Jingxuan Zhao, MPH @AmercianCancer #ASCO20 Health insurance status and cancer stage at diagnosis and survival in the United States
Bottom line:
Although previous research found correlations between Medicaid coverage or no health insurance with both advanced cancer diagnosis stage and worse survival, access to health care in the United States has significantly improved over the past decade. Using recent national data , this study examined associations of health insurance status with stage at diagnosis and survival among 17 common cancers.
Approaches:
We reported 1,427,532 newly diagnosed cancer patients aged 18-64 years with 17 common cancers from the National Cancer Database from 2010-2013. Multivariable logistic regression models were used to analyze the overall and for a cancer site, stage distribution at diagnosis by health insurance status (private, Medicare, Medicaid, dual Medicare / Medicaid, and uninsured). For each location, Cox models compared stage-specific survival through health insurance.
Reviews:
Medicaid and uninsured patients were slightly more likely to be diagnosed with advanced-stage cancer (III / IV) compared with privately insured patients for all 17 cancers combined (adjusted odds ratio [AOR]: 2.27, 95 percent confidence interval [95CI]: 2.24-2.29; AOR: 2.39, 95CI: 2.36-2.42, respectively) and separately for all included cancer sites. For all of the 17 cancers combined, Medicare and Medicare-Medicaid patients were both more likely to be diagnosed at the advanced stage, although findings differed by cancer location. Worse survival was observed for patients with all other forms of insurance, and uninsured at each point for all 17 cancers together with most cancer sites, relative to private insured patients. For example, modified mortality hazard ratios for Medicare , Medicaid, Medicare-Medicaid, and uninsured patients among patients diagnosed at stage I were 1.72 (95CI: 1.70-1.75), 1.73 (95CI: 1.71-1.76), 2.07 (95CI: 2.02-2.17) and 1.56 (95CI: 1.53-1.58), compared with privately insured patients , respectively.
Findings:
Non-private insurance patients were more likely to be diagnosed with advanced-stage cancer and have poorer survival. In order to obtain sufficient cancer screening, detection and quality treatment, expanding access to health insurance with reasonable coverage is essential.