Insurance Disparity in Cardiovascular Mortality among Non-Elderly Cancer Survivors

Abstract

Background:Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancer patients have higher cardiovascular disease (CVD) mortality than the general population. Methods: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVD mortality among cancer patients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Private vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVD mortality. Results: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with private insurance (HR=1.71; 95%CI, 1.61-1.81; p<0.001). Older age, male gender, and black race were all associated with increased CVD mortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVD mortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Private insured patients had similar CVD mortality to the general population after 2 years out from their cancer diagnosis. Conclusion: Cancer patients with private insurance have significantly lower CVD mortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.