Clinical Report: Medicare Claims Reveal Cancer-Related Disparities Among AI/AN Beneficiaries

Overview

Olsen and Tobey’s analysis of traditional Medicare claims from 2016 through 2023 found that American Indian and Alaska Native (AI/AN) beneficiaries diagnosed with cancer had approximately twice the all-cause mortality, more inpatient and emergency care, and higher per-person spending than the overall traditional Medicare population. They also had lower claims-based breast and colorectal cancer screening rates and less hospice use near the end of life. The findings identify disparities while illustrating limits of claims data, including the inability to determine cause of death or fully capture access and care experiences.

Background

Cancer inequities among AI/AN peoples occur in the context of intersecting health risks, comorbidities, structural inequities, and barriers to health services. Medicare claims do not specify cause of death, so the reported mortality difference cannot be attributed specifically to cancer. Race identification in administrative and cancer registry data also has limitations; federal sources describe methods to improve AI/AN identification, including linkage with Indian Health Service records. Care may involve IHS, tribally operated programs, Urban Indian Organizations, and outside providers, complicating measurement of service use and spending.

Data Highlights

Key Findings

• Olsen and Tobey analyzed national traditional Medicare claims from 2016 through 2023, assessing cancer prevalence, health care use, expenditures, and mortality.
• Among beneficiaries diagnosed with cancer, AI/AN individuals had approximately twice the all-cause mortality of the overall traditional Medicare population; the claims data do not establish cancer-specific mortality.
• AI/AN beneficiaries had more frequent inpatient admissions and emergency care and greater per-person spending, alongside lower breast and colorectal screening claim rates and less hospice use near the end of life.
• IHS data from 2017 reported breast and cervical cancer screening among 55% of AI/AN women and colorectal screening among 41% of AI/AN people aged 50 to 75 years.
• The source describes multiple potential contributors to disparities, including chronic oncogenic infections, type 2 diabetes, hypertension, smoking, excess body weight, and broader structural and health service inequities.
• Screening and specialty care access may be affected by IHS resource constraints, social barriers such as transportation and distance, and reliance on referrals to outside health systems for oncology and other specialty services.

Clinical Implications

The source cautions that lower screening claim rates should not be interpreted as screening being available and then declined, because claims do not establish availability or the reasons for nonreceipt. It also notes that cancer care measurement should account for the roles of IHS, tribal programs, Urban Indian Organizations, and outside providers, as well as limitations in race identification and cause-of-death data.

Conclusion

Traditional Medicare claims document substantial differences in mortality, service use, spending, screening claims, and hospice use among AI/AN beneficiaries with cancer. Interpretation requires attention to all-cause mortality measurement, race classification, and the structural and care-delivery context described in the source.

Related Resources & Content

1. Olsen and Tobey, JAMA Network Open, Year not stated in supplied material — Cancer Outcomes Among American Indian and Alaska Native Beneficiaries in Traditional Medicare
2. Kratzer et al., source and year not stated in supplied material — Related evidence on cancer mortality among American Indian and Alaska Native people
3. Centers for Medicare & Medicaid Services, CMS Data, Year not stated — Medicare and Medicaid Reports Methodology
4. United States Preventive Services Task Force, 2024 — Breast Cancer: Screening
5. ASCO Publications — Disparities in Native American Patients With Hepatocellular Carcinoma: An NCDB Analysis
6. the asco post — Overcoming the Disparity in Cancer Incidence and Mortality Rates Among Alaska Native Individuals
7. ASCO Publications — The association between American Indian/Alaska Native race and time to treatment initiation for nonmetastatic breast, colorectal, and lung cancer patients in Medicare.
8. Medicare and Medicaid Reports Methodology | CMS Data
9. Recommendation: Breast Cancer: Screening | United States Preventive Services Task Force
10. Medicare and Medicaid Reports Methodology | CMS Data
11. Recommendation: Breast Cancer: Screening | United States Preventive Services Taskforce
12. Screening for Breast Cancer: US Preventive Services Task Force Recommendation