Age-Related Treatment Disparities among Medicaid Beneficiaries with Metastatic Colorectal Cancer

Objective To evaluate the impact of age on receipt of chemotherapy among low-income individuals with metastatic colorectal cancer. Data Sources/Study Setting North Carolina Medicaid enrollees with metastatic colorectal cancer diagnosed from 1999 to 2002 with colorectal as their only cancer (N=326). Study Design Retrospective analysis using linked data from the North Carolina Cancer Registry and Medicaid claims. Data Collection/Extraction Methods Outcomes were chemotherapy use within one year of diagnosis and time to initiation of chemotherapy. Cox regression models were fit to evaluate the association between chemotherapy use and age, stratifying for comorbidity, and adjusting for patient, community, and health services characteristics. Principal Findings Compared to 67.4% of patients aged <70 years, only 26.2% of patients ≥70 years received chemotherapy. After adjustment, younger patients with and without comorbidity were more likely to receive chemotherapy than older patients (hazard ratio (HR)=2.27, 95% confidence interval (CI) 1.41-3.66 and HR=6.33, 95% CI 2.87-13.96, respectively). Among those who received chemotherapy, the median time to receipt was 53 days, and did not differ significantly by age or comorbidity. Conclusion In this low-income cohort, older age was consistently associated with non-receipt of chemotherapy but not longer time to initiation of chemotherapy regardless of comorbidity status.