Colorectal, Breast, and Prostate Cancers in Medicaid: DISCUSSION part 2

29 Dec
2009

The comparison across racial groups for each cancer was generally consistent with previous studies. Previous studies have found racial disparities between whites and blacks in the prevalence rates for lung cancer, breast cancer, and prostate cancer at the national level. For lung cancer, estimates based on SEER Program and Connecticut Cancer Registry among men reported that whites generally had lower rates for lung/bronchus cancer than blacks. A more complicated trend was reported among women. In older age groups, white women had higher prevalent rates for lung cancer than black women, according to both the Connecticut Cancer Registry and SEER Program. An opposite trend was identified in younger age groups. Our findings of higher prevalence rates among whites do not contradict results from the SEER Program and Connecticut Cancer Registry, which demonstrated a higher prevalence rate overall among whites than blacks. Site-specific rates were also higher in whites, with the exception of colorectal cancer, which was higher for black males through ages 59 and black females through age 64.

A study by Byrne using NHIS data reported that whites had higher rates for colorectal cancer than blacks. Estimates based on the SEER program and Connecticut Cancer Registry reported that whites had higher prevalence rates for colorectal cancer than did blacks in older age groups; however, the rate in whites was lower than blacks in younger age groups. A similar picture exists for breast cancer. Estimates by Byrne et al. reported that the rates for breast cancer were higher among whites than blacks. For female breast cancer, estimates based on the Connecticut Cancer Registry and SEER program both reported that whites had higher prevalence rates than blacks in older age groups, but blacks had higher prevalence rates in younger age groups. For colorectal cancer and breast cancer, our report of higher prevalence rates among whites than among blacks before age adjustment is consistent with reports in NHIS and the estimates based on the Connecticut Cancer Registry and SEER program. After age adjustment, our results showed higher prevalence rates in blacks than whites for both cancers. canadian pharmacy viagra

For prostate cancer, both the study by Byrne and estimates based on SEER and the Connecticut Cancer Registry reported that blacks had higher prevalence rates than whites. We found higher rates in blacks than in whites both before and after age adjustment, consistent both with estimates based on NHIS and estimates based on the Connecticut Cancer Registry and SEER program.

Our study population is relatively homogeneous in socioeconomic status. However, most of the differences in cancer prevalence between whites and blacks are still significant. Thus, our study results do not support the hypothesis that when we control for socioeconomic status, the disparities between racial groups are fully eliminated. Although Medicaid eligibility is not a perfect measure for socioeconomic status, our study results suggest that factors in addition to socioeconomic differences contribute to racial disparities in cancer. suhagra 100

The study by Sung and colleagues on Georgia Medicaid cancer patients showed that differences in cancer prevalence rates between whites and blacks existed in metropolitan areas. They offered a reasonable argument for higher rates in blacks than in whites—that is, blacks were still somehow in a more disadvantaged position even though blacks and whites were all in Medicaid program and were all financially distressed. However, their argument cannot explain the higher prevalence rates for certain cancers among whites in our study. Thus, further studies are warranted to document the reasons for racial disparity in Medicaid populations.

Our study results also provide insight for the apparently conflicting racial disparity patterns in urban and rural regions reported by Sung and colleagues. We found differences in prevalence rates for cancers in urban, rural, and suburban areas. This leads us to believe that small area variation plays a role in explaining different racial disparity patterns in urban and rural areas. Previous studies on small area variation reported that small area variation and socioeconomic status simultaneously help to explain patterns of health services utilization. In the case of the study by Sung et al., there is still small area variation, although they studied a reasonably homogeneous socioeconomic group. c

The variation across age and gender groups in our study was consistent with that reported by previous studies. We reported that people 65 and older compared with those under 65 consistently had higher rates for each of these four cancers. This pattern was also identified in report based on NHIS. We reported that males had higher rates for lung cancer and colorectal cancer than females both before and after age adjustment. These estimates were consistent with estimates based on NHIS and the SEER Program and Connecticut Cancer Registry.

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