scholarly journals Survival Outcomes for US and Canadian Patients Diagnosed with Hodgkin Lymphoma before and after Brentuximab Vedotin Approval for Relapsed/Refractory Disease: A Retrospective Cohort Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-4
Author(s):  
Gwynivere A Davies ◽  
John E. Orav ◽  
Kristen Brantley
Keyword(s):  
Brentuximab Vedotin ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Risk Of Death ◽  
Period 2 ◽  
Fda Approval ◽  
The Us ◽  
Insured Patients ◽  
Privately Insured

Background: Insurance status impacts access and survival for cancer patients within mixed healthcare systems, such as the US (Walker et al., 2014). Universal healthcare, as in Canada, provides broad coverage, though new drug funding is delayed for financial evaluations given escalating costs of oncologic therapies. Brentuximab Vedotin (BV) was the first FDA approved medication (2011) for Hodgkin lymphoma (HL) since 1977, with a 75% response rate and median overall survival (OS) 40.5 months in patients relapsing post transplant, compared to OS 10.5 to 27.6 months with prior therapies (Chen et al., 2016). Approximately 20% of HL patients develop refractory/relapsed disease, and most proceed to transplant; a further 50% relapse however, thus effective therapy is critical. Given the cost ($232 320 CAD per course; pCODR, 2018), an extensive cost-efficacy analysis was completed in Canada prior to funding, leading to a 3 year delay compared to FDA approval and US funding. We therefore compared OS for US and Canadian patients diagnosed with HL pre/post FDA approval of BV for post-transplant relapse, hypothesizing that 1) survival differences within the US according to insurance would be present and widen after approval and 2) a survival gap would emerge between privately insured US vs. Canadian patients. Methods: A retrospective cohort study was performed of patients 16-64 years diagnosed with classical HL in 2007-2010 (period 1) or 2011-2014 (period 2) from the US SEER and Canadian Cancer Registry (CCR), with vital status updated to November 2016 and December 31, 2014 respectively. A surrogate date for access (FDA approval) was used as neither dataset captures chemotherapy. Exclusion criteria included missing histology, follow-up or insurance data, or post-mortem diagnosis. Log-rank test and Kaplan-Meier analysis compared OS (primary outcome) between groups: in period 2 vs. 1 by US insurance status (aim 1) and including a Canadian/universal category (aim 2). Analysis was performed within each dataset to allow for maximal adjustment utilizing Cox proportional hazards by covariates (age, gender, insurance status, stage, lymphoma subtype, race, ethnicity, marital status within SEER; age, gender, subtype within CCR), then merged using common variables. Secondary outcomes examined 36-month OS (longest calculable given censoring dates) to compare the direction and degree of change in survival between time periods. Results: 12,003 US and 4,210 Canadian patients were included. Demographics were similar, though follow up was shorter for the latter due to censoring date. US patients demonstrated improved survival (crude HR=0.90 (95%CI 0.80-1.02), adjusted HR=0.80 (95%CI 0.71-0.91)), between periods. Canadian patients had a similar reduced risk of death between periods, though this became statistically insignificant after adjustment (crude HR=0.72 (95%CI 0.54-0.95), adjusted HR=0.77 (95%CI 0.59-1.02)). Comparing all patients by country (periods combined) demonstrated a non-significant increased crude risk of death in US vs. Canadian patients (HR 1.13, p=0.059, 95% CI 1.00-1.27). Stratifying US patients by insurance demonstrated stable OS for privately insured, significantly improved OS for Medicaid and non-significantly worse survival for uninsured patients, demonstrating divergence by time likely not solely due to BV access. No difference in OS improvement occurred between periods for privately insured vs. universal patients. In an adjusted model including time period, compared with universal there was increased risk for both uninsured (HR 1.80, p<0.0001, 95% CI 1.46-2.20) and Medicaid patients (HR 2.36, p<0.0001, 95% CI 2.02-2.76), and reduced risk in privately insured patients (HR 0.87, p=0.044, 95% CI 0.77-1.00). Unadjusted 36-month OS quantified divergence according to insurance, with a large (+7.4%) and small (+2.4%) improvement in Medicaid and universal patients respectively, no change in privately insured and worse survival (-4.1%) for uninsured patients. Conclusions: HL survival was worse for Medicaid/uninsured compared to privately/universally insured patients, however all had stable or improved survival in period 2 except uninsured patients. No difference in change between periods for privately or universally insured patients occurred due to delayed access, however robust datasets capturing chemotherapy and comorbidities are needed. Disclosures Davies: Novartis: Honoraria; TEVA: Honoraria.

Survival Outcome and Insurance Status Among Hodgkin's Lymphoma (HL) Patients: Data from SEER 2007-2014

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 915-915
Author(s):  
Qian Wang ◽  
Changchuan Jiang ◽  
Yaning Zhang ◽  
Stuthi Perimbeti ◽  
Prateeth Pati ◽  
...  
Keyword(s):  
Cox Regression ◽  
Conflicts Of Interest ◽  
Age Groups ◽  
Survival Outcome ◽  
Disease Stage ◽  
Insurance Status ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Us ◽  
Insured Patients

Abstract Introduction: Previous studies have shown that uninsured and Medicaid patients had higher morbidity and mortality due to limited access to healthcare. Disparities in cancer-related treatment and survival outcome by different insurance have been well established (Celie et al. J Surg Oncol.,2017). There are approximately 8,260 newly diagnosed HL cases in the US yearly (Master et al. Anticancer Res.2017). Therefore, we aim to investigate the variation of survival outcome and insurance status among HL patients. Methods: We extracted data from the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 18 program. HL patients who were diagnosed from 2007-2014 were included. Demographic information including age, sex, race, annual household income, education and insurance were also collected. Insurance includes uninsured, insured and any Medicaid. Race/ethnicity includes white, black and other (including American Indian/AK native, Asian/Pacific Islander). HL is categorized by using International Classification of Disease for Oncology (ICD-O-3) into classical HL NOS (CHL NOS), nodular lymphocyte predominant HL (NLP), lymphocyte rich (LR), mixed cellularity (MC), lymphocyte depleted (LD), and nodular sclerosis (NS). Treatment modality included RT alone, CT alone, RT and CT combined, and no RT or CT. Survival time was estimated by using the date of diagnosis and one of the following dates: date of death, date last known to be alive or date of the study cutoff (December 31, 2014). Chi-square test and multivariate Cox regression were performed by using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Exclusion criteria include: 1) patients with unknown or unspecified race; 2) patients who survived less than 6 months because time of radiotherapy/chemotherapy was not known to the time of diagnosis; 3) patients with any other type of cancer prior to the diagnosis of HL; 4) patients with second or later primaries, and who were not actively followed. Results: A total of 14.286 HL patients were included in the analysis. Table 1 indicates the insurance status and demographic and tumor characteristics among HL patients diagnosed between 2007 and 2014. Patients with black race, male sex, and B symptoms were more likely to be uninsured and on any Medicaid compared to other races, female sex and without B symptoms (p<0.01). As stage of disease increased, the percentage of insured patients decreased from 82.0% to 71.7%, (p<0.01). As with year of diagnosis advanced, the percentage of uninsured did not appear to be changed however the proportion of both those with insurance and any Medicaid decreased slightly by 2.4% (p<0.01). Those who received RT only were most likely to have insurance (89.6%) followed by combination modality (80.1%). As expected, uninsured status was associated with lower income and education level (p<0.01). Table 2 shows the insurance and hazard ratio among HL patients by year of diagnosis adjusting for race, sex, histology type, income, education, and year of diagnosis. Any Medicaid patients had the highest HR of death from 2007-2010 compared to insured patients. Without insurance was also associated with increased risk of death but only significant in 2008, HR=2.26, 95% CI (1.35, 3.80). The survival outcomes comparing different insurance status by age groups (<=29 and 30-64) were demonstrated in Kaplan-Meier Curve. In the age 29 or less group, insured patient showed has the best survival outcome followed by any Medicaid and then the uninsured. In the age 30-64 group, Medicaid patients had the worst survival outcome compared to those with or without insurance. Conclusion: Insurance status is one of the most important contributors of health disparity, especially in malignancy given the significant financial toxicity of therapies. We found that the proportion of the uninsured was trending up before the Affordable Care Act (ACA). Regarding the HL outcome, insured patients had the best survival across all age groups even though not significantly while Medicaid patients had the worst outcomes in almost all age groups, even worse than the uninsured after adjusting for the disease stage at diagnosis and sociodemographic factors. It would be of interest to explore the reason behind Medicaid patients' relatively poor outcomes. Future studies may also investigate how ACA, Medicaid expansion, and the possible upcoming republican healthcare reform influence HL outcome. Disclosures No relevant conflicts of interest to declare.

Abstract WMP93: Uninsured Patients have Longer Hospital Stays and are Less Likely to Receive Rehab than Insured Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Daniel Korya ◽  
Kendra Drake ◽  
Bruce Coull
Keyword(s):  
Social Services ◽  
Private Insurance ◽  
Functional Independence ◽  
University Hospital ◽  
Insurance Status ◽  
Uninsured Patients ◽  
The Us ◽  
The Mean ◽  
Insured Patients

Background: In 2010 the estimated direct and indirect cost of stroke was $53.9 billion. The long-term burden to society is thought to be much more costly. Whether or not this sum can be reduced has been a subject of great debate. Recently, healthcare reform has been a priority for policy makers with health insurance as a prevailing issue. We examined the healthcare records of patients in the US who presented with stroke symptoms in a 10-year period from 2001-2011, and compared them to patients in the state of Arizona as well as our University Hospital in the same time period. We then looked for differences in the cost of stroke with regard to variations in insurance status. Methods: The records of 978,813 patients with stroke symptoms in the US from January 2001 through December 2011 were compared with 18,875 Arizona (AZ) patients. This data was evaluated and compared with data obtained from the records of 1,123 patients admitted to the University Medical Center (UMC), and separated by insurance status, discharge location and length of stay (LOS) for different stroke subtypes. The information was gathered from the get with the guidelines stroke database and only included hospitals that reported their information. Results: The mean LOS for stroke patients in the US, AZ and UMC were: 5.25 days, 4.69 and 4.75 days, respectively. When separated by insurance status, the mean LOS for patients at UMC with Medicare was 4.27 days (n=470), for Medicaid it was 6.17 days (n=150) and 5.13 days (n=464) for private insurance. Compared with insured patients, uninsured patients had a LOS of 8.18 days (n=39; p=.001). Uninsured patients were discharged home without rehab 24.4% of the time compared with only 8.8% of insured patients (p=.001), even though 93.5% of uninsured patients were considered for rehab. Conclusion: Uninsured patients had a LOS that was 3.3 days longer than insured patients and had an estimated 72% higher cost of hospitalization. Uninsured patients were almost 3 times less likely than insured patients to be discharged with rehab, and consequently were less likely to achieve long-term functional independence. Ultimately, the price of stroke in the uninsured is paid for by taxpayers, since these patients will require social services granted by the government for disability.

scholarly journals Insurance Status Is Related to Receipt of Therapy and Survival in Patients with Early-Stage Pancreatic Exocrine Carcinoma

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Emily Boevers ◽  
Bradley D. McDowell ◽  
Sarah L. Mott ◽  
Anna M. Button ◽  
Charles F. Lynch
Keyword(s):  
Overall Survival ◽  
Early Stage ◽  
Personal Characteristics ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Study Objective ◽  
Risk Of Death ◽  
Seer Data ◽  
Pancreatic Exocrine ◽  
Insured Patients

Objectives. The study objective was to determine how insurance status relates to treatment receipt and overall survival for patients with early-stage pancreatic exocrine carcinoma. Methods. SEER data were evaluated for 17,234 patients diagnosed with Stage I/II pancreatic exocrine carcinoma. Multivariate regression models controlled for personal characteristics to determine whether insurance status was independently associated with overall survival and receipt of radiation/surgery. Results. Odds of receiving radiation were 1.50 and 1.75 times higher for insured patients compared to Medicaid and uninsured patients, respectively (p<0.01). Insured patients had 1.68 and 1.57 times increased odds of receiving surgery compared to Medicaid and uninsured patients (p<0.01). Risk of death was 1.33 times greater (p<0.01) in Medicaid patients compared to insured patients; when further adjusted for treatment, the risk of death was attenuated but remained significant (HR = 1.16, p<0.01). Risk of death was 1.16 times higher for uninsured patients compared to insured patients (p=0.02); when further adjusted for treatment, the risk of death was no longer significant (HR = 1.01, p=0.83). Conclusions. Uninsured and Medicaid-insured patients experience lower treatment rates compared to patients who have other insurances. The increased likelihood of treatment appears to explain the insured group’s survival advantage.

scholarly journals Insurance Status Impacts Survival in Follicular Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1327-1327
Author(s):  
Loretta J. Nastoupil ◽  
Xuesong Han ◽  
Ahmedin Jemal ◽  
Elizabeth Ward ◽  
Christopher R. Flowers
Keyword(s):  
Overall Survival ◽  
Follicular Lymphoma ◽  
Research Funding ◽  
Insurance Status ◽  
Advanced Stage ◽  
Clinical Factors ◽  
Uninsured Patients ◽  
The Us ◽  
To Receive ◽  
Privately Insured

Abstract Introduction: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma. Though no agreed upon standard of care has been established, the incorporation of immunotherapy has been widely adopted given a number of studies demonstrating improvement in response rates, progression-free survival (PFS), and overall survival (OS) with the addition of rituximab. The most common frontline management strategy in the United States (US) for FL is chemoimmunotherapy. However, there is significant heterogeneity in practice patterns, and the relationships between insurance status, chemoimmunotherapy use, and survival in patients (pts) with FL across the US remain unclear. We utilized a national cohort of adult pts with long-term follow-up of FL to test the hypotheses that uninsured patients are less likely to receive chemoimmunotherapy and more likely to experience poorer OS even after controlling for socieodemographic factors, clinical factors, and treatment. Methods: We used data from the National Cancer Data Base (NCDB), a nationwide oncology outcomes database jointly sponsored by the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. Begun in 1989, NCDB currently contains approximately 29 million records from hospital cancer registries covered by more than 1,500 CoC-accredited cancer programs in US and Puerto Rico. Approximately 75% of all newly diagnosed cancer cases in the US are captured. Data collection by CoC-accredited cancer program uses national standardization, and vital status and date of death are reported to the NCDB on a yearly basis. Pts with FL were identified using the International Classification Oncology (ICD-O) histology codes 9690, 9691, 9695, 9698. The population was restricted to pts diagnosed in 2004, adults age 18-101, and those who received all/part of their first course of treatment at the reporting facility. Cases with missing data (age, gender, race, region, insurance data, treatment) and those with non-Medicare/Medicaid government insurance (VA, Indian Health Services) were removed. Pts with HIV, ≥65 years of age, or aged <65 years whose primary insurance was Medicare were also removed. All information was captured using standardized codes defined by the Facility Oncology Registry Data Standards (FORDS). Chi-square tests were used to compare clinical characteristics by insurance status. Log-binomial models were fitted to examine the association of insurance status with clinical factors including advanced stage (III/IV), presence of B-symptoms, comorbidities, and receipt of chemoimmunotherapy. Kaplan-Meier survival curves and log-rank tests were performed. Multiple variable Cox proportional hazards models examined the contribution of prognostic factors to survival disparity by insurance status. Results: 2,703 pts diagnosed in 2004 in the NCDB met inclusion criteria. Compared with privately insured pts, uninsured or Medicaid insured pts were more likely to have advanced stage disease and B symptoms, but no significant difference in the presence of comorbidities. Compared with privately insured pts, there were no differences in chemoimmunotherapy use for uninsured patients, but Medicaid insured pts were more likely to receive chemoimmunotherapy (Medicaid risk ratio [RR] 1.41; 95% confidence interval [CI] 1.09-1.82). Medicaid and uninsured pts had a significantly higher risk of death compared with privately insured pts even after controlling for socieodemographic, prognostic, and treatment factors (uninsured hazard ratio [HR] 1.78; 95% CI 1.24-2.54; Medicaid HR 2.50; 95% CI 1.84-3.39). Disease stage, age, sex, residing in an area with > 20% of residents not graduating from high school, the presence of B symptoms, and comorbidities, but not treatment were significant, independent predictors of survival in pts with FL and contributed to the disparities in survival by insurance status. Conclusions: Although uninsured and Medicaid insured pts with FL in the US did not have lower use of chemoimmunotherapy, both groups had inferior survival compared to privately insured pts. Despite heterogeneity in management strategies for FL, access to adequate health care has the potential to improve survival for pts with FL. Figure 1: Overall survival of FL patients by insurance status, NCDB 2004 Figure 1:. Overall survival of FL patients by insurance status, NCDB 2004 Disclosures Nastoupil: Genentech: Honoraria; Celgene: Honoraria; TG Therapeutics: Research Funding; Janssen: Research Funding.

Health insurance status and cancer stage at diagnosis and survival in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7026-7026
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Leticia Nogueira ◽  
Ahmedin Jemal ◽  
Michael T. Halpern ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Site ◽  
Insurance Status ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
Uninsured Patients ◽  
Health Insurance Status ◽  
Access To Health ◽  
Insured Patients ◽  
Privately Insured

7026 Background: While previous studies demonstrated associations between Medicaid coverage or no health insurance with both advanced stage at cancer diagnosis and worse survival, access to health care in the U.S. has changed substantially in the past decade. This study examined associations of health insurance status with stage at diagnosis and survival among 17 common cancers using recent national data. Methods: We identified 1,427,532 cancer patients aged 18-64 years newly diagnosed with 17 common cancers from the 2010-2013 National Cancer Database. Multivariable logistic regression models were used to examine the distribution of stage at diagnosis by health insurance status (private, Medicare, Medicaid, dual Medicare/Medicaid, and uninsured) overall and for each cancer site. Cox models compared stage-specific survival by health insurance for each site. Results: Compared to privately insured patients, Medicaid and uninsured patients were significantly more likely to be diagnosed with advanced-stage cancer (III/IV) for all the 17 cancers combined (adjusted odds ratio [AOR]: 2.27, 95% confidence interval [95CI]: 2.24-2.29; AOR: 2.39, 95CI: 2.36-2.42, respectively) and for all included cancer sites separately. Medicare and Medicare-Medicaid patients were also more likely to be diagnosed at advanced-stage for all the 17 cancers combined, but results varied by cancer site. Compared to the privately insured patients, worse survival was observed for patients with all other insurance types and uninsured at each stage for all the 17 cancers combined and most cancer sites. For example, among patients diagnosed at stage I, adjusted mortality hazard ratios for Medicare, Medicaid, Medicare-Medicaid, and uninsured patients were 1.72 (95CI: 1.70-1.75), 1.73 (95CI: 1.71-1.76), 2.07 (95CI: 2.02-2.17) and 1.56 (95CI: 1.53-1.58), respectively, compared with privately-insured patients. Conclusions: Patients with non-private insurance were more likely to be diagnosed with cancer at advanced stage and have worse survival. Improving access to health insurance with adequate coverage is crucial for receiving appropriate cancer screening, diagnosis, and quality care.

Abrogation of survival disparity between insured and uninsured individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 77-77
Author(s):  
Isaac Elijah Kim ◽  
Daniel D. Kim ◽  
Sinae Kim ◽  
Eric A. Singer ◽  
Thomas L. Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Marital Status ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Housing Status ◽  
Diagnostic Time ◽  
Urban Rural ◽  
Insured Patients

77 Background: In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer. Studies have found that insured patients with prostate cancer have better outcomes than uninsured patients. We examined the recommendation’s effects on survival disparities based on insurance status as well as socioeconomic quintile, marital status, and housing (urban/rural). Methods: Using the SEER18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and one of four factors: insurance status, socioeconomic quintile, marital status, and housing (urban/rural). The SEER-designated socioeconomic quintile was based on variables including median household income and education index. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. Disparities were measured with the Cox proportional hazards model. Results: We identified 282,994 patients diagnosed with prostate cancer. During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.29, 95% CI 1.06-1.58, p = 0.01). This survival disparity narrowed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients. Moreover, the survival disparity was no longer observed during the post-USPSTF era (aHR 0.91, 95% CI 0.61-1.38, p = 0.67). The survival disparity based on socioeconomic quintile also narrowed but remained significant. In contrast, the survival disparity based on marital status widened, while housing status was not associated with survival disparities in either era. Conclusions: From the pre- to the post-USPSTF era, insured patients with prostate cancer observed a significant decrease in survival that made their survival outcomes similar to that of uninsured patients. Although the underlying reasons are not clear, the USPSTF’s 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without improving the survival of uninsured patients.[Table: see text]

scholarly journals The effect of insurance status on overall survival among children and adolescents with cancer

2020 ◽  
Vol 49 (4) ◽  
pp. 1366-1377 ◽  
Author(s):  
Xiaoyan Wang ◽  
Rohit P Ojha ◽  
Sonia Partap ◽  
Kimberly J Johnson
Keyword(s):  
Children And Adolescents ◽  
Cancer Survival ◽  
Proportional Hazards ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Cox Proportional Hazards ◽  
Insurance Status ◽  
Risk Of Death ◽  
Adolescent Cancer ◽  
Privately Insured

Abstract Background Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms. Methods Data from 58 421 children (aged ≤14 years) and adolescents (15–19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses. Results Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and −1.73 months, 95% CI: −2.07 to −1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and −2.13 months, 95% CI: −2.91 to −1.34). The HR for Medicaid vs. private insurance was larger (pinteraction &lt;0.001) in adolescents (HR = 1.52, 95% CI: 1.41 to 1.64) than children (HR = 1.16, 95% CI: 1.10 to 1.23). Despite statistical evidence violation of the PH assumption, RMST results supported all interpretations. Earlier diagnosis for staged cancers in the Medicaid and uninsured populations accounted for an estimated 13% and 19% of the survival deficit, respectively, vs. the privately insured population. Any treatment received did not account for insurance-associated survival differences in children and adolescents with cancer. Conclusions Children and adolescents without private insurance had a higher risk of death and shorter survival within 5 years following cancer diagnosis. Additional research is needed to understand underlying mechanisms.

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Brian R. Englum ◽  
Xuan Hui ◽  
Cheryl K. Zogg ◽  
Muhammad Ali Chaudhary ◽  
Cassandra Villegas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients ◽  
Uninsured Patients ◽  
National Trauma ◽  
Insured Patients ◽  
The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

scholarly journals Association between health insurance status and malignant glioma

2020 ◽  
Vol 7 (5) ◽  
pp. 531-540
Author(s):  
Igor Fischer ◽  
Hendrik-Jan Mijderwijk ◽  
Ulf D Kahlert ◽  
Marion Rapp ◽  
Michael Sabel ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Brain Tumors ◽  
Malignant Neoplasms ◽  
German Population ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Neurosurgical Patients ◽  
Insured Patients ◽  
Privately Insured

Abstract Background Prior studies have suggested an association between patient socioeconomic status and brain tumors. In the present study we attempt to indirectly validate the findings, using health insurance status as a proxy for socioeconomic status. Methods There are 2 types of health insurance in Germany: statutory and private. Owing to regulations, low- and middle-income residents are typically statutory insured, whereas high-income residents have the option of choosing a private insurance. We compared the frequencies of privately insured patients suffering from malignant neoplasms of the brain with the corresponding frequencies among other neurosurgical patients at our hospital and among the German population. To correct for age, sex, and distance from the hospital, we included these variables as predictors in logistic and binomial regression. Results A significant association (odds ratio [OR] = 1.59, CI = 1.45-1.74, P &lt; .001) between health insurance status and brain tumors was found. The association is independent of patients’ sex or age. Whereas privately insured patients generally tend to come from farther away, such a relationship was not observed for patients suffering from brain tumors. Comparing the out of house and in-house brain tumor patients showed no selection bias on our side. Conclusion Previous studies have found that people with a higher income, level of education, or socioeconomic status are more likely to suffer from malignant brain tumors. Our findings are in line with these studies. Although the reason behind the association remains unclear, the probability that our results are due to some random effect in the data is extremely low.

scholarly journals Effect of Health Insurance on Hepatitis C Sustained Virologic Response Rates to Sofosbuvir-Based Treatment Regimens in a South Florida Community Hospital

2019 ◽  
Vol 18 ◽  
pp. 232595821983559 ◽  
Author(s):  
Paula Eckardt ◽  
Jianli Niu ◽  
Angela Savage ◽  
Tara Griffin ◽  
Elizabeth Sherman
Keyword(s):  
Health Insurance ◽  
Hepatitis C ◽  
Sustained Virologic Response ◽  
Community Hospital ◽  
Virologic Response ◽  
South Florida ◽  
Uninsured Patients ◽  
Loss To Follow Up ◽  
Insured Patients

The high cost of direct-acting antiviral–based regimens raises concerns about the outcome of treatment in uninsured patients with chronic hepatitis C virus (HCV) infection. This study assessed the relationship between health insurance status and sustained virologic response (SVR) rates in a community hospital in South Florida. Sofosbuvir-based therapy was initiated in 82 patients, of which 73% were uninsured and 28 (34%) were HIV coinfection. The overall SVR rate for those tested was 98%. The SVR rates were similar between HCV mono- and HCV/HIV coinfected patients (96% versus 100%, P = .204). Uninsured patients, with access to patient assistance programs, had comparable SVR rates to insured patients (100% versus 95%, P = .131). However, there was a trend toward a higher rate of loss to follow-up in uninsured compared to insured patients (25% versus 9%, P = .116). Strategies specific to adherence to treatment for uninsured patients are needed to reduce rates of loss to follow-up.

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