Medicare access increases cancer detection and drives down mortality rates

Having Medicare coverage significantly impacts both the detection of certain cancers as well as life expectancy after diagnosis, researchers from the University of Wisconsin School of Medicine and Public Health found. Their study, published in the Journal of Policy Analysis and Management, analyzed cancer detection and mortality rates at age 65 years, the age at which near-universal Medicare eligibility begins.1 Using vital statistics data and data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program from 2001 to 2015, investigators specifically assessed individuals aged 59 to 71 years. They honed in on breast, colorectal, and lung cancer incidence because screening for these diseases is recommended both before and after age 65 years, and because these tumors are the leading causes of cancer mortality nationwide. The findings indicated that the detection of all 3 cancers rose by 50 diagnoses per 100,000 population at age 65 years, a 10% increase compared with individuals aged 63 and 64 years, with early-stage cancers contributing to much of that surge. At the same time, mortality rates for these cancers among individuals aged 65 years declined by 9 per 100,000 population for women, a 4.5% decrease compared with that for women aged 63 and 64 years. However, the cancer mortality rate did not change significantly for men. Additional findings have demonstrated a pronounced increase in diagnoses among black women. Only 55% of this group was diagnosed with cancer prior to metastases at ages 63 and 64 years compared with 62% of nonblack women. Black women at these ages also had a 22% higher cancer mortality rate compared with nonblack women. Once they became eligible for Medicare at age 65 years, early detection rates among black women increased significantly: up to 62 diagnoses per 100,000 population (15%) compared with 47 per 100,000 population (11%) among nonblack women. Their mortality rates also underwent a large decline at age 65 years, falling to 20 per 100,000 population, or 9%. Although no significant changes in detection or mortality rates were noted to occur in black men, Medicare eligibility does appear to improve health equity among women with cancer, according to investigators. In an effort to demonstrate the validity of their findings, researchers also analyzed data from Canada, where residents of any age have access to public health insurance, therefore experiencing no change in coverage at age 65 years. The authors found that cancer mortality rates were nearly identical for both countries prior to age 65 years. However, at age 65 years in the United States, cancer mortality declined and cancer detection increased whereas individuals residing in Canada experienced no such change. The finding alleviates concerns that life changes at age 65 years, other than Medicare eligibility, could have affected the results of the study, researchers say. The authors hope their findings will inform future policy discussions regarding both Medicare and medical insurance in general.

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