The association between insurance status and prostate cancer outcomes: implications for the Affordable Care Act

Mahal, Brandon A.; AA, Anigbo; Ziehr, David R.; As, Hyatt; Lago-Hernandez, Carlos; Chen, Yu-Wei; Tk, Choueiri; Jc, Hu; Cj, Sweeney; Beard, Caroline; D’Amico, A.V.; Ne, Martin; Trinh, Q-D.; Pl, Nguyen

doi:10.1038/pcan.2014.23

Cited by 62 publications

(49 citation statements)

References 36 publications

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“…Although previous studies have indicated that insurance status is associated with a reduction in racial treatment disparities among men diagnosed with localized CaP, we found that racial disparities were only mitigated among men with Medicaid coverage. This appears to be due to factors that we can only hypothesize: perhaps more equal screening, detection of disease, adjuvant care, or posttreatment support is driving the reduced disparate outcomes.…”

Section: Discussioncontrasting

confidence: 97%

Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Mahal

Nguyen

et al. 2017

Cancer

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Racial disparities in the outcomes of patients with CaP were observed in privately insured cohorts, whereas these disparities appeared to be reduced among patients with Medicaid insurance. However, outcomes need to be improved overall. Whether the equality in outcomes for Medicaid is due to white and African American patients doing "equally poorly" or "equally well" is unclear. Cancer 2018;124:752-9. © 2017 American Cancer Society.

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Section: Discussioncontrasting

confidence: 97%

Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Mahal

Nguyen

et al. 2017

Cancer

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“…U.S. Census data published in 2012 showed that 15.4%, or 48 million Americans, went uncovered by health insurance, and Medicaid covered 16.4%, or 51 million Americans (DeNavas-Walt, US census bureau, 2013). Lack of insurance coverage has been associated with worse survival and postoperative complications in critical illness (21), trauma (22), breast cancer (23), uterine cancer (24), colorectal cancer (25, 26), prostate cancer (27), diffuse large cell lymphoma (28), head and neck cancer (29), and lung cancer (30). Attributable causes for worse clinical outcomes in uninsured Americans include more advanced disease at time of diagnosis, fewer diagnostic tests performed, and decreased healthcare literacy (31, 32).…”

Section: Discussionmentioning

confidence: 99%

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Melvan

Sancheti

Gillespie

et al. 2015

Journal of the American College of Surgeons

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Background Clinical variables associated with 30-day mortality after lung cancer surgery are well known. However, the effects of non-clinical factors, including insurance coverage, household income, education, type of treatment center, and area of residence, on short term survival are less appreciated. We studied the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify disparities in 30-day mortality after lung cancer resection based on these non-clinical factors. Study Design We performed a retrospective cohort analysis of patients undergoing lung cancer resection from 2003-2011, using the NCDB. Data were analyzed using a multivariable logistic regression model to identify risk factors for 30-day mortality. Results 215,645 patients underwent lung cancer resection during our study period. We found that clinical variables such as age, gender, comorbidity, cancer stage, preoperative radiation, extent of resection, positive surgical margins, and tumor size were associated with 30-day mortality after resection. Non-clinical factors including living in lower income neighborhoods with a lesser proportion of high school graduates, and receiving cancer care at a non-academic medical center were also independently associated with increased 30-day postoperative mortality. Conclusions This study represents the largest analysis of 30-day mortality for lung cancer resection to date from a generalizable national cohort. Our results demonstrate that, in addition to known clinical risk factors, several non-clinical factors are associated with increased 30-day mortality after lung cancer resection. These disparities require further investigation to improve lung cancer patient outcomes.

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“…1 Reducing sociodemographic disparities in high-risk cancers has been a major goal of the American Cancer Society and other major cancer organizations for the last 2 decades. [5][6][7][8][9] Disparities in cancer care certainly present a barrier to mitigating disparities in cancer outcome, although it is unclear whether reducing disparities in care patterns would actually translate to better cancer outcomes. [5][6][7][8][9] Disparities in cancer care certainly present a barrier to mitigating disparities in cancer outcome, although it is unclear whether reducing disparities in care patterns would actually translate to better cancer outcomes.…”

Section: Introductionmentioning

confidence: 99%

National sociodemographic disparities in the treatment of high‐risk prostate cancer: Do academic cancer centers perform better than community cancer centers?

Mahal

Chen

Muralidhar

et al. 2016

Cancer

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The association between insurance status and prostate cancer outcomes: implications for the Affordable Care Act

Cited by 62 publications

References 36 publications

Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

National sociodemographic disparities in the treatment of high‐risk prostate cancer: Do academic cancer centers perform better than community cancer centers?

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