Insurance status and racial differences in uterine cancer survival: a study of patients in the National Cancer Database.

OBJECTIVE: To examine the impact of race and insurance on survival among a large cohort of uterine cancer patients from the National Cancer Database (NCDB).
METHODS: Women diagnosed with stages I-III uterine cancer between 2000 and 2001 were selected from the NCDB. Kaplan-Meier (KM) and multivariate Cox proportional hazards were used to estimate 4 year survival rates and hazard ratios (HR) and 95% confidence intervals (CIs), respectively.
RESULTS: Among the 39,510 evaluable patients, African Americans had a higher risk of death compared to whites (HR=1.43 95% CI 1.31-1.56) after adjusting for age, clinical and facility factors and zip code level education. After additional adjustment for treatment, the risk death decreased among African Americans (HR=1.33 95%CI 1.21-1.46) and subsequent adjustment for insurance further reduced the hazard of death (HR=1.28 95% CI 1.17-1.40). Patients with insurance other than private had an increased risk of death (uninsured HR=1.44 95% CI 1.20-1.72, Medicaid HR=1.70, 95% CI 1.46-1.99, Medicare among patients aged 18-64 HR=2.49, 95% CI 2.10-2.95, Medicare among patients aged 65-99 HR=1.22, 95% 1.11-1.34).
CONCLUSIONS: The largest contributors to African American/white survival disparities in this study were clinical factors, including stage at diagnosis, grade and histopathology. Patients without private health insurance had worse uterine cancer survival that may be improved through future health care reform aimed at improving access to preventive services and adequate treatment.