Insurance Status Linked to Higher Rates of Certain Cancer Types

Uninsured Americans and those with Medicaid insurance are more likely to be younger, nonwhite, unmarried, and live in rural areas than those with non-Medicaid insurance, according to a study recently published in Cancer.1 Furthermore, despite the extension of Medicaid eligibility to women diagnosed with breast and cervical cancer in the Breast and Cervical Cancer Prevention and Treatment Act of 2000, women with cervical cancer have one of the highest rates of being uninsured among patients with cancer. Patients with testicular and stomach cancers are also likely to be uninsured.

The authors indicate that further efforts may improve awareness and accessibility of care for these patients, and that continuing research will help clarify the impact of recent legislative efforts to increase the number of people with insurance coverage.

“Additional efforts may help to expand access to care among patients with those cancer types and demographic groups with the highest rate of uninsurance,” wrote Usama Mahmood, MD, and colleagues. They also noted that “with such wide discrepancies in insurance coverage, the PPACA [Patient Protection and Affordable Care Act] will disproportionately benefit certain populations,” although “further research will be needed to determine whether and to what extent cancer care is ultimately impacted by the upcoming changes in insurance coverage.”

Dr Mahmood, Assistant Professor, Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, and colleagues used the Surveillance, Epidemiology, and End Results (SEER) database in their study to determine the association between demographics and insurance status among patients with cancer. They identified 646,611 patients aged 18 to 64 years who were diagnosed with the 25 most common types of cancer between 2007 and 2010 and who were uninsured, had non-Medicaid insurance (ie, private insurance, Medicare, or insurance from the military or Department of Veterans Affairs), or Medicaid insurance.

The rate of non-Medicaid insurance coverage among white patients (87.4%) was second only to the rate among a small number of patients who indicated their race was unknown (91.1%), while rates of Medicaid insurance coverage were highest among American Indian/Alaska Native patients. Rates of uninsured patients were highest among Hispanic patients. Moreover, the rate of non-Medicaid insurance coverage fell from 79.1% in 2007 to 76.2% in 2010, whereas in this time frame the rate of uninsured patients rose from 4.8% to 5.1%. The authors posited that the latter increase was likely because of an economic downturn during that period.

The investigators’ multivariate analysis showed that younger age, nonwhite race, and being unmarried were among the factors associated with a greater probability of patients being uninsured or having Medicaid insurance compared with patients having non-Medicaid insurance. Furthermore, among the top 25 most common cancer types, those types with the highest proportion of uninsured patients were testicular cancer (10.5%), stomach cancer (9.7%), and cervical cancer (8.9%). The lowest rates of uninsured patients were found among those with thyroid cancer (3.2%), prostate cancer (2.7%), and breast cancer (2.6%). The highest rates of Medicaid insurance coverage were among patients with cervical cancer (27.0%), liver cancer (24.1%), and vulvar cancer (20.3%), whereas the highest rates of non-Medicaid insurance coverage were among patients with prostate cancer (92.3%), skin melanoma (92.5%), and thyroid cancer (89.5%).

Among patients without insurance and patients with Medicaid, the most common causes of cancer mortality were lung, colorectal, and liver cancers. In patients with non-Medicaid insurance, the most common causes of cancer mortality were lung, pancreatic, and colorectal cancers. Among all 3 insurance categories, patients with lung cancer presented the highest estimated annual mortality burden, exceeding the combined mortality burden of the next 4 most common causes of cancer mortality.

Generally, expanded insurance coverage offered through PPACA will likely impact certain patient populations more than others. Researchers concluded that more research will be warranted once PPACA is fully implemented to further examine the trends found in this first analysis of insurance status differences among patients with cancer in the SEER database.

“Time will tell how the incidence and mortality of the individual cancers will be impacted by the full rollout of the PPACA,” Dr Mahmood told Oncology Practice Management. “And our role as oncologists is to, as best as we can, monitor these changes and help ensure the best outcomes possible for our patients.”


Reference

  1. Grant SR, Walker GV, Guadagnolo BA, et al. Variation in insurance status by patient demographics and tumor site among nonelderly adult patients with cancer. Cancer. 2015 Apr 27 [Epub ahead of print].

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