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 56.6 and not significantly different than the national rate of 54.6.
- North Dakota ranks 26th 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 27.8%, which is not significantly different than the national rate of 26.6%.
- It ranks 13th among the 42 states with survival data, placing it in the average tier.
- Over the last five years, the survival rate in North Dakota improved by 20%.
Early Diagnosis:
- 28.0% of cases are caught at an early stage, which is not significantly different than the national rate of 26.6%.
- It ranks 14th among the 47 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 37th (out of the 47 states with available data) with 17.2% of cases undergoing surgery as part of the first course of treatment.
- This is significantly lower than the national rate of 20.8% 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 3rd (out of the 47 states with available data) with 14.3% of cases not receiving any treatment.
- This is significantly lower than the national rate of 20.6% 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, 10.2% of those at high risk were screened, which was significantly higher than the national rate of 4.5%.
- It ranks 3rd among all states, placing it in the top average tier.
- Actual 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 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023.
- 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 15.0% and significantly higher than the national rate of 13.5%.
- It ranks 31st among all states, placing it in the average tier.
Radon:
- In North Dakota, 58.0% 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 individuals:
- Lung cancer rates are not available for Black individuals in North Dakota due to too few cases over the time period to allow for accurate analysis.
Latino individuals:
- Lung cancer rates are not available for Latino individuals 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 or Pacific Islander individuals 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 132.4 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in North Dakota, significantly higher than the rate of 39.4 among Indigenous Peoples nationally, and significantly higher than the rate of 54.8 among white individuals 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 22.3% and not significantly different than the rate of 25.0% among white individuals.
- 26.9% 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 23.5% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 28.2% among white individuals in North Dakota.
- 15.0% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in North Dakota underwent surgery, not significantly different than the rate of 16.3% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 17.4% among white individuals in North Dakota.
- 21.3% 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 23.2% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and significantly higher than the rate of 14.0% among white individuals 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.