The rates of health insurance coverage for patients with cancer tend to vary based on patient demographics and their cancer type, according to study results.
These findings suggest that expanded coverage as part of the Affordable Care Act may result in disproportionate benefits to certain patient populations, according to the researchers.
Approximately 48 million Americans have no health insurance, according to study background. Usama Mahmood, MD, assistant professor in the department of radiation oncology in the division of radiation oncology at The University of Texas MD Anderson Cancer Center, and colleagues sought to examine how insurance coverage differs among nonelderly patients with cancer according to various factors such as race, age, gender, cancer type, marital status and rural vs. urban residence.
The researchers identified 688,794 patients from the SEER database aged 18 to 64 years who were diagnosed between 2007 and 2010 with one of the top 25 most frequently diagnosed cancers. The researchers classified patients as uninsured, having Medicaid or having non-Medicaid insurance.
Data indicated that younger age, male sex, nonwhite race, being unmarried, residence in counties with higher levels of poverty and rural residence were associated with being uninsured vs. having non-Medicaid insurance (P < .001 for all).
The highest rates of non-Medicaid insurance occurred among patients with prostate cancer (92.3%), melanoma of the skin (92.5%) and thyroid cancer (89.5%), whereas the lowest rates for non-Medicaid insurance occurred among patients with cervical cancer (64.2%), liver cancer (67.9%) and stomach cancer (70.9%; P < .001 for all).
The most prevalent cancers among patients without insurance were lung cancer (14.9%), colorectal cancer (12.1%) and breast cancer (10.2%; P < .001 for all).
Lung cancer was the leading cause of death among all insurance groups.
“Both insurance status and type of cancer are affected by demographic factors,” Mahmood said in a press release. “It was interesting to see how each varies with the other.”
The researchers concluded that the association between tumor site and insurance status had three possible contributing factors:
- Uninsured patients are less likely to use cancer screening tests.
- The association between younger age and no insurance contributes to age-associated cancers. Thus, a cancer such as testicular cancer (median age at diagnosis, 33 years) is more prevalent among uninsured patients, whereas prostate cancer (median at diagnosis, 66 years) is more prevalent among insured patients.
- A lack of insurance is associated with cancer risk factors, such as tobacco use and alcohol abuse.
The investigators noted that because income is not reported in SEER, the data instead included county-level income data as a measure of socioeconomic status. Also, identifying insurance status is new to SEER — which does not create subsets among privately insured patients — and, therefore, could lead to misclassification in some instances. Finally, 6.1% of the cohort had an unknown insurance status.
“Further research will be required to determine how changes in health care coverage impact the presentation, treatment and survival of cancer patients,” Mahmood said in the release.
Overall, these data may suggests certain implications of the Patient Protection and Affordable Care Act (PPACA), according to the researchers.
“Rates of insurance vary greatly by patient demographic factors and by cancer type, suggesting that the expansion of coverage under the PPACA will likely disproportionately impact certain patient populations with cancer more greatly than others,” Mahmood and colleagues concluded. “The effect on quality of care and outcomes remains to be seen.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.