Table 2.

Association between Medicaid enrollment patterns and the likelihood of stage IV diagnoses among Medicaid-insured children and AYAs diagnosed with lymphoma

CharacteristicsTotal (N = 3524)Among Hodgkin lymphoma (n = 1655)Among non-Hodgkin lymphoma (n = 1869)
Unadjusted percentage (row %)ME∗ 95% CIP valueUnadjusted percentage (row %)ME∗ 95% CIP valueUnadjusted percentage (row %)ME∗ 95% CIP value
Insurance continuity             
Continuous Medicaid 25.8 Ref.   18.5 Ref.   33.1 Ref.   
Newly gained Medicaid 41.0 13.9 (8.5 to 19.2) <.001 27.5 6.9 (0.5 to 13.3) .03 50.1 17.5 (12.0 to 23.1) <.001 
Other Medicaid enrollment patterns 29.5 4.6 (2.2 to 7.0) <.001 19.4 2.9 (–1.8 to 7.5) .23 40.0 7.9 (4.1 to 11.7) <.001 
Sex             
Male 37.0 Ref.   26.0 Ref.   44.4 Ref.   
Female 26.5 −7.1 (−9.3 to −4.8) <.001 17.6 −6.6 (−8.9 to −4.4) <.001 37.1 −3.3 (−6.5 to −0.1) .04 
Race/ethnicity             
Non-Hispanic White 31.0 Ref.   19.7 Ref.   42.3 Ref.   
Non-Hispanic Black 36.6 6.0 (2.2 to 9.7) .002 29.1 10.9 (7.5 to 14.3) <.001 42.7 0.4 (−4.6 to 5.4) .87 
Hispanic 30.3 −1.6 (−4.6 to 1.5) .32 18.2 −0.3 (−4.6 to 4.0) .89 40.6 −5.2 (−10.6 to 0.2) .06 
Non-Hispanic other or unknown race/ethnicity†  30.5 −1.4 (−8.3 to 5.5) .70 19.5 1.0 (−7.1 to 9.2) .80 36.9 −7.3 (−16.1 to 1.4) .10 
Age at diagnosis, y             
0-14 34.0 Ref.   21.7 Ref.   42.0 Ref.   
15-25 28.6 −6.4 (−11.2 to −1.6) .009 18.3 −3.5 (−7.1 to 0.2) .06 44.3 −1.7 (−8.6 to 5.2) .63 
26-39 34.3 −3.0 (−8.8 to 2.9) .32 25.1 1.6 (−2.0 to 5.1) .39 40.2 −6.2 (−14.2 to 1.7) .13 
Rurality of residence             
Metropolitan areas 32.6 Ref.   22.1 Ref.   41.6 Ref.   
Nonmetropolitan (including rural) areas 29.2 −2.6 (−8.7 to 3.4) .40 18.6 −1.6 (−9.1 to 5.9) .68 41.2 −0.6 (−7.3 to 6.2) .87 
Neighborhood SES quintiles             
Q5: highest SES 37.9 Ref.   31.3 Ref.   42.9 Ref.   
Q4 29.7 −7.1 (−11.9 to −2.3) .004 20.4 −11.2 (−18.0 to −4.4) .001 37.9 −3.4 (−9.4 to 2.7) .27 
Q3 32.3 −4.8 (−13.1 to 3.4) .25 18.2 −14.6 (−25.1 to −4.1) .006 46.4 5.2 (−2.3 to 12.6) .17 
Q2 32.6 −4.6 (−9.4 to 0.2) .06 22.6 −9.6 (−16.0 to −3.3) .003 41.0 −0.2 (−6.4 to 6.1) .96 
Q1: lowest SES 31.5 −6.1 (−10.0 to −2.3) .002 20.2 −14.2 (−21.7 to −6.6) <.001 41.5 2.2 (−3.7 to 8.1) .47 
Unknown SES 25.0 −11.6 (−26.8 to 3.6) .14 21.7 −11.7 (−33.8 to 10.4) .30 27.6 −11.5 (−27.8 to 4.7) .16 
Diagnosis, y             
2007 25.7 Ref.   14.5 Ref.   37.2 Ref.   
2008 33.4 6.3 (1.5 to 11.2) .01 22.2 7.0 (2.5 to 11.5) .002 42.1 4.1 (−3.6 to 11.8) .29 
2009 33.2 6.2 (0.4 to 11.9) .04 24.2 8.8 (3.5 to 14.0) .001 40.9 2.3 (−6.0 to 10.5) .59 
2010 31.4 4.7 (−1.7 to 11.0) .15 19.4 4.8 (−1.4 to 10.9) .13 42.2 3.9 (−5.3 to 13.1) .41 
2011 30.5 3.8 (−3.9 to 11.5) .33 22.5 7.0 (−0.8 to 14.8) .08 37.6 0.2 (−12.9 to 13.4) .97 
2012 35.3 7.7 (2.2 to 13.3) .006 24.9 8.6 (4.4 to 12.9) <.001 45.2 6.7 (−3.5 to 16.8) .20 
2013 35.8 8.6 (3.6 to 13.6) <.001 23.0 8.0 (0.4 to 15.6) .04 46.3 8.1 (−0.8 to 16.9) .07 
p0‡   26.0%  18.5%  32.7% 
CharacteristicsTotal (N = 3524)Among Hodgkin lymphoma (n = 1655)Among non-Hodgkin lymphoma (n = 1869)
Unadjusted percentage (row %)ME∗ 95% CIP valueUnadjusted percentage (row %)ME∗ 95% CIP valueUnadjusted percentage (row %)ME∗ 95% CIP value
Insurance continuity             
Continuous Medicaid 25.8 Ref.   18.5 Ref.   33.1 Ref.   
Newly gained Medicaid 41.0 13.9 (8.5 to 19.2) <.001 27.5 6.9 (0.5 to 13.3) .03 50.1 17.5 (12.0 to 23.1) <.001 
Other Medicaid enrollment patterns 29.5 4.6 (2.2 to 7.0) <.001 19.4 2.9 (–1.8 to 7.5) .23 40.0 7.9 (4.1 to 11.7) <.001 
Sex             
Male 37.0 Ref.   26.0 Ref.   44.4 Ref.   
Female 26.5 −7.1 (−9.3 to −4.8) <.001 17.6 −6.6 (−8.9 to −4.4) <.001 37.1 −3.3 (−6.5 to −0.1) .04 
Race/ethnicity             
Non-Hispanic White 31.0 Ref.   19.7 Ref.   42.3 Ref.   
Non-Hispanic Black 36.6 6.0 (2.2 to 9.7) .002 29.1 10.9 (7.5 to 14.3) <.001 42.7 0.4 (−4.6 to 5.4) .87 
Hispanic 30.3 −1.6 (−4.6 to 1.5) .32 18.2 −0.3 (−4.6 to 4.0) .89 40.6 −5.2 (−10.6 to 0.2) .06 
Non-Hispanic other or unknown race/ethnicity†  30.5 −1.4 (−8.3 to 5.5) .70 19.5 1.0 (−7.1 to 9.2) .80 36.9 −7.3 (−16.1 to 1.4) .10 
Age at diagnosis, y             
0-14 34.0 Ref.   21.7 Ref.   42.0 Ref.   
15-25 28.6 −6.4 (−11.2 to −1.6) .009 18.3 −3.5 (−7.1 to 0.2) .06 44.3 −1.7 (−8.6 to 5.2) .63 
26-39 34.3 −3.0 (−8.8 to 2.9) .32 25.1 1.6 (−2.0 to 5.1) .39 40.2 −6.2 (−14.2 to 1.7) .13 
Rurality of residence             
Metropolitan areas 32.6 Ref.   22.1 Ref.   41.6 Ref.   
Nonmetropolitan (including rural) areas 29.2 −2.6 (−8.7 to 3.4) .40 18.6 −1.6 (−9.1 to 5.9) .68 41.2 −0.6 (−7.3 to 6.2) .87 
Neighborhood SES quintiles             
Q5: highest SES 37.9 Ref.   31.3 Ref.   42.9 Ref.   
Q4 29.7 −7.1 (−11.9 to −2.3) .004 20.4 −11.2 (−18.0 to −4.4) .001 37.9 −3.4 (−9.4 to 2.7) .27 
Q3 32.3 −4.8 (−13.1 to 3.4) .25 18.2 −14.6 (−25.1 to −4.1) .006 46.4 5.2 (−2.3 to 12.6) .17 
Q2 32.6 −4.6 (−9.4 to 0.2) .06 22.6 −9.6 (−16.0 to −3.3) .003 41.0 −0.2 (−6.4 to 6.1) .96 
Q1: lowest SES 31.5 −6.1 (−10.0 to −2.3) .002 20.2 −14.2 (−21.7 to −6.6) <.001 41.5 2.2 (−3.7 to 8.1) .47 
Unknown SES 25.0 −11.6 (−26.8 to 3.6) .14 21.7 −11.7 (−33.8 to 10.4) .30 27.6 −11.5 (−27.8 to 4.7) .16 
Diagnosis, y             
2007 25.7 Ref.   14.5 Ref.   37.2 Ref.   
2008 33.4 6.3 (1.5 to 11.2) .01 22.2 7.0 (2.5 to 11.5) .002 42.1 4.1 (−3.6 to 11.8) .29 
2009 33.2 6.2 (0.4 to 11.9) .04 24.2 8.8 (3.5 to 14.0) .001 40.9 2.3 (−6.0 to 10.5) .59 
2010 31.4 4.7 (−1.7 to 11.0) .15 19.4 4.8 (−1.4 to 10.9) .13 42.2 3.9 (−5.3 to 13.1) .41 
2011 30.5 3.8 (−3.9 to 11.5) .33 22.5 7.0 (−0.8 to 14.8) .08 37.6 0.2 (−12.9 to 13.4) .97 
2012 35.3 7.7 (2.2 to 13.3) .006 24.9 8.6 (4.4 to 12.9) <.001 45.2 6.7 (−3.5 to 16.8) .20 
2013 35.8 8.6 (3.6 to 13.6) <.001 23.0 8.0 (0.4 to 15.6) .04 46.3 8.1 (−0.8 to 16.9) .07 
p0‡   26.0%  18.5%  32.7% 

Authors’ analysis of the 2006 to 2013 SEER-Medicaid data. All regression models also controlled for SEER cancer registries. Standard errors were clustered by SEER cancer registries.

Ref., reference group.

∗

ME and the associated 95% CI were generated using the delta method with the “margins” command of Stata software. MEs were interpreted as the absolute percentage-point difference in the model-adjusted proportion of late-stage diagnoses between patients with a specific characteristic (eg, newly gained Medicaid) and their reference group (eg, those with continuous Medicaid; p0).

†

Include 11 patients with unknown race/ethnicity.

‡

Model-predicted percentage with stage IV diagnoses among patients with continuous Medicaid (ie, the reference group for Medicaid enrollment status), with other covariates held at their observed values.

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