Moreover, African-Americans who are dually eligible for and enrolled in both Medicaid and Medicare for 12 or more months before a cancer diagnosis show higher cancer rates than their white counterparts, according to data on patients ages 65 and older, tracked by a Michigan tumor registry between 1997 and 2000.
"Cancer pushes low-income people living on the margins into dual eligibility because they've spent all their savings on health care," said lead author Cathy Bradley, Ph.D., a professor of health administration at Virginia Commonwealth University. "So they wind up in Medicare and Medicaid at the costly end stages of the disease, and this may be happening disproportionately to blacks."
The incidence of cancer among the continuously dual-eligible patients, a group with higher poverty and less access to health resources, is a third higher for African-American women than for white women and 70 percent higher for African-American men than for white men, the study found.
Prostate cancer incidence in African-American men is two to two-and-a-half times that of white men, depending on whether the men are dual-eligible. The incidence of colorectal cancer in dual-eligible African-American women is 50 percent higher than that of dual-eligible white women.
The results appear in the latest online issue of the journal Health Services Research.
In Bradley's view, increased health care access earlier in life could lower the higher cancer rates among African-Americans.
James McCurtis, Jr., spokesman for the Michigan Department of Community Health, agreed. "A lot of Medicaid patients don't find out about cancer until it's in its latter stages," he said. "Many smoke and live in low-income neighborhoods with no access to a primary-care physician. What are needed are better screening and prevention messages in this population."
Specifically, a healthier lifestyle that includes a produce-rich diet and exercise can prevent colorectal cancer, added Bradley. Individuals can avoid lung cancer can by not smoking, and regular, vigilant screening can facilitate early detection of breast and prostate cancer.
Health Behavior News Service: Lisa Esposito at (202) 387-2829 or hbns-editorcfah.
Health Services Research is the official journal of the AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or jshawaha. HSR is available online at www.blackwell-synergy/loi/hesr.
Bradley CJ, Luo Z, Given CW. Cancer incidence in elderly Medicare and dual eligible beneficiaries. Health Services Research online, 2008.
By Bridget Murray Law, Contributing Writer Health Behavior News Service
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