North Dakota
Fee-For-Service Medicaid Coverage of Screening
Covered
Highlighted Disparity
Indigenous Peoples in North Dakota are most likely to be diagnosed with lung cancer.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 57 and not significantly different than the national rate of 57.
- North Dakota ranks 24th among all states, placing it in the average tier.
- Over the last five years, the rate of new cases did not change significantly.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in North Dakota is 26%, which is not significantly different than the national rate of 25%.
- It ranks 16th among the 46 states with survival data, placing it in the average tier.
- The change in the survival rate over the last five years is not available for North Dakota.
Early Diagnosis:
- 28% of cases are caught at an early stage, which is not significantly different than the national rate of 26%.
- It ranks 11th among the 49 states with data on diagnosis at an early stage, placing it in the above average tier.
- Over the last five years, the early diagnosis rate in North Dakota did not change significantly.
Lung Cancer Treatment
Surgical Treatment:
- North Dakota ranked 36th (out of the 49 states with available data) with 17% of cases undergoing surgery as part of the first course of treatment.
- This is significantly lower than the national rate of 21% and puts North Dakota in the below average tier.
- Over the last five years, the percent of cases undergoing surgery in North Dakota did not change significantly.
Lack of Treatment:
- North Dakota ranked 1st (out of the 49 states with available data) with 14% of cases not receiving any treatment.
- This is significantly lower than the national rate of 21% and puts North Dakota in the top tier.
- Over the last five years, the percent of cases receiving no treatment in North Dakota did not change significantly.
Screening
Screening for High Risk:
- In North Dakota, 10% of those at high risk were screened, which was significantly higher than the national rate of 6%.
- It ranks 7th among all states, placing it in the above average tier.
- Screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- North Dakota was one of the 46 states whose Medicaid fee-for-service programs covered lung cancer screening as of July 2022.
- While their program did not require prior authorization or copays, it did not use recommended guidelines for determining eligibility.
Prevention
Tobacco Use:
- The smoking rate in North Dakota is 17% and significantly higher than the national rate of 14%.
- It ranks 35th among all states, placing it in the below average tier.
Radon:
- In North Dakota, 58% of radon tests results were at or above the action level recommended by EPA.
- It ranks 50th among all states, placing it in the bottom tier.
Racial & Ethnic Disparities
Black Americans:
- Lung cancer rates are not available for Black Americans in North Dakota due to too few cases over the time period to allow for accurate analysis.
Latino Americans:
- Lung cancer rates are not available for Latino Americans in North Dakota due to too few cases over the time period to allow for accurate analysis.
Asian Americans or Pacific Islanders:
- Lung cancer rates are not available for Asian Americans or Pacific Islanders in North Dakota due to too few cases over the time period to allow for accurate analysis.
Indigenous Peoples:
- The rate of new lung cancer cases is 138 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in North Dakota, significantly higher than the rate of 41 among Indigenous Peoples nationally, and significantly higher than the rate of 56 among whites in North Dakota.
- State-level survival rates are not available for Indigenous Peoples at this time. Nationally, the five-year survival rate among Indigenous Peoples is 19% and not significantly different than among white Americans.
- 26% of lung cancer cases are diagnosed at an early stage among Indigenous Peoples (American Indians/Alaska Natives) in North Dakota, not significantly different than the rate of 23% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 28% among whites in North Dakota.
- 15% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in North Dakota underwent surgery, not significantly different than the rate of 17% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 18% among whites in North Dakota.
- 19% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in North Dakota did not receive any treatment, not significantly different than the rate of 22% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 14% among whites in North Dakota.
Summary
Despite the early diagnosis rate in North Dakota falling into the above average tier, the state still has a lot of work to do to make sure that more of those at high risk for lung cancer are screened.
The Lung Association encourages all states to cover lung cancer screening based on the latest guidelines across all fee-for-service and managed care plans without any financial or administrative barriers in their Medicaid programs.
North Dakota falls into the top tier for percent of patients receiving no treatment. Some patients do refuse treatment, but issues such as fatalism and stigma can prevent eligible patients from accessing treatment that may save or extend their lives. All patients should work with their doctors to establish a treatment plan and goals.