Presenting Stage in Colon Cancer is Associated with Insurance Status

Abstract

Colorectal cancer continues to be the third most common cause of cancer death in the United States. Access to health care is also a nationwide problem. The purpose of the current study is to see if insurance status is associated with stage of colon cancer at presentation. The tumor registry was queried for all patients with colon cancer from 2009 to 2014. Demographics, including insurance status was statistically analyzed to determine if an association existed between insurance status and stage of colon cancer at the time of presentation. There were 434 patients identified that underwent colonic resection during the study period; 224 were female and 210 were male. Of the 434 patients, 388 were insured and 46 were uninsured. When insurance status was compared with stage at diagnosis there was a statistically significant difference between the two groups. For patients that were uninsured, 13.01 per cent presented with stage I disease, 15.22 per cent with stage II disease, 34.78 per cent with stage III disease, and 36.96 with stage IV disease. For insured patients, 24.03 per cent present with stage I disease, 26.10 with stage II disease, 23.26 per cent with stage III disease, and 29.61 per cent with stage IV disease (P = 0.047). Access to health care continues to be a large problem and results in patients without insurance presenting with a high stage of disease.

Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection

“…The effectiveness of health insurance in influencing the stage of cancer detection and various other outcomes may also depend on the social determinants of a given population. 34 Other studies using state and hospital tumor registry data found associations between health insurance status and stage at diagnosis [35][36][37] ; however, these studies lacked multivariable analyses or were restricted to only 1 site, highlighting a need for more research examining this association across various population types.…”

“…A major strength of this study was the ability to disentangle the associations among health insurance status, mode of detection, and stage at diagnosis, as most other studies on this topic have been unable to do. 14,15,32,[34][35][36] This disentanglement was possible because of our detailed approach to data collection. We used a highly structured computerassisted personal interview, informed beforehand by cognitive interviews with our patient population and administered by trained staff members employed by the University of Illinois at Chicago's Survey Research Laboratory.…”