Tiantian Shi1, Changchuan Jiang2, Cenjing Zhu3, Fangcheng Wu4, Irma Fotjhadi5, Stuart Zarich6. 1. Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USA. 2. Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. 3. Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, CT, USA. 4. Department of Medicine, Memorial Hospital West, Pembroke Pines, FL, USA. 5. Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 00610, USA. 6. Division of Cardiovascular Medicine, Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 00610, USA. pszari@bpthosp.org.
Abstract
BACKGROUND: Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancer patients have higher cardiovascular disease (CVD) mortality than the general population. METHODS: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVD mortality among cancer patients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Non-Medicaid vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVD mortality. RESULTS: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with Non-Medicaid insurance (HR = 1.71; 95%CI, 1.61-1.81; p < 0.001). Older age, male gender, and black race were all associated with increased CVD mortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVD mortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Non-Medicaid insured patients had similar CVD mortality to the general population after 2 years out from their cancer diagnosis. CONCLUSION: Cancer patients with Non-Medicaid insurance have significantly lower CVD mortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.
BACKGROUND: Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancerpatients have higher cardiovascular disease (CVD) mortality than the general population. METHODS: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVDmortality among cancerpatients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Non-Medicaid vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVDmortality. RESULTS: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with Non-Medicaid insurance (HR = 1.71; 95%CI, 1.61-1.81; p < 0.001). Older age, male gender, and black race were all associated with increased CVDmortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVDmortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Non-Medicaid insured patients had similar CVDmortality to the general population after 2 years out from their cancer diagnosis. CONCLUSION:Cancerpatients with Non-Medicaid insurance have significantly lower CVDmortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.
Entities:
Keywords:
Cancer survivorship; Cardio-oncology; Insurance disparities; Outcomes