Colorectal, Breast, and Prostate Cancers in Medicaid: RESULTS

27 Dec
2009

On January 1, 2000, Maryland Medicaid had 246,430 enrollees, with demographic characteristics as reported in Table 1. Most enrollees were under the age of 65 (77.55%). More females (75.74%) than males (24.26%) were Maryland Medicaid beneficiaries. Whites constituted 41.20% of the total Medicaid population, while blacks represented a slightly larger share of the Maryland Medicaid population (48.93%). Less than 10% (9.88%) of the total population represented people of other racial groups. More than half of the beneficiaries (53.96%) lived in suburban areas in Maryland. The next largest group of beneficiaries was urban, which represents Baltimore city. Enrollees from rural areas represented less than 14% of the total Medicaid population.

In our population, there were 1,836 lung cancer patients, 1,558 colorectal cancer patients, 2,255 patients, and 1,098 prostate cancer patients. Since the number of Maryland Medicaid enrollees on January 1, 2000 was 246,430, the lung cancer prevalence rate was 75/10,000. The prevalence rates were 64/10,000 for colorectal cancer, 92/10,000 for breast cancer, and 45/10,000 for prostate cancer.

Table 1. Demographic Characteristics of Maryland Medicaid Enrollees (N=246,430)

CharacteristicNumber of PeoplePercentage (%)a
Age18-64

191,104

77.55
65+

55,326

22.45
GenderFemale

186,636

75.74
Male

59,794

24.26
RaceBlack

120,577

48.93
White

101,517

41.20
Other

24,336

9.88
RegionsUrban

80,159

32.53
Suburban

132,980

53.96
Rural

32,914

13.36
Unspecified6

377

0.15
a Percentages do not always add up to 100 because ot rounding. b Unknown or out-of-state on January 1, 2000.

We reported the cancer prevalence rates across racial groups both before and after age adjustment in Table 2. Age-adjusted rates are being presented for the purposes of making comparisons in the rates of age-related health events (in this case, cancer). Age-adjusted rates are essential for events that vary with age (e.g., cancer deaths), when comparing populations with different age distributions. Age-adjusted rates should be used only for the purpose of comparison. Because an age-adjusted rate is based on an external standard population, it does not reflect the absolute frequency of the event in a population; therefore no significance tests are presented.
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Table 2. Cancer Cases and Prevalence Rates (per 10,000) among Maryland Medicaid Enrollees across Races in 2000°

Lung Cance           Colorectal Cancer          Breast Cancer           Prostate Cancer Number   Prev.    AP     Number    Prev.     AP    Number   Prev.    AP      Number   Prev.   AP
Black  810     67.18 103.19      724       60.04    84.94     1,092    90.56 116.04      616     51.09  71.31 White 872     85.90 116.38     681       67.08    76.15       994    97.91   104.07      361      35.56 37.93
a Prev. = unadjusted prevalence rate; AP = age-adjusted prevalence rate. Significance tests are for unadjusted prevalence rates; b x2 =25.3070, pO.OOOl;c f = 4.2877, p=0.0384; d    = 3.1404, p=0.0764; e x2 = 30.0776, pO.OOOl

These rates varied across cancers and across racial groups. For lung cancer, whites had a higher prevalence rate than blacks, and the difference between them was statistically significant (p< 0.0001). After age adjustment, the prevalence rate for whites remained higher than blacks. For colorectal cancer, the prevalence rate in blacks was lower than in whites and the difference was significant (p=0.0384). After age adjustment, the prevalence rate for blacks was 1.1 times the rate for whites, in contrast to the comparison before age adjustment.

Table 3. Cancer Cases and Prevalence Rates (per 10,000) across Regions among Maryland Medicaid Enrollees in 2000°

Lung Cancer* Number  Prev.  APColorectal Cancer0          Breast Cancer*1           Prostate Cancer* Number   Prev.    AP     Number   Prev.   AP       Number Prev.   AP
Urban     681    84.96 123.35 Suburban 856    64.37  89.21 Rural      293    89.02 118.54556     69.36   91.34       783      97.68 119.10      358    44.66 57.87 789     59.33   70.82     1,162      87.38   96.89       595    44.74 49.61 210     63.80   72.79       307      93.27 100.74       145    44.05 47.02
a Prev. = unadjusted prevalence rate. AP = age-adjusted prevalence rate. Significance tests are difference for unadjusted prevalence rates across three regions; b %2 =39.1541, pO.OOOl;c x2 = 7.9311, p=0.0190; d у2 = 5.8685, p=0.0532; e y2 = 0.0283, p=0.9859

For breast cancer, before age adjustment, the prevalence rate for blacks was 0.9 times the rate for whites but the difference was not statistically significant (p=0.0764). After age adjustment, the prevalence rate was higher for blacks. As reported in Table 2, blacks had a higher prevalence rate for prostate cancer than whites both before and after age adjustment. The racial difference for prostate cancer before age adjustment was statistically significant.

Table 4. Cancer Cases and Unadjusted Prevalence Rates (per 10,000) across Age Groups among Maryland Medicaid Enrollees in 2000

Lung Cancer0 Number Prevalence

Colorectal Cancerb Number    Prevalence

Breast Cancer0 Number Prevalence

Prostate Cancer*1 Number    Prevalence

18-64   1,001          52.38 65+        835        150.92

595            31.13 963           174.06

1,038        54.32 1,217       219.97

284            14.86 814          147.13

a x2 = 552.1205, pO.OOOl; b f

= 1366.8999, pO.OOOl ;cx2

= 1263.5857, pO.OOOl; d

X2 =1665.1059, pO.OOOl

Cancer prevalence rates across regions are reported in Table 3. The unspecified group was excluded from the analysis since the number of people was small, which makes calculation of the prevalence rate inappropriate. For lung, colorectal, and breast cancers, the unadjusted prevalence rates in urban and rural regions were closer than after age-adjustment and were both higher than the rates in suburban area. However, these geographic differences were statistically significant at p<0.05 only for lung cancer and colorectal cancer. For prostate cancer, the unadjusted prevalence rates for the three regions were similar. After age adjustment, the urban region had higher rates than the other two regions for all four cancers.
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Table 5. Cancer Cases and Prevalence Rates (per 10,000) across Genders among Maryland Medicaid Enrollees in 2000°

Lung Cancerb Number     Prev.     AP

Colorectal Cancer0 Number     Prev.        APBreast Cancerd Number      Prev.    AP

Male         838       140.15   203.09 Female       998        53.47    72.85

539         90.14      111.67 1019         54.60       66.4550           8.36     9.81 2205         118.14  135.42

a Prev. = Unadjusted prevalence rate. AP = age-adjusted prevalence rate. Significance tests are for unadjusted prevalence rates; b %2 = 451.2623, pO.OOOl; c f = 89.7650, pO.OOOl; d %2 = 594.3795, pO.OOOl

Table 4 presents the differences across age groups for the four cancers. As expected, the older group consistently had a higher level of prevalence rates. All these differences were statistically significant.
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Table 5 includes the comparison between genders. Males had higher prevalence rates than females for two of the three cancers: lung and colorectal cancers. Females had higher rates for breast cancer compared with males. The differences across genders were significant for all three cancers. The trend was unchanged after age adjustment.

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