Uterine Cancer Diagnosis at Age 65: Onset of Medicare Eligibility and Impact of Medicaid Expansion.

Abstract

BACKGROUND Uterine cancer, for which diagnosis is based on evaluation of symptoms, most commonly postmenopausal bleeding, is one of the few cancers in the United States with rising incidence and mortality. Inability to access diagnostic services due to lack of insurance coverage may lead to delayed diagnosis and inferior outcomes. OBJECTIVE The aim of the study was to examine whether the onset of Medicare eligibility at age 65 was associated with a spike in the incidence of uterine cancer and whether this association was attenuated by Medicaid expansion through the Affordable Care Act (ACA). STUDY DESIGN The ecological study used cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) program to estimate the incidence rate of uterine cancer among women aged 55-74 from 2000 to 2021 in the United States. Second order polynomial modeling was used to fit the association between age (in single years) and incidence rate at the population level while excluding age 65 to identify the expected incidence rate at age 65 in the absence of a spike. The expected uterine cancer incidence rate at age 65 was generated from the model and compared to the observed rate at age 65 in the overall sample. Similar analyses were also conducted further stratified by stage, race/ethnicity, pre-ACA (2004-2013) versus post ACA (2014-2021) period and states' Medicaid expansion status. RESULTS In the overall sample, the observed uterine cancer incidence rate at age 65 was 108.2 cases per 100,000 woman-years (95% confidence interval (CI) 106.4-110.1), which exceeded the expected rate projected from the polynomial model (102.5, 95% CI 101.4-103.5). A similar pattern was observed in analysis stratified by stage at diagnosis and by race/ethnicity. The spike in incidence at age 65 diminished in Medicaid expansion states in the post-ACA period but persisted in non-expansion states. CONCLUSION Onset of Medicare eligibility at age 65 was associated with a spike in uterine cancer diagnoses, which appeared to be mitigated by Medicaid expansion. These findings underscore the importance of insurance coverage in facilitating timely uterine cancer diagnoses.