Parsa Erfani1, Ayotomiwa Ojo1, E John Orav2, Fumiko Chino3, Miranda B Lam4. 1. Harvard Medical School, Boston, MA, USA. 2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA. Miranda_Lam@dfci.harvard.edu.
Abstract
BACKGROUND: Little is known about which patients use National Cancer Institute-designated cancer centers (NCICCs) nationally. This study aimed to identify sociodemographic characteristics associated with decreased NCICC use among Medicare beneficiaries. METHODS: This study examined a national cohort of 534,008 Medicare beneficiaries with cancer in 2017 using multivariable logistic regressions for NCICC use. The covariates in the study were sex, age, cancer type, race/ethnicity, dual-eligibility status for Medicaid and Medicare, and NCICC presence in the home state. RESULTS: In 2017, 19.5 % of Medicare beneficiaries with cancer used an NCICC at least once. Dual-eligible beneficiaries had 29 % lower adjusted odds of NCICC use than non-dual-eligible beneficiaries (adjusted odds ratio [aOR], 0.71; 95 % confidence interval [CI], 0.70-0.73; p < 0.001). American Indian/Alaska Native beneficiaries had 40 % lower odds of NCICC use than non-Hispanic white (NHW) beneficiaries (aOR, 0.60; 95 % CI, 0.53-0.68; p < 0.001). Compared with NHW beneficiaries, the odds of NCICC use were higher for black beneficiaries by 15 % (aOR, 1.15; 95 % CI, 1.12-1.18; p < 0.001), for Hispanic beneficiaries by 31 % (aOR, 1.31; 95 % CI, 1.26-1.35; p < 0.001), and for Asian/Pacific Islander beneficiaries by 126 % (aOR, 2.26; 95 % CI, 2.16-2.36; p < 0.001). Utilization declined steadily in older groups, with beneficiaries older than 95 years showing 73 % lower odds of NCICC use than beneficiaries younger than 65 years (aOR, 0.27; 95 % CI, 0.24-0.29; p < 0.001). CONCLUSIONS: Medicaid-eligible, American Indian/Alaska Native, and older patients are substantially less likely to use NCICCs. Future research should focus on defining and addressing the barriers to NCICC access for these populations.
BACKGROUND: Little is known about which patients use National Cancer Institute-designated cancer centers (NCICCs) nationally. This study aimed to identify sociodemographic characteristics associated with decreased NCICC use among Medicare beneficiaries. METHODS: This study examined a national cohort of 534,008 Medicare beneficiaries with cancer in 2017 using multivariable logistic regressions for NCICC use. The covariates in the study were sex, age, cancer type, race/ethnicity, dual-eligibility status for Medicaid and Medicare, and NCICC presence in the home state. RESULTS: In 2017, 19.5 % of Medicare beneficiaries with cancer used an NCICC at least once. Dual-eligible beneficiaries had 29 % lower adjusted odds of NCICC use than non-dual-eligible beneficiaries (adjusted odds ratio [aOR], 0.71; 95 % confidence interval [CI], 0.70-0.73; p < 0.001). American Indian/Alaska Native beneficiaries had 40 % lower odds of NCICC use than non-Hispanic white (NHW) beneficiaries (aOR, 0.60; 95 % CI, 0.53-0.68; p < 0.001). Compared with NHW beneficiaries, the odds of NCICC use were higher for black beneficiaries by 15 % (aOR, 1.15; 95 % CI, 1.12-1.18; p < 0.001), for Hispanic beneficiaries by 31 % (aOR, 1.31; 95 % CI, 1.26-1.35; p < 0.001), and for Asian/Pacific Islander beneficiaries by 126 % (aOR, 2.26; 95 % CI, 2.16-2.36; p < 0.001). Utilization declined steadily in older groups, with beneficiaries older than 95 years showing 73 % lower odds of NCICC use than beneficiaries younger than 65 years (aOR, 0.27; 95 % CI, 0.24-0.29; p < 0.001). CONCLUSIONS: Medicaid-eligible, American Indian/Alaska Native, and older patients are substantially less likely to use NCICCs. Future research should focus on defining and addressing the barriers to NCICC access for these populations.
Authors: Jean G Ford; Mollie W Howerton; Gabriel Y Lai; Tiffany L Gary; Shari Bolen; M Chris Gibbons; Jon Tilburt; Charles Baffi; Teerath Peter Tanpitukpongse; Renee F Wilson; Neil R Powe; Eric B Bass Journal: Cancer Date: 2008-01-15 Impact factor: 6.860
Authors: Narjust Duma; Jesus Vera Aguilera; Jonas Paludo; Candace L Haddox; Miguel Gonzalez Velez; Yucai Wang; Konstantinos Leventakos; Joleen M Hubbard; Aaron S Mansfield; Ronald S Go; Alex A Adjei Journal: J Oncol Pract Date: 2017-11-03 Impact factor: 3.840
Authors: Tracy Onega; Eric J Duell; Xun Shi; Eugene Demidenko; Daniel Gottlieb; David C Goodman Journal: Med Care Res Rev Date: 2009-05-19 Impact factor: 3.929
Authors: Ryan P Merkow; Anthony D Yang; Emily Pavey; Min-Woong Song; Jeanette W Chung; David J Bentrem; Karl Y Bilimoria Journal: JAMA Intern Med Date: 2019-08-01 Impact factor: 21.873