Stanford, California
dNorthern California Cancer Center, Fremont, California
eDermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
Address correspondence and reprint requests to: Susan M. Swetter, MD, Dept. of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, 900 Blake Wilbur Drive, W0069, Stanford CA 94305.
The full text of this article is available via AJPM Online at www.ajpm-online.net; 1 unit of Category-1 CME credit is also available, with details on the website.
ABSTRACT