Lack of Private Health Insurance Impacted Cancer Survival

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• Study conducted among patients with uterine cancer.
• African-Americans had higher death rates, even with insurance.
• Mortality higher among patients with public vs. private insurance.

MIAMI — Lack of private health insurance and its consequent lack of access to care appears to affect mortality among patients with uterine cancer and may partly explain the mortality disparity between African-Americans and other racial groups, according to data presented at the Third AACR Conference on The Science of Cancer Health Disparities.

“African-Americans were twice as likely to die within four years compared to white patients after adjusting for age, facility and education level. However, when insurance, treatment and clinical factors were accounted for, this likelihood decreased to 30 percent greater,” said Dana Chase, M.D., a clinical fellow at the University of California, Irvine.

Chase and colleagues presented a retrospective analysis on 178,891 patients in the National Cancer Database. Whites made up approximately 74 percent of the cohort, while Hispanics comprised 5 percent and 9 percent were African-Americans. The remaining patients did not have specific racial information.

The unadjusted four-year survival rate with uterine cancer was 82 percent for whites and Hispanics, but only 63 percent for African-Americans. Some of the differences in survival by race were accounted for by more advanced stage of disease at diagnosis. However, even after accounting for disease severity, African-Americans experienced poorer survival compared to white patients.

The unadjusted four-year survival rates were 80.7 percent among uninsured, 75.93 percent for Medicaid insured, 79.45 percent for younger Medicare patients, 69.35 percent for older Medicare patients and 88.93 percent for privately insured patients.

Patients without insurance were 1.46 times likely to die within four years after adjusting for demographic and clinical factors. Medicaid insured and those insured through Medicare at younger ages (18 to 64 years) were 1.74 and 2.5 times as likely to die within four years compared to privately insured patients, respectively. However, survival patterns among Medicaid and younger Medicare patients are difficult to interpret due to retroactive enrollment in these insurance plans as a result of a cancer diagnosis. Additionally, this study did not account for comorbidity, which may vary by insurance and contribute to poorer survival outcomes.

“Other variables may be playing a role in access to care among minority populations and we’ll have to look at it further, but it’s clear from this study that insurance definitely plays a role,” said Chase.

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The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 32,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowships and career development awards. The AACR Annual Meeting attracts more than 18,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists, providing a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

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