Hawaii
Fee-For-Service Medicaid Coverage of Screening
Covered
Highlighted Disparity
Latino individuals in Hawaii are most likely to be diagnosed with lung cancer.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 41.9 and significantly lower than the national rate of 54.6.
- Hawaii ranks 6th among all states, placing it in the above average tier.
- Over the last five years, the rate of new cases in Hawaii improved by 24%.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Hawaii is 22.8%, which is significantly lower than the national rate of 26.6%.
- It ranks 35th among the 42 states with survival data, placing it in the bottom tier.
- Over the last five years, the survival rate in Hawaii improved by 22%.
Early Diagnosis:
- 20.3% of cases are caught at an early stage, which is significantly lower than the national rate of 26.6%.
- It ranks 47th among the 47 states with data on diagnosis at an early stage, placing it in the bottom tier.
- Over the last five years, the early diagnosis rate in Hawaii improved by 33%.
Lung Cancer Treatment
Surgical Treatment:
- Hawaii ranked 35th (out of the 47 states with available data) with 17.7% 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 Hawaii in the below average tier.
- Over the last five years, the percent of cases undergoing surgery in Hawaii did not change significantly.
Lack of Treatment:
- Hawaii ranked 41st (out of the 47 states with available data) with 24.3% of cases not receiving any treatment.
- This is significantly higher than the national rate of 20.6% and puts Hawaii in the below average tier.
- Over the last five years, the percent of cases receiving no treatment in Hawaii did not change significantly.
Screening
Screening for High Risk:
- In Hawaii, 2.6% of those at high risk were screened, which was significantly lower than the national rate of 4.5%.
- It ranks 40th among all states, placing it in the below average tier.
- Actual screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- Hawaii was one of the 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023.
- While their program used recommended guidelines for determining eligibility, it did require prior authorization and copays.
Prevention
Tobacco Use:
- The smoking rate in Hawaii is 10.1% and significantly lower than the national rate of 13.5%.
- It ranks 4th among all states, placing it in the above average tier.
Radon:
- In Hawaii, 0.4% of radon tests results were at or above the action level recommended by EPA.
- It ranks 1st among all states, placing it in the top tier.
Racial & Ethnic Disparities
Black individuals:
- The rate of new lung cancer cases is 35.9 per 100,000 population among Black individuals in Hawaii, significantly lower than the rate of 56.3 among Black individuals nationally, and not significantly different than the rate of 39.2 among white individuals in Hawaii.
- The five-year survival rate is 22.7% among Black individuals in Hawaii, not significantly different than the rate of 23.8% among Black individuals nationally, and not significantly different than the rate of 24.4% among white individuals in Hawaii.
- Other lung cancer rates are not available for Black individuals in Hawaii due to too few cases over the time period to allow for accurate analysis.
Latino individuals:
- The rate of new lung cancer cases is 76.6 per 100,000 population among Latino individuals in Hawaii, significantly higher than the rate of 28.2 among Latino individuals nationally, and significantly higher than the rate of 39.2 among white individuals in Hawaii.
- State-level survival rates are not available for Latino individuals at this time. Nationally, the five-year survival rate among Latino individuals is 22.7%, not significantly different than the rate of 25.0% among white individuals.
- 19.3% of lung cancer cases are diagnosed at an early stage among Latino individuals in Hawaii, not significantly different than the rate of 23.1% among Latino individuals nationally, and not significantly different than the rate of 22.6% among white individuals in Hawaii.
- 15.5% of Latino individuals with lung cancer in Hawaii underwent surgery, significantly lower than the rate of 21.6% among Latino individuals nationally, and significantly lower than the rate of 23.4% among white individuals in Hawaii.
- 25.3% of Latino individuals with lung cancer in Hawaii did not receive any treatment, not significantly different than the rate of 26.1% among Latino individuals nationally, and not significantly different than the rate of 23.9% among white individuals in Hawaii.
Asian Americans or Pacific Islanders:
- The rate of new lung cancer cases is 43.0 per 100,000 population among Asian or Pacific Islanders individuals in Hawaii, significantly higher than the rate of 32.9 among Asian or Pacific Islanders individuals nationally, and significantly higher than the rate of 39.2 among white individuals in Hawaii.
- State-level survival rates are not available for Asian or Pacific Islander individuals at this time. Nationally, the five-year survival rate among Asian or Pacific Islander individuals is 28.6% and significantly higher than the rate of 25.0% among white individuals.
- 19.5% of lung cancer cases are diagnosed at an early stage among Asian or Pacific Islander individuals in Hawaii, significantly lower than the rate of 22.8% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 22.6% among white individuals in Hawaii.
- 15.8% of Asian or Pacific Islander individuals with lung cancer in Hawaii underwent surgery, significantly lower than the rate of 24.7% among Asian or Pacific Islander individuals nationally, and significantly lower than the rate of 23.4% among white individuals in Hawaii.
- 24.4% of Asian or Pacific Islander individuals with lung cancer in Hawaii did not receive any treatment, significantly higher than the rate of 20.2% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 23.9% among white individuals in Hawaii.
Indigenous Peoples:
- The rate of new lung cancer cases is 77.9 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Hawaii, not significantly different than the rate of 39.4 among Indigenous Peoples nationally, and not significantly different than the rate of 39.2 among white individuals in Hawaii.
- 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.
- Other lung cancer rates are not available for Indigenous Peoples (American Indians/Alaska Natives) in Hawaii due to too few cases over the time period to allow for accurate analysis.
Summary
The early diagnosis rate in Hawaii falls into the bottom 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.
It is alarming that Hawaii falls into the below average 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.