Cancer survival disparities by health insurance status

Abstract

Previous studies found that uninsured and Medicaid insured cancer patients have poorer outcomes than cancer patients with private insurance. We examined the association between health insurance status and survival of New Jersey patients 18–64 diagnosed with seven common cancers during 1999–2004. Hazard ratios (HRs) with 95% confidence intervals for 5-year cause-specific survival were calculated from Cox proportional hazards regression models; health insurance status was the primary predictor with adjustment for other significant factors in univariate chi-square or Kaplan–Meier survival log-rank tests. Two diagnosis periods by health insurance status were compared using Kaplan–Meier survival log-rank tests. For breast, colorectal, lung, non-Hodgkin lymphoma (NHL), and prostate cancer, uninsured and Medicaid insured patients had significantly higher risks of death than privately insured patients. For bladder cancer, uninsured patients had a significantly higher risk of death than privately insured patients. Survival improved between the two diagnosis periods for privately insured patients with breast, colorectal, or lung cancer and NHL, for Medicaid insured patients with NHL, and not at all for uninsured patients. Survival from cancer appears to be related to a complex set of demographic and clinical factors of which insurance status is a part. While ensuring that everyone has adequate health insurance is an important step, additional measures must be taken to address cancer survival disparities.

Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

“…In contrast to our data, the authors only looked at patients of age 18 -64 years and follow-up was limited to one year. Similar studies using statewide registries have found that patients with colorectal cancer who were uninsured or had medicaid, had a higher risk of death compared to private insurance [20] [25] [26]. These studies, however, did not consistently adjust for SES or comorbidities.…”

“…For example, in an equal access system, the Veteran's Administration, outcomes disparities across racial lines are significantly diminished [12] [14]. It is likely that poorer outcomes for AA are, in part, secondary to unequal use of screening, surgical resection, adjuvant therapy and appropriate follow-up [13] [16]- [20].…”

Temporal trends in the association between socioeconomic status and cancer survival in Ontario: a population-based retrospective study

“…11 In a prospective cohort study in the United Kingdom, Ramsay and colleagues 12 investigated the same time trend by social class, defined by occupation, among 7489 men and observed no change in the association between cancer survival and occupation during their 35-year follow-up period. In the US, Niu and colleagues 13 examined whether the disparity in cancer survival by insurance status changed between 1999 and 2004 and found that survival improved for privately insured patients but not for those insured by Medicaid. The objective of the current study was to determine whether the magnitude of the association between socioeconomic status and cancer survival changed between 1993 and 2009 in Ontario.…”

Effect of care-delivery delay on the survival of Mexican women with breast cancer

“…[14][15][16][17] In the United States, women without insurance or with Medicaid showed lower survival rates. 15,18,19 In addition, lower education, greater distance between the patient's home and the hospital where women receive health care and delay in starting treatment have been, also associated with larger tumors. 20,21 This study assess the effect of health care delays: from the first symptoms to the first contact with a doctor, from receipt of mammography results to receipt of diagnostic biopsy results, and from diagnosis to the initiation of treatment, on five-year survival.…”