Cancer survival disparities by health insurance status

 Blogger's Note: ovarian cancer was not included in this study; data taken from New Jersey registry ("All first primary invasive breast, cervical, colorectal, lung, prostate, and bladder (also in situ) cancers and NHLs in the NJSCR diagnosed during 1999–2004 in persons aged 18–64 years were included.")

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Background

Previous studies found that in the United States, uninsured and Medicaid insured patients with breast, cervical, colorectal, head and neck, lung, prostate or uterine cancer have higher mortality or lower survival than do patients with private insurance or Medicare, even after adjustment for other factors [1-13]. Authors of studies comparing cancer survival among Canadian residents with U.S. residents concluded that low-income Canadians have a survival advantage over low-income U.S. residents, probably due to Canada's universal health care system which provides equal access to medically necessary care [14, 15]. These and other studies also found that age, sex, race, ethnicity, socioeconomic status (SES), marital status, stage at diagnosis, comorbidities, behavioral risk factors, and treatment significantly impact survival from cancer [1-25]. As substantial proportions of the U.S. population are uninsured or enrolled in Medicaid – 48.6 million (15.7%) and 50.8 million (16.5%), respectively, in 2011 [26], it is important to determine differential effects of health insurance on health status. We examined the association between health insurance status and cause-specific survival from seven common cancers diagnosed in New Jersey (NJ) residents aged 18–64 using a high-quality population-based cancer registry and adjusting for other significant factors. We excluded patients aged 65 or older because nearly all are insured through Medicare. We also compared cancer survival by insurance status between two time periods. The cancers we examined, female breast (breast), cervical, colorectal, lung and bronchus (lung), non-Hodgkin lymphoma (NHL), prostate and urinary bladder (bladder), accounted for 61% of the incident cancers and 56% of cancer deaths among NJ residents during 2005–2009 [27]. To our knowledge, this is the first study of survival disparities by insurance status to include NHL and urinary bladder cancer, as well as changes in the relationship between health insurance status and cancer survival over time....

Conclusions

Survival from cancer appears to be related to a complex set of interrelated demographic and clinical factors of which insurance status is a part......