In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 15_suppl ( 2020-05-20), p. 7026-7026
Abstract:
7026 Background: While previous studies demonstrated associations between Medicaid coverage or no health insurance with both advanced stage at cancer diagnosis and worse survival, access to health care in the U.S. has changed substantially in the past decade. This study examined associations of health insurance status with stage at diagnosis and survival among 17 common cancers using recent national data. Methods: We identified 1,427,532 cancer patients aged 18-64 years newly diagnosed with 17 common cancers from the 2010-2013 National Cancer Database. Multivariable logistic regression models were used to examine the distribution of stage at diagnosis by health insurance status (private, Medicare, Medicaid, dual Medicare/Medicaid, and uninsured) overall and for each cancer site. Cox models compared stage-specific survival by health insurance for each site. Results: Compared to privately insured patients, Medicaid and uninsured patients were significantly more likely to be diagnosed with advanced-stage cancer (III/IV) for all the 17 cancers combined (adjusted odds ratio [AOR]: 2.27, 95% confidence interval [95CI] : 2.24-2.29; AOR: 2.39, 95CI: 2.36-2.42, respectively) and for all included cancer sites separately. Medicare and Medicare-Medicaid patients were also more likely to be diagnosed at advanced-stage for all the 17 cancers combined, but results varied by cancer site. Compared to the privately insured patients, worse survival was observed for patients with all other insurance types and uninsured at each stage for all the 17 cancers combined and most cancer sites. For example, among patients diagnosed at stage I, adjusted mortality hazard ratios for Medicare, Medicaid, Medicare-Medicaid, and uninsured patients 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), respectively, compared with privately-insured patients. Conclusions: Patients with non-private insurance were more likely to be diagnosed with cancer at advanced stage and have worse survival. Improving access to health insurance with adequate coverage is crucial for receiving appropriate cancer screening, diagnosis, and quality care.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2020.38.15_suppl.7026
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2020
detail.hit.zdb_id:
2005181-5
