Race, insurance type, and stage of presentation among lung cancer patients

Abstract

The purpose of this study was to determine whether African-American lung cancer patients are diagnosed at a later stage than white patients, regardless of insurance type. The relationship between race and stage at diagnosis by insurance type was assessed using a Poisson regression model, with relative risk as the measure of association. The setting of the study was a large tertiary care cancer center located in the southeastern United States. Patients who were diagnosed with lung cancer between 2001 and 2010 were included in the study. A total of 717 (31%) African-American and 1,634 (69%) white lung cancer patients were treated at our facility during the study period. Adjusting for age, sex, and smoking-related histology, African-American patients were diagnosed at a statistically significant later stage (III/IV versus I/II) than whites for all insurance types, with the exception of Medicaid. Our results suggest that equivalent insurance coverage may not ensure equal presentation of stage between African-American and white lung cancer patients. Future research is needed to determine whether other factors such as treatment delays, suboptimal preventive care, inappropriate specialist referral, community segregation, and a lack of patient trust in health care providers may explain the continuing racial disparities observed in the current study.

Does access to private healthcare influence potential lung cancer cure rates?

“…The poor may also prioritise health to a lesser degree and therefore postpone seeing a doctor, which can contribute to later stage of presentation. [6,28] However, these findings were not reproducible in this study, which showed that although patients without health insurance presented with later-stage disease, there was no significant difference between the privately insured and uninsured groups.…”

“…[5] Stage at diagnosis is therefore an important indicator of survival in lung cancer. [6] Diagnosis at an advanced stage (IIIB or IV) usually precludes the possibility of cure and leads to poor long-term outcomes. [7][8][9] Five-year survival rates of patients diagnosed with late-stage disease range from ~4% to 6%, whereas those for early-stage disease range from 40% to 54%.…”

“…[7][8][9] Five-year survival rates of patients diagnosed with late-stage disease range from ~4% to 6%, whereas those for early-stage disease range from 40% to 54%. [6,[10][11][12][13][14] Health insurance status is commonly used as a surrogate marker of socioeconomic status (SES). [15] In turn, SES has been shown to be an independent contributor to health status, as a surrogate for lifestyle, diet, and working and living conditions.…”

Cancer Stage in American Indians and Alaska Natives Enrolled in Medicaid

“…14 Though this study found no differences in cancer stage distribution between AI/ANs and NHWs within Medicaid, the proportion of study patients with distant disease exceeded national proportions for breast (9% vs 5%), cervical (21% vs 12%), colorectal (27% vs 20%), lung (65% vs 57%), and prostate (11 vs 4%) cancer, 15 consistent with previous reports. 8,9,16 Although later stage may be due to limited access to cancer screening, 11 much of the Medicaid population is below recommended screening age and, furthermore, disparities persist in lung cancer, for which there was no screening in the period of the present study.…”

Germline Genetic Variants and Lung Cancer Survival in African Americans

“…Notably African Americans have poorer LC survival compared to whites, namely a 14% 5-year survival in African Americans compared to 17% in whites (2). This poor survival can largely be attributed to presentation at a later stage in African Americans, which is associated with reduced LC survival (3). In the clinical setting, an individual’s treatment plan is tailored to the stage of LC diagnosis and can impact LC survival (4).…”