Quantitative associations between health insurance and stage of melanoma at diagnosis among nonelderly adults in the United States

Abstract

Background Health insurance plays a critical role in the accessibility to and quality of health care for patients with melanoma in the United States. Current knowledge regarding the association between insurance status and stage of melanoma is limited because few studies to date have simultaneously controlled for factors known to influence the risk of diagnosis of late‐stage melanoma. The current study was conducted to examine the association between health insurance status and stage of melanoma at the time of diagnosis in nonelderly adults, accounting for known risk factors for late‐stage diagnosis. Methods In this cross‐sectional study, the authors analyzed the National Cancer Data Base for cases of invasive melanoma diagnosed between 2004 and 2015 among individuals aged 26 to 64 years. Using the American Joint Committee on Cancer melanoma staging system, early‐stage melanoma was defined as stage I or stage II whereas late‐stage melanoma was defined as stage III or stage IV. Late‐stage diagnosis was the primary outcome compared across 4 insurance types (private, Medicaid, none, and unknown). Adjusted covariates were age, sex, race/ethnicity, educational level, income, year of diagnosis, number of comorbidities, and facility location. Logistic regression was used for univariable and multivariable analyses. Results Among 177,247 cases, individuals with Medicaid or no health insurance were found to have 3.12 (95% CI, 2.97‐3.28) and 2.21 (95% CI, 2.10‐2.33) times greater odds, respectively, of being diagnosed with late‐stage melanoma compared with individuals with private insurance after adjusting for risk factors in late‐stage diagnosis. Conclusions Future investigation into insurance disparities in the diagnosis of late‐stage melanoma may help to prioritize melanoma screening in populations with nonprivate insurance.

Skin cancer outcomes and risk factors in renal transplant recipients: Analysis of organ procurement and transplantation network data from 2000 to 2021

“…Considering that graft kidneys are unlikely to affect the patient's skin and Caucasian candidates are more likely to be paired with Caucasian donors in living donor donations, whether Caucasian donors are a risk factor need to be determined by further studies. Generally, lower socioeconomic status is associated with decreased sun protection practices (34)(35)(36), but recipients with private insurance in our study, which usually means greater socioeconomic status, displayed an elevated risk of PTSC, which may be explained by the fact that most private insurance owners are Caucasian. Meanwhile, Caucasians or private insurance owners have a relatively lower risk of mortality, resulting from timely therapy with a shorter delay between diagnosis and definitive surgery (37,38).…”

Rural melanoma patients in Maryland do not present with more advanced disease than urban patients

“…This may have Dermatology Online Journal || Original been influenced by our urban population coming almost entirely from the city of Baltimore, one of the poorest cities with highest crime rates in the United States, possibly masking disparities between rural and urban patients because both groups in the study were disadvantaged [11,12]. A recent study by Abudu et al found that patients with Medicaid or no health insurance were two and three times more likely, respectively, to be diagnosed with late-stage melanoma than those with private insurance [13]. Such findings highlight the impact of socioeconomic factors on melanoma outcomes and it is important to note that both rural and low-income urban communities face barriers to skin cancer care.…”

An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma

“…11,43 This suggests that having insurance, particularly plans that cover liver-directed therapies or surgical interventions, independently provide survival benefits to patients. 40,99,100 In other malignancies, studies have shown that expansion of public health-insurance options has resulted in a lower percentage of late-stage diagnoses and ultimately improved survival. 101 Enhanced primary care physician visits and screening services for insured patients may also lead to improved patient outcomes due to earlier diagnoses.…”