Disparities in colorectal cancer stage of diagnosis among Medicaid-insured residents of North Carolina.

OBJECTIVE

To evaluate the individual and community factors correlated with local disease among the North Carolina Medicaid-insured population diagnosed with colorectal cancer between 7998 and 2002.

METHODS

North Carolina residents diagnosed with first primary, SEER-staged colorectal cancer between 1998-2002 and enrolled in Medicaid were included in this study. Secondary data from the North Carolina Central Cancer Registry linked to Medicaid claims were utilized for this study. Descriptive and logistic regression analyses were conducted.

RESULTS

One out of every three individuals insured by Medicaid with colorectal cancer between 1998 and 2002 in North Carolina were diagnosed with local stage disease. Factors associated with increased likelihood of diagnosis with local disease included age > or = 65 (OR = 1.48, 95% CI, 1.27-7.72) and living in an urban area (OR = 1.19, 95% CI, 7.03-1.36). Persons with race defined as non-white and non-black were significantly less likely than non-Latino whites to be diagnosed with local disease (OR = 0.49, 95% CI, 0.27-0.97).

LIMITATIONS

Reliance on secondary data limits the utility of data regarding factors contributing to late-stage diagnosis.

CONCLUSIONS

Interventions to increase early diagnosis of colorectal cancer among the Medicaid-insured are needed. More research is needed to confirm and explain our finding that individuals <65 years of age and persons living in rural areas insured by Medicaid are more likely to be diagnosed at a later stage. The benefit of aging into Medicare among the Medicaid-insured population needs further elucidation.