Association of Insurance Status and Ethnicity With Cancer Stage at Diagnosis for 12 Cancer Sites: A Retrospective Analysis

Abstract

Persons living in the United States who lack private medical insurance are less likely to have access to medical care and to take part in cancer screening programs. Regional studies suggest that uninsured and Medicaid-insured individuals are likelier than those who are privately insured to present with advanced-stage cancer, but this has not been confirmed using contemporary national-level information. Complicating the problem is the observation that cancer patients from ethnic minorities are likelier than non-Hispanic whites to be uninsured or Medicaid insured. This study sought relationships between insurance status and disease stage at the time of diagnosis for twelve cancer sites (breast, colorectal, kidney, lung, melanoma, non-Hodgkin lymphoma, ovary, pancreas, prostate, urinary bladder, uterus, thyroid). The study population included 3,742,407 patients whose characteristics resembled those of the U.S. population not included in the analysis. The patients, diagnosed in the years 1998-2004, were enrolled in the U.S. National Cancer Database, a hospital-based registry with patient information from approximately 1430 facilities.Uninsured and Medicaid-insured patients were significantly more likely than privately insured patients to present with advanced-stage (stage III or stage IV) cancer. The relationship was most evident for patients whose cancers can potentially be detected at an early stage by symptom assessment or screening. They include breast and colorectal cancers, lung cancer, and melanoma. Compared with privately insured patients, the odds ratios (ORs) for advanced-stage disease at diagnosis for uninsured and Medicaid-insured patients with colorectal cancer were 2.0 (95% confidence interval, 1.9-2.

Widening socioeconomic disparities in cervical cancer mortality among women in 26 states, 1993‐2007

“…The generalizability of the NCDB stage and insurance analyses also may be limited to patients who are seen at CoC-accredited facilities, which are more likely to be in urban areas and larger in size than non-CoC facilities. 35 There has been no formal validation of insurance status in the NCDB, which is another potential limitation that has been described elsewhere 36 ; however, it is the only national registry with insurance data. In addition, trends in increasing disparities should be interpreted cautiously, because the CIs overlapped for non-Hispanic whites and non-Hispanic blacks across the various periods.…”

Reaching high-risk underserved individuals for cancer genetic counseling by video-teleconferencing

“…Compared with their nonHispanic white counterparts, Hispanic women are less likely to have received a screening mammogram within the past year, are more likely to be diagnosed with breast cancer at a later stage, experience a longer time from diagnosis to treatment, have greater disruptions in breast cancer treatment, and have a higher mortality rate from the disease. [3][4][5][6] Lynch syndrome, the most common hereditary colon cancer predisposition, accounts for 2%-4% of colorectal cancer. 7 It is recommended that individuals with Lynch syndrome or a family history of colorectal cancer increase the frequency of their screening colonoscopy and start screening at an earlier age.…”

Socioeconomic factors may contribute to neoadjuvant chemotherapy use in metastatic epithelial ovarian carcinoma

“…These pre-treatment factors then affect treatment allocation. It has been documented that out of 12 cancer sites, ovary has the largest amount of uninsured patients [8]. Several studies have demonstrated that African-Americans and Hispanics are more likely to present in advanced stages in various cancers including ovarian.…”

“…Because mortality rate has remained unchanged across all ethnicities throughout this time period, the representation of non-White ethnicities in the ovarian cancer population is likely on the rise [7]. Recent studies have also documented a larger proportion of non-White women presenting with advanced stage ovarian cancer in 75% of the total U.S. cancer population [8]. Furthermore, race, income and age have been associated with substandard treatment choices for ovarian cancer [9].…”