Treatment Disparities for Disabled Medicare Beneficiaries With Stage I Non-Small Cell Lung Cancer

Abstract 

Iezzoni LI, Ngo LH, Li D, Roetzheim RG, Drews RE, McCarthy EP. Treatment disparities for disabled Medicare beneficiaries with stage I non-small cell lung cancer.

Objective

To compare initial treatment and survival of nonelderly adults with and without disabilities newly diagnosed with non-small cell lung cancer.

Design

Retrospective analyses; population-based cohorts.

Setting

Eleven Surveillance, Epidemiology, and End Results cancer registries.

Participants

Persons with disability Medicare entitlement (n=1016) and nondisabled persons (n=8425) ages 21 to 64 years when diagnosed with stage I, pathologically confirmed, first primary non-small cell lung cancer between January 1, 1988, and December 31, 1999.

Interventions

Not applicable.

Main Outcome Measures

Initial cancer treatments (surgery, radiotherapy), survival (through December 31, 2001). Multivariable logistic regression and Cox proportional hazards regression estimated adjusted associations of disability status with treatments and survival.

Results

Persons with disabilities were much more likely to be male, non-Hispanic black, and not currently married. Although 82.2% of nondisabled persons had surgery, 68.5% of disabled persons received operations. Adjusted relative risks (RRs) of receiving surgery were especially low for persons with respiratory disabilities (adjusted RR=.76; 95% confidence interval [CI], .67–.85), nervous system conditions (adjusted RR=.86; 95% CI, .76–.98), and mental health and/or mental retardation disorders (adjusted RR=.92; 95% CI, .86–.99). Persons with disabilities had significantly higher cancer-specific mortality rates (hazard ratio [HR]=1.37; 95% CI, 1.24–1.51) than persons without disabilities. Observed differences in cancer mortality persisted after adjusting for demographic and tumor characteristics (adjusted relative HR=1.23; 95% CI, 1.10–1.39). Further adjustment for surgery use eliminated statistically significant differences in cancer mortality between persons with and without disabilities across disabling conditions.

Conclusions

Persons with disabilities were much less likely than nondisabled Medicare beneficiaries to receive surgery; statistically significant cancer-specific mortality differences disappeared after accounting for these treatment differences. Future research must explore reasons for these findings and whether survival of disabled Medicare beneficiaries with early-stage, non-small cell lung cancer could improve if surgical treatment disparities were eliminated.

Key Words: Disabled persons, Lung cancer, Medicare, Rehabilitation