BACKGROUND: Although debate continues on US healthcare and insurance reform, data are lacking on the effect of insurance on community-level cancer outcomes. Therefore, the objective of the present study was to examine the association of insurance and cancer outcomes. MATERIALS AND METHODS: The US Census Bureau Current Population Survey, Small Area Health Insurance Estimates (2000) were used for the rates of uninsurance. Counties were divided into tertiles according to the uninsurance rates. The data were compared with the cancer incidence and survival for patients residing in counties captured by the Surveillance, Epidemiology, and End Results database (2000-2006). Aggregate patient data were collected of US adults (aged ≥18 y) diagnosed with the following cancers: pancreatic, esophageal, liver or bile duct, lung or bronchial, ovarian, colorectal, breast, prostate, melanoma, and thyroid. The outcomes included the stage at diagnosis, surgery, and survival. Univariate tests and proportional hazards were calculated. RESULTS: The US uninsurance rate was 14.2%, and the range for the Surveillance, Epidemiology, and End Results counties was 8.3%-24.1%. Overall, patients from lower uninsurance rate counties demonstrated longer median survival. Adjusting for patient characteristics and cancer stage (for each cancer), the patients in the higher uninsurance rate counties demonstrated greater mortality (8%-15% increased risk on proportional hazards). The county uninsurance rate was associated with the stage at diagnosis for all cancers, except pancreatic and esophageal, and was also associated with the likelihood of being recommended for cancer-directed surgery (for all cancers). CONCLUSIONS: Health insurance coverage at a community level appears to influence survival for patients with cancer. Additional investigations are needed to examine whether individual versus community associations exist and how best to surmount barriers to cancer care.
BACKGROUND: Although debate continues on US healthcare and insurance reform, data are lacking on the effect of insurance on community-level cancer outcomes. Therefore, the objective of the present study was to examine the association of insurance and cancer outcomes. MATERIALS AND METHODS: The US Census Bureau Current Population Survey, Small Area Health Insurance Estimates (2000) were used for the rates of uninsurance. Counties were divided into tertiles according to the uninsurance rates. The data were compared with the cancer incidence and survival for patients residing in counties captured by the Surveillance, Epidemiology, and End Results database (2000-2006). Aggregate patient data were collected of US adults (aged ≥18 y) diagnosed with the following cancers: pancreatic, esophageal, liver or bile duct, lung or bronchial, ovarian, colorectal, breast, prostate, melanoma, and thyroid. The outcomes included the stage at diagnosis, surgery, and survival. Univariate tests and proportional hazards were calculated. RESULTS: The US uninsurance rate was 14.2%, and the range for the Surveillance, Epidemiology, and End Results counties was 8.3%-24.1%. Overall, patients from lower uninsurance rate counties demonstrated longer median survival. Adjusting for patient characteristics and cancer stage (for each cancer), the patients in the higher uninsurance rate counties demonstrated greater mortality (8%-15% increased risk on proportional hazards). The county uninsurance rate was associated with the stage at diagnosis for all cancers, except pancreatic and esophageal, and was also associated with the likelihood of being recommended for cancer-directed surgery (for all cancers). CONCLUSIONS: Health insurance coverage at a community level appears to influence survival for patients with cancer. Additional investigations are needed to examine whether individual versus community associations exist and how best to surmount barriers to cancer care.
Authors: Ankush Chandra; Jonathan W Rick; Cecilia Dalle Ore; Darryl Lau; Alan T Nguyen; Diego Carrera; Alexander Bonte; Annette M Molinaro; Philip V Theodosopoulos; Michael W McDermott; Mitchel S Berger; Manish K Aghi Journal: Neurosurg Focus Date: 2018-06 Impact factor: 4.047
Authors: Jeffrey H Silber; Paul R Rosenbaum; Richard N Ross; Joseph G Reiter; Bijan A Niknam; Alexander S Hill; Diana M Bongiorno; Shivani A Shah; Lauren L Hochman; Orit Even-Shoshan; Kevin R Fox Journal: Milbank Q Date: 2018-12 Impact factor: 4.911
Authors: Stephen R Grant; Gary V Walker; B Ashleigh Guadagnolo; Matthew Koshy; Pamela K Allen; Usama Mahmood Journal: Cancer Date: 2015-04-27 Impact factor: 6.860
Authors: Gary V Walker; Stephen R Grant; B Ashleigh Guadagnolo; Karen E Hoffman; Benjamin D Smith; Matthew Koshy; Pamela K Allen; Usama Mahmood Journal: J Clin Oncol Date: 2014-08-04 Impact factor: 44.544
Authors: Alexandra Smith; Simon Crouch; Debra Howell; Cathy Burton; Russell Patmore; Eve Roman Journal: Cancer Epidemiol Date: 2015-09-02 Impact factor: 2.984