Clinical Scorecard: Medicare Claims Reveal Cancer-Related Disparities Among American Indian and Alaska Native Beneficiaries

At a Glance

Key Highlights

• Compared with the overall traditional Medicare population, American Indian and Alaska Native beneficiaries with cancer had higher all-cause mortality, more inpatient admissions and emergency care, and greater per-person spending.
• Breast and colorectal cancer screening claims and hospice use near the end of life were lower.
• The approximately twofold mortality difference reported in the article is all-cause mortality; claims data cannot establish cancer-specific mortality or explain the causes of the difference.
• The article describes barriers across screening, diagnostic follow-up, specialty referral, treatment, and survivorship, including travel, resource constraints, and coordination across organizations and payers.
• National estimates may obscure differences among Tribal Nations, and some national datasets place American Indian and Alaska Native participants in broad categories because of small sample sizes.

Guideline-Based Recommendations

Diagnosis

• The article notes that Medicare claims do not specify cause of death; the reported approximately twofold mortality difference is all-cause mortality.
• The article reports differences between populations in age, disability or end-stage kidney disease eligibility, and dual Medicaid eligibility.

Management

• The article describes cancer care involving IHS-operated facilities, tribally operated health programs, Urban Indian Organizations, and purchased or referred services; it does not provide a clinical treatment guideline.

Monitoring & Follow-up

• The analysis evaluated cancer prevalence, health care use, expenditures, and mortality in traditional Medicare claims from 2016 through 2023.
• The article notes that national datasets may not adequately represent American Indian and Alaska Native people or distinguish experiences among Tribal Nations.

Risks

• The article identifies chronic oncogenic infections, type 2 diabetes, hypertension, cigarette smoking, and excess body weight as factors that may contribute to cancer-related mortality.
• The article describes underfunding, limited practitioner and specialty capacity, referral and travel burdens, and social barriers as factors affecting access to screening and cancer care.

Patient & Prescribing Data

American Indian and Alaska Native beneficiaries represented in national traditional Medicare claims; the article reports that this group was younger, more often eligible through disability or end-stage kidney disease, and more frequently dually eligible for Medicaid than the comparison population.

The article reports greater inpatient and emergency care use and spending, and lower hospice use near the end of life. It does not report medication prescribing data or specific treatment regimens.

Clinical Best Practices

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