Jessica L Baedke1, Lauren A Lindsey2, Aimee S James3, I-Chan Huang1, Kirsten K Ness1, Carrie R Howell4, Tara M Brinkman1,5, Nickhill Bhakta1,6,7, Matthew J Ehrhardt1,7, Cindy Im2, William Letsou1, Qi Liu2, Leslie L Robison1, Melissa M Hudson1,7, Yutaka Yasui8,9. 1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA. 2. School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada. 3. Department of Surgery, Washington University School of Medicine, Campus Box 8109, 4590 Children's Place, Suite 9600, St. Louis, MO, 63110, USA. 4. Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers, MT-621, 1720 2nd Avenue South, Birmingham, AL, 35294, USA. 5. Department of Psychology, St. Jude Children's Research Hospital, Mailstop 740, 262 Danny Thomas Place, Memphis, TN, 38105, USA. 6. Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Mailstop 721, 262 Danny Thomas Place, Memphis, TN, 38105, USA. 7. Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA. 8. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA. yutaka.yasui@stjude.org. 9. School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada. yutaka.yasui@stjude.org.
Abstract
PURPOSE: To investigate racial/ethnic-related disparities by insurance status in "forgoing needed medical care in the last year due to finances" in childhood cancer survivors. METHODS: Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen's Healthcare Utilization Model, were adjusted for "predisposing" (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and "need" (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered. RESULTS: Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30-2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01-2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results. CONCLUSIONS: Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites. IMPLICATIONS FOR CANCER SURVIVORS: Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.
PURPOSE: To investigate racial/ethnic-related disparities by insurance status in "forgoing needed medical care in the last year due to finances" in childhood cancer survivors. METHODS: Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen's Healthcare Utilization Model, were adjusted for "predisposing" (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and "need" (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered. RESULTS: Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30-2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01-2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results. CONCLUSIONS: Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites. IMPLICATIONS FOR CANCER SURVIVORS: Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.
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