Outcomes for American Indian and Alaska Native Populations With Cancer in Traditional Medicare

Importance American Indian and Alaska Native patients represent a uniquely vulnerable population in the US. Epidemiological studies have shown significant health disparities within this group. Contemporary outcomes and utilization studies of cancer in this population could aid in public health interventions in the future. Objective To analyze utilization, spending, and mortality outcomes for American Indian and Alaska Native beneficiaries with cancer covered by traditional Medicare (TM). Design, Setting, and Participants A multiyear cross-sectional analysis of a near population of TM beneficiaries in the US using Medicare beneficiary summary files and prescription drug event International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) linked claims from January 1, 2016 to December 31, 2023. Exposures TM coverage for American Indian and Alaska Native beneficiaries with cancer. Main Outcomes and Measures Aggregate claims for care utilization and spending from Medicare Parts A, B, and D to assess cancer prevalence, care utilization (ie, inpatient, outpatient, and prescription usage), total spending, mortality and secondary outcomes (hospice usage, screening utilization, and out-of-pocket costs). Results A sample of 26 867 866 TM beneficiaries in 2023 had 123 597 (0.46%) identifying as American Indian and Alaska Native (69 294 [56%] female). In this American Indian and Alaska Native subpopulation, 10.8% (n = 13 291) had a cancer diagnosis, lower than the 19.4% (5 211 773) prevalence noted in the overall TM population. The annual all-cause mortality rate among American Indian and Alaska Native beneficiaries with cancer in 2023 was 12.4% (1643), nearly double the overall TM cancer population at 6.9% (358 049). American Indian and Alaska Native beneficiaries had elevated rates of renal, hepatocellular, and biliary carcinomas. The mean (SD) spending per American Indian and Alaska Native beneficiary with cancer spent was $32 775 ($58 089) annually whereas the mean (SD) spending per TM beneficiary was $25 073 ($47 226) annually. Annual uptake of breast and colorectal screenings were lowest among American Indian and Alaska Native beneficiaries. Finally, only 939 of 1642 American Indian and Alaska Native beneficiaries with cancer (57.2%) filed hospice claims near date of death, lower than the 234 809 of 357 941 in the overall TM population (65.6%). Conclusions and Relevance In this cross-sectional analysis the American Indian and Alaska Native cancer population experienced significant differences in spending and outcomes in TM from 2016 through 2023. American Indian and Alaska Native beneficiaries with cancer displayed the worst all-cause mortality across demographics, elevated total and out-of-pocket spending as well as lower rates of apparent access to preventive and hospice services. The magnitude of these differences is critical in formulating action plans to promote health and reduce cancer among American Indian and Alaska Native beneficiaries.