1
|
Kim EJ, Lee JY, Ganga A, Barton A, Rana V, Araia E, Adriance W, Wang R, Somasundar P, Kim LA. Analysis of Uveal Melanoma 5-Year Survival Rates by Medicaid Status: A Nationwide Analysis. Ophthalmic Epidemiol 2024; 31:385-391. [PMID: 37964586 DOI: 10.1080/09286586.2023.2280962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The survival outcomes of patients with primary uveal melanomas based on Medicaid status have not been previously discussed in the literature. METHODS The Surveillance, Epidemiology, and End Results Medicaid database were utilized to identify patients with primary uveal melanomas diagnosed between 2006 and 2013. The Kaplan-Meier method was utilized to construct 5-year survival curves in adult, non-elderly patients. Log-rank testing was used to determine differences in survival rates, and multivariate Cox proportional hazards modeling was utilized to perform adjusted survival analysis. RESULTS A total of 1,765 patients were included (Medicaid: 81, non-Medicaid: 1684). A total of 1683 (95.4%) were White. The average age was 51.75 years (SD = 9.5 years). Medicaid patients were more likely to be unmarried, live in a high poverty neighborhood, and live in a rural area (all p < .001). We observed no significant difference in 5-year survival rates between those enrolled in Medicaid (86.6%, 95% CI: 79.1%1-94.7%) and those not enrolled in Medicaid (85.5, 95% CI: 83.8%-87.2%) (p = .80). After controlling for socioeconomic and clinical factors, Medicaid enrollment was not associated with an increased risk of mortality compared to non-Medicaid enrollment. Age (aHR: 1.04, 95% CI: 1.02-1.06, p < .001) and tumor size >10 mm (aHR: 3.04, 95% CI: 1.49-6.21, p = .002) were associated with an increased risk of mortality. CONCLUSION Medicaid enrollment was not associated with worse cancer-specific 5-year survival. Further research needs to be elicited to better understand the role of Medicaid enrollment in patients with primary uveal melanoma.
Collapse
Affiliation(s)
- Eric J Kim
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Ophthalmology at Harvard Medical School, Schepens Eye Research Institute of Mass Eye and Ear, Boston, Massachusetts, USA
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - James Y Lee
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Arjun Ganga
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Andrew Barton
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Viren Rana
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ermias Araia
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - William Adriance
- Department of Computer Science, Brown University, Providence, Rhode Island, USA
| | - Rachel Wang
- Department of Computer Science, Brown University, Providence, Rhode Island, USA
| | - Ponnandai Somasundar
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Leo A Kim
- Department of Ophthalmology at Harvard Medical School, Schepens Eye Research Institute of Mass Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Torabi SJ, Nguyen TV, Du AT, Birkenbeuel JL, Manes RP, Kuan EC. Medicaid Acceptance Varies by Physician Seniority and Specialty in California. Popul Health Manag 2024; 27:185-191. [PMID: 38629631 DOI: 10.1089/pop.2024.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year. We found that emergency medicine, radiology, pathology, anesthesiology, general surgery, and internal medicine had the highest percent of Medi-Cal-accepting physicians, whereas dermatology, psychiatry, physical medicine & rehabilitation, and plastic & reconstructive surgery physicians had the lowest. There also appears to be an inverse relationship between acceptance of Medi-Cal and earlier year of graduation (P < 0.05). This study demonstrated striking variability in Medi-Cal acceptance based upon physician years in practice and specialty. Older, experienced physicians, as well as physicians of certain specialties, are less likely to accept Medi-Cal.
Collapse
Affiliation(s)
- Sina J Torabi
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Theodore V Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Amy T Du
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - R Peter Manes
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward C Kuan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| |
Collapse
|
3
|
Edwards ER, Fei-Zhang DJ, Stein AP, Lott DG, Chelius DC, Sheyn A, Rastatter J. The impact of digital inequities on laryngeal cancer disparities in the US. Am J Otolaryngol 2024; 45:104066. [PMID: 37820390 DOI: 10.1016/j.amjoto.2023.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. METHODS DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. RESULTS With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03-1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04-1.08), and radiation therapy (OR 1.02; 95 % CI 1.00-1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94-97). CONCLUSIONS Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.
Collapse
Affiliation(s)
- Evan R Edwards
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA
| | - Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Chicago, IL 60611, USA
| | - David G Lott
- Division of Laryngology, Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163-2242, USA
| | - Jeffrey Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Chicago, IL 60611, USA
| |
Collapse
|
4
|
Ganga A, Kim EJ, Lee JY, Leary OP, Sastry RA, Fridley JS, Chang KE, Niu T, Sullivan PZ, Somasundar PS, Gokaslan ZL. Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis. World Neurosurg 2024; 181:e192-e202. [PMID: 37777175 DOI: 10.1016/j.wneu.2023.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. METHODS Using the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy. RESULTS A total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P = 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P = 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P = 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR] = 2.51, [95% CI 1.18-5.35], P = 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P = 0.001). For all patients, not receiving surgery (aHR = 1.90 [1.23-2.95], P = 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P = 0.023) were associated with an increased risk of mortality. CONCLUSIONS Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.
Collapse
Affiliation(s)
- Arjun Ganga
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric J Kim
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Y Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Patricia Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ponnandai S Somasundar
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA; Department of Surgery, Boston University, Boston, Massachusetts, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| |
Collapse
|
5
|
Ganga A, Kim EJ, Mintzer GL, Adriance W, Wang R, Cholankeril G, Balkrishnan R, Somasundar PS. Disparities in primary pancreatic adenocarcinoma survival by Medicaid-status: A national population-based risk analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1242-1249. [PMID: 36801151 DOI: 10.1016/j.ejso.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PAC) has one of the highest mortality rates among all malignancies. While previous research has analyzed socioeconomic factors' effect on PAC survival, outcomes of Medicaid patients are understudied. METHODS Using the SEER-Medicaid database, we studied non-elderly, adult patients with primary PAC diagnosed between 2006 and 2013. Five-year disease-specific survival analysis was performed using the Kaplan-Meier method and adjusted analysis using Cox proportional-hazards regression. RESULTS Among 15,549 patients (1799 Medicaid, 13,750 non-Medicaid), Medicaid patients were less likely to receive surgery (p < .001) and more likely to be non-White (p < .001). The 5-year survival of non-Medicaid patients (8.13%, 274 days [270-280]) was significantly higher than that of Medicaid patients (4.97%, 152 days, [151-182], p < .001). Among Medicaid patients, those in high poverty areas had significantly lower survival rates (152 days [122-154]) than those in medium poverty areas (182 days [157-213], p = .008). However, non-White (152 days [150-182]) and White Medicaid patients (152 days [150-182]) had similar survival (p = .812). On adjusted analysis, Medicaid patients were still associated with a significantly higher risk of mortality (aHR 1.33 [1.26-1.41], p < .0001) compared to non-Medicaid patients. Unmarried status and rurality were associated with a higher risk of mortality (p < .001). DISCUSSION Medicaid enrollment prior to PAC diagnosis was generally associated with a higher risk of disease-specific mortality. While there was no difference in the survival between White and non-White Medicaid patients, Medicaid patients living in high poverty areas were shown to be associated with poor survival.
Collapse
Affiliation(s)
- Arjun Ganga
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA
| | - Eric J Kim
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA
| | - Gabriel L Mintzer
- Massachusetts Institute of Technology, Department of Computer Science, Cambridge, MA, USA
| | - William Adriance
- Brown University, Department of Computer Science, Providence, RI, USA
| | - Rachel Wang
- Brown University, Department of Computer Science, Providence, RI, USA
| | | | | | - Ponnandai S Somasundar
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA; Boston University Chobanian & Avedisian School of Medicine, Department of Surgery, Boston, MA, USA.
| |
Collapse
|
6
|
Harley RJ, Lee JH, Ostrander BT, Finegersh A, Pham TB, Tawfik KO, Ren Y, Faraji F, Friedman RA. Local Tumor Behavior Associated With Survival Among Patients With Paraganglioma of the Head and Neck. OTO Open 2022; 6:2473974X221086872. [PMID: 35571573 PMCID: PMC9096223 DOI: 10.1177/2473974x221086872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this study was to evaluate the utility of
ICD-O-3–classified local tumor behavior as a
prognosticator of head and neck paraganglioma (HNP) outcomes. Study Design Retrospective cohort study. Setting National Cancer Database between 2004 and 2016. Methods This study included patients aged ≥18 years who were diagnosed with HNP.
Clinical outcomes and clinicopathologic features were compared with regard
to local tumor behavior. Results Our study included 525 patients, of which the majority had HNP classified as
locally invasive (45.9%) or borderline (37.9%). The most common anatomic
sites involved were the carotid body (33.7%), intracranial regions (29.0%),
or cranial nerves (25.5%). Carotid body tumors were exclusively locally
invasive, whereas intracranial and cranial nerve HNP were overwhelmingly
benign or borderline (94% and 91%, respectively). One-fourth of patients
underwent pathologic analysis of regional lymph nodes, of which the majority
were positive for metastasis (80.6%). Metastasis to distant organs was twice
as common in patients with locally invasive tumors vs benign (15% vs 7.1).
For benign disease, surgery with radiotherapy (adjusted hazard ratio [aHR],
40.45; P = .006) and active surveillance (aHR, 24.23;
P = .008) were associated with worse survival when
compared with surgery alone. For locally invasive tumors, greater age (aHR,
1.07; P < .0001) and positive surgical margins (aHR,
4.13; P = .010) were predictors of worse survival, while
combined surgery and radiotherapy were predictors of improved survival vs
surgery alone (aHR, 0.31; P = .027). Conclusion While criteria for tumor behavior could not be defined, our results suggest
that such a classification system could be used to enhance HNP risk
stratification and guide clinical management decisions.
Collapse
Affiliation(s)
- Randall J. Harley
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason H. Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Benjamin T. Ostrander
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Tammy B. Pham
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Kareem O. Tawfik
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Yin Ren
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Farhoud Faraji
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Rick A. Friedman
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| |
Collapse
|