Ayal A Aizer1, Benjamin Falit2, Mallika L Mendu2, Ming-Hui Chen2, Toni K Choueiri2, Karen E Hoffman2, Jim C Hu2, Neil E Martin2, Quoc-Dien Trinh2, Brian M Alexander2, Paul L Nguyen2. 1. Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA. aaaizer@partners.org. 2. Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
Abstract
PURPOSE: The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults. METHODS: We used the SEER program to identify 39,447 patients age 20 to 40 years diagnosed with a malignant neoplasm between 2007 and 2009. The association between insurance status and stage at presentation, employment of definitive therapy, and all-cause mortality was assessed using multivariable logistic or Cox regression, as appropriate. RESULTS: Patients who were uninsured were more likely to be younger, male, nonwhite, and unmarried than patients who were insured and were also more likely to be from regions of lower income, education, and population density (P < .001 in all cases). After adjustment for pertinent confounding variables, an association between insurance coverage and decreased likelihood of presentation with metastatic disease (odds ratio [OR], 0.84; 95% CI, 0.75 to 0.94; P = .003), increased receipt of definitive treatment (OR, 1.95; 95% CI, 1.52 to 2.50; P < .001), and decreased death resulting from any cause (hazard ratio, 0.77; 95% CI, 0.65 to 0.91; P = .002) was noted. CONCLUSION: The improved coverage fostered by the ACA may translate into better outcomes among most young adults with cancer. Extra consideration will need to be given to ensure that patients who will face premium increases in the individual market can obtain insurance coverage under the ACA.
PURPOSE: The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults. METHODS: We used the SEER program to identify 39,447 patients age 20 to 40 years diagnosed with a malignant neoplasm between 2007 and 2009. The association between insurance status and stage at presentation, employment of definitive therapy, and all-cause mortality was assessed using multivariable logistic or Cox regression, as appropriate. RESULTS:Patients who were uninsured were more likely to be younger, male, nonwhite, and unmarried than patients who were insured and were also more likely to be from regions of lower income, education, and population density (P < .001 in all cases). After adjustment for pertinent confounding variables, an association between insurance coverage and decreased likelihood of presentation with metastatic disease (odds ratio [OR], 0.84; 95% CI, 0.75 to 0.94; P = .003), increased receipt of definitive treatment (OR, 1.95; 95% CI, 1.52 to 2.50; P < .001), and decreased death resulting from any cause (hazard ratio, 0.77; 95% CI, 0.65 to 0.91; P = .002) was noted. CONCLUSION: The improved coverage fostered by the ACA may translate into better outcomes among most young adults with cancer. Extra consideration will need to be given to ensure that patients who will face premium increases in the individual market can obtain insurance coverage under the ACA.
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