Medicaid status and stage at diagnosis of cervical cancer

Objectives. We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid. Methods. Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status. Results. Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk. Conclusions. Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.