The impact of ethnicity and insurance status on stage of cancer at diagnosis and overall survival of breast cancer.

154 Background: Major advances in early diagnosis and treatment of breast cancer (BC) have been achieved with significant declines in mortality. However, not all segments of the United States population have experienced equal benefits from this progress. Though ethnic disparities in BC outcome have been attributed to lack of adequate health insurance, the differences in outcome when insurance and socioeconomic status are similar still exist. We elected to examine the effect of insurance status at diagnosis, and whether race is an independent risk of poor outcome in a population from a community-based cancer database. Methods: A retrospective study on BC among patients aged 18 to 64 years were identified, between 1993 and 2005, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics included age, race, stage at diagnosis, and primary payer. Insurance status was classified as uninsured/Medicaid, private insurance, and Medicare disability (Medicare under age 65). The 5-year overall survival (OS) was calculated, in respect to patient ethnicity, and compared between the three insurance groups using Fisher’s exact test. Results: A total of 779 patients have been identified with diagnosis of BC. 147 patients were excluded due to incomplete data. 632 patients were analyzed. African Americans were 228 (36%), Caucasians 391 (62%), and other ethnicities 13 (2%). Mean age at diagnosis was (49.21) for African Americans versus (51.35) for Caucasians (p = 0.002). African Americans were more likely to present at advanced stage (III, IV) than Caucasians (17% versus 10%, p = 0.017). However, this difference was not statistically significant when adjusting for insurance status. Although both ethnicities had similar OS in respect of their insurance group, patients with Medicaid/uninsured had significantly lower OS compared to patients with Medicare disability (p = 0.006) and private insurance (p < 0.0001) respectively. Conclusions: Uninsured/Medicaid patients with breast cancer have worse outcome when compared to patients with Medicare or private insurance. Ethnicity is not an independent risk factor of advanced stage at diagnosis and poorer outcome.

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Impact of insurance status on survival in neuroendocrine tumors: A multi-institutional Study from the U.S. Neuroendocrine Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.371 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 371-371

Author(s):

Paula Marincola Smith ◽

Alexandra G Lopez-Aguiar ◽

Mary Dillhoff ◽

Eliza W Beal ◽

George A. Poultsides ◽

...

Keyword(s):

Overall Survival ◽

Surgical Resection ◽

Neuroendocrine Tumors ◽

Private Insurance ◽

The United States ◽

Study Group ◽

Insurance Status ◽

Insured Patients ◽

The Impact ◽

The U.S

371 Background: Insurance status predicts access to medical care in the United States. Previous studies show uninsured and government insured patients have worse outcomes than those with private insurance. However, the impact of insurance status on survival in patients with Gastrointestinal Neuroendocrine Tumors (GI-NETs) is unclear. We evaluate the association between insurance status and survival in patients with GI-NETs. Methods: Our analysis includes 2022 patients who had surgical resection of GI-NETs at 8 institutions in the U.S. Neuroendocrine Study Group. Patients were categorized based on insurance as private (PI), government (GovI) or uninsured (UI). Factors associated with insurance status were assessed by uni- and multi-variate analysis. Primary endpoint was overall survival. Results: Patient demographics between the insurance categories were similar in ECOG performance status and tumor size at presentation. GovI patients had a higher median age than PI or UI (66 vs. 54 vs. 56 years respectively; p<0.01). Uninsured patients were more likely African American (21.5%) or Latino (5%) compared to PI (11.5%, 2%) or GovI (15%, 2%) (p<0.01). The UI group had a higher proportion of patients who underwent no surveillance imaging post-operatively (39%) compared to PI (26%) and GovI patients (26%) but this was not statistically significant (p=0.15). There was no difference in operative intent (curative vs. palliative) between groups (p=0.2). Five-year overall survival was 86% for PI, 82% for GovI, and 73% for UI patients (p<0.01). On multivariate regression analysis, being uninsured was independently associated with reduced survival when controlling for ASA Class, ECOG, race, tumor location, neoadjuvant and adjuvant chemotherapy, Somatostatin analog, or radiation therapy (HR 1.39, p = 0.012). Conclusions: This is the first systematic analysis of insurance status’s association with overall survival in GI-NET patients. Our analysis shows uninsured or government insured patients have shortened survival compared to the privately insured. The disparity is likely underrepresented in this study, as we examined only patients who underwent surgical resection.

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Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

Cancer Control ◽

10.1177/1073274820956615 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482095661

Author(s):

Bryce D. Beutler ◽

Mark B. Ulanja ◽

Rohee Krishan ◽

Vijay Aluru ◽

Munachismo L. Ndukwu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Cohort Study ◽

Native American ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Private Insurance ◽

Insurance Status ◽

The Impact ◽

To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

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Worse Outcomes Associated with Public Insurance in AYAs with Leukemia and Lymphoma

Blood ◽

10.1182/blood-2018-99-115519 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 977-977

Author(s):

Elysia Alvarez ◽

Helen Parsons ◽

Frances Maguire ◽

Yi Chen ◽

Cyllene Morris ◽

...

Keyword(s):

Overall Survival ◽

Health Insurance ◽

Late Stage ◽

Private Insurance ◽

Stage At Diagnosis ◽

Public Insurance ◽

Medicaid Enrollment ◽

Stage Disease ◽

Late Stage Disease ◽

The Impact

Abstract Introduction: Adolescent and young adult (AYAs: 15-39) patients with cancer have not had the same relative improvement in survival as other age groups over the last decades. Studies have shown that having public insurance or being uninsured at diagnosis is associated with more advanced disease at presentation and worse overall survival. However, previous studies have not differentiated patients who joined Medicaid at diagnosis from those with continuous enrollment which may have different implications for access to care prior to diagnosis. Therefore, we examined the impact of insurance status, including Medicaid enrollment at diagnosis, on stage at diagnosis for AYAs with non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) only] and on survival for AYAs with NHL, HL, acute myeloblastic leukemia (AML), and acute lymphoblastic leukemia (ALL). Methods: Using Medicaid enrollment data linked to the California Cancer Registry, we identified AYAs with NHL, HL, ALL, and AML diagnosed from 2005 to 2014. Insurance type was classified as: continuous Medicaid, discontinuous Medicaid prior to diagnosis, Medicaid at diagnosis, other public (Medicare, Indian/Public Health Service, county), private/military, and uninsured. Multivariable logistic regression and Cox proportional hazards regression were used to determine the impact of insurance type on stage at diagnosis (for NHL and HL) and overall survival, respectively. Results are represented as adjusted odds ratios (OR) and hazard ratios (HR) with associated 95% confidence intervals (CI). Results: Of the 11,667 AYA patients in our study, 4,435 had NHL, 4,161 had HL, 1,522 had AML and 1,549 had ALL. Patients with HL had the highest proportion of private insurance (66%) followed by those with NHL (60%), AML (50%) and ALL (37%). Of the 4,059 patients enrolled in Medicaid, 41% had continuous Medicaid, 15% had discontinuous Medicaid and 43% received Medicaid at diagnosis. Only 2-4% of patients, depending on primary diagnosis, remained uninsured after cancer diagnosis. The majority of AYAs with HL and NHL were diagnosed with stage I/II disease (59% and 52% respectively). Compared to AYAs with private insurance, NHL and HL patients with discontinuous Medicaid and Medicaid at diagnosis had a higher likelihood of later stage disease (III-IV vs I/II) at diagnosis (NHL: discontinuous OR 1.45, CI 1.10-1.92; at diagnosis OR 1.69, CI 1.38-2.06; HL: discontinuous OR 1.63, CI 1.19-2.23; at diagnosis OR 1.68, CI 1.35-2.09) after adjusting for sociodemographic factors, baseline comorbidities and type of facility. In addition, NHL patients with continuous Medicaid (OR 1.23, CI 1.01, 1.51) and HL patients with other public insurance (OR 1.56, CI 1.05-2.32) had a higher odds of late stage disease. Type of health insurance was associated with overall survival in multivariable models (Table). NHL patients with Medicaid (continuous HR 1.74, CI 1.39-2.17; discontinuous HR 2.52, CI 1.94-3.27; at diagnosis HR 1.88, CI 1.53-2.31), other public (HR 1.83, CI 1.16-2.87) and no insurance (HR 1.87, CI 1.09-3.20) had worse survival than NHL patients with private insurance. Similarly, HL patients with Medicaid (continuous HR 2.10, CI 1.42-3.12; discontinuous HR 1.89, CI 1.08-3.29; at diagnosis HR 2.43, CI 1.699-3.48) and no insurance (HR 1.87, CI 1.09-3.20) experienced worse survival. For AML, health insurance was not significantly associated with survival. For ALL, only continuous Medicaid (HR 1.32, CI 1.05-1.67) and other public (HR 1.32, CI 1.05-1.67) insurance were associated with worse survival, though discontinuous Medicaid trended toward significance (p=0.06). Conclusion: Our study demonstrates that a significant proportion of patients previously thought to have public insurance were discontinuously insured with Medicaid or uninsured at time of diagnosis, only receiving Medicaid after diagnosis. While important, insurance enrollment at diagnosis does not provide the same pre-diagnosis access to services as those with continuous enrollment. Indeed, for NHL and HL, we observed the strongest associations between discontinuous Medicaid and Medicaid at diagnosis and late stage disease. However, Medicaid, regardless of type of enrollment, was associated with worse survival in AYAs with NHL, HL and ALL relative to private insurance. Therefore, future studies should focus on factors influencing worse outcomes for AYA patients with public insurance. Disclosures No relevant conflicts of interest to declare.

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Racial Disparities in Lung Cancer Diagnosis and Treatment: A Single Center, Retrospective Study in Central Indiana

Proceedings of IMPRS ◽

10.18060/24660 ◽

2020 ◽

Vol 3 ◽

Author(s):

Andrew Killion ◽

Francesca Duncan ◽

Nawar Al Nasrallah ◽

Catherine Sears

Keyword(s):

Lung Cancer ◽

African Americans ◽

Racial Differences ◽

Cancer Diagnosis ◽

Private Insurance ◽

The United States ◽

Cancer Center ◽

Stage At Diagnosis ◽

Lung Cancer Diagnosis ◽

Incidence And Mortality

Background/Objective: Lung cancer is the second most common cancer and the leading cause of death from cancer in the United States. However, there is a disparity in incidence and mortality between African Americans and Caucasians. This study aims to analyze factors that could describe this difference, such as treatment, socioeconomic, or behavioral differences using information from an Indiana University Simon Cancer Center (IUSCC) lung cancer registry. We hypothesized that African Americans will have a higher lung cancer stage at diagnosis and mortality, associated with less timely, stage-appropriate treatment. Methods: Using data collected from patients diagnosed with lung cancer at IUSCC from 2000-2016, we compared racial differences in diagnoses and subsequent management. Patients were categorized by race and clinical stage at diagnosis. Further categorization by sex, vital status, age at diagnosis, time from diagnosis to treatment and death, tobacco use, surgery, chemotherapy, insurance coverage, and histology was performed. We determined the rates of surgery or chemotherapy by stage at diagnosis. Statistical analyses are by student t-test or 2-way ANOVA. Results: African Americans were younger than Caucasians at lung cancer diagnosis (average 63.4 vs. 61.2 years p-value < 0.001). African American race was associated with a longer time from diagnosis to treatment (36.4 vs. 32.1 days, p=0.023) and shorter time from diagnosis to death (475.1 vs. 623.7 days, p=0.001). The data suggests that African Americans have a later stage at diagnosis, are more likely to be uninsured and less likely to be covered by private insurance. The data suggests African Americans have a lower rate of surgery (Stages 1-3) and chemotherapy (Stages 3B and 4). Conclusion and Potential Impact: This data suggests racial differences in lung cancer diagnosis, treatment and outcomes. Future analyses will focus on multiple comparisons to determine possible impacts of socioeconomic and environmental factors on these outcomes at IUSCC and other university-affiliated health care systems.

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The impact of COVID-19 on breast cancer stage at diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.528 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 528-528

Author(s):

Maxwell Roger Lloyd ◽

Sarah Jo Stephens ◽

Julian C. Hong ◽

Ted A. James ◽

Tejas Mehta ◽

...

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Late Stage ◽

The United States ◽

Stage At Diagnosis ◽

Lower Income ◽

Control Cohort ◽

Stage Disease ◽

Late Stage Disease ◽

The Impact

528 Background: During the SARS-CoV-2 pandemic, routine screening mammography (SM) was stopped and diagnostic mammography (DM) was limited for several months across the United States in order to reduce patient exposure and redeploy medical personnel. We hypothesized that this delay would result in patients presenting with later-stage disease following the initial shutdown. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center Cancer Registry. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with our electronic medical record. Late-stage disease was defined as initial anatomic stage III-IV disease in the AJCC 8th edition staging system. The control cohort consisted of patients diagnosed from 2016-2019; patients diagnosed in 2020 were the test cohort. Chi-squared analysis was used to compare monthly distributions in stage at diagnosis between the control and test cohorts. Multivariate analysis was performed using a logistic regression model. Results: There were 1597 patients diagnosed with invasive breast cancer between 2016-2019 and 333 in 2020. Median age at diagnosis was 60 years; 99% were female, and 69.1% were white. Mammography was limited from 3/16/20-6/8/20, with 90% reduction in volume during this time. The number of screening studies performed in March, April, May, and June of 2020 were 987, 1, 4, and 721 compared to 2042, 2141, 2241, and 2142 in 2019. The volume of new diagnoses per month decreased substantially during the shutdown (see table). The proportion of patients diagnosed with late-stage disease was 6.6% in the control cohort compared to 12.6% in the 2020 test cohort (p < 0.001); 92.9% of late-stage diagnoses in 2020 occurred from June to December following the shutdown period. On multivariate analysis, year of diagnosis (2020 vs 2016-2019; OR = 4.25 95% CI 0.035-0.095, p < 0.001), lower income (<200% of the federal poverty level; OR = 2.73 95% CI 0.016-0.099, p = 0.006) and increased Charlson Comorbidity Index (OR = 12.01 95% CI 0.037-0.052, p < 0.001) were associated with later stage at diagnosis. Conclusions: Patients were more likely to be diagnosed with late-stage breast cancer following the global shutdown due to the SARS-CoV-2 pandemic. Patients with lower income and medical comorbidities were disproportionately affected. These data raise significant concerns regarding the impact of SARS-CoV-2 on cancer diagnoses and long-term outcomes, especially in vulnerable patient populations.[Table: see text]

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Investigation of an ethnic predisposition to developing brain metastases (BM) in Asian patients with colorectal cancer (CRC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15023 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15023-e15023

Author(s):

Kerri McGovern ◽

Teresa Rodriguez ◽

Melissa H Smith ◽

Antonia Maloney ◽

Wasif M. Saif

Keyword(s):

Overall Survival ◽

Molecular Markers ◽

Ethnic Disparities ◽

The United States ◽

Treatment Modalities ◽

Increased Risk ◽

Incidence And Mortality ◽

Race Ethnicity ◽

The Impact ◽

Hispanic White

e15023 Background: CRC, the third most common cancer in the United States, carries racial/ethnic disparities in both incidence and mortality. With availability of effective systemic therapies, the life of CRC patients can be prolonged which thereby increases the risk of metastases at uncommon sites, such as the brain. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients using retrospective data (2010 – 2018) at a single institution. Methods: We retrospectively reviewed patients diagnosed with CRC and collected data on age, race/ethnicity, stage, treatment modalities, metastatic sites, and survival. Race and ethnicity were defined in accordance with federal standards set by the U.S. Census. Following this, race/ethnicity was self-declared and/or based on the primary language declared and categorized as non-Hispanic White, Hispanic White, non–Hispanic Black, Asian, or Unknown/Other. CRC location was classified as right-sided, left-sided or rectal. Results: We identified 264 CRC patients (median age: 61; range: 38 - 99). Among them 123 identified as non-Hispanic white, 28 non-Hispanic black, 26 Hispanic white, and 9 declared Other. There were 76 (29%) who identified as Asian. Of those 76 patients, 5 (7%) developed BM. All 5 patients were male and stage IV at initial diagnosis. BM was a late stage phenomenon with rectal primary and lung metastases seemly associated with an increased risk in the specific cohort. Molecular markers such as KRAS were available in 3 patients without clear association. Median time to development of BM was 29 months (range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery. Conclusions: Our study showed an incidence of BM of 7% in the Asian sub-population compared to the historical control of 0.6 – 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of BM in CRC patients with emphasis on molecular markers. Recognition of BM in CRC patients is clinically relevant secondary to multiple lines of therapy as mentioned earlier and its grave impact on outcome.

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The Impact of Race, and Insurance Status on Breast Cancer Screening: Results from the Behavioral Risk Factor Surveillance System Data

10.21203/rs.3.rs-427806/v1 ◽

2021 ◽

Author(s):

Salamata Yoda ◽

Jennifer Mallow ◽

Laurie A. Theeke

Keyword(s):

Breast Cancer ◽

Health Insurance ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Multinomial Logistic Regression ◽

The United States ◽

Minority Women ◽

Insurance Status ◽

The Past ◽

The Impact

Abstract Purpose Breast cancer is the second major cause of cancer-related death of women in the United States 1, yet current gaps exist in breast cancer screening for minority women 2. The purpose of this study is to address these gaps by assessing the relationships among race, health insurance coverage, and breast cancer screening in a nationally representative sample of women. Design: A cross-sectional descriptive analysis of the 2018 BRFSS survey data was used to meet the study purpose. BRFSS participants who declared themselves to be of female sex and who were adults with the age ≥ of 40 years were selected for inclusion. Methods Data were analyzed using SPSS version 26. Exploratory and descriptive analyses were performed, followed by comparative analyses based on the variable type. Relationships between race, insurance status, and mammogram screening were examined. Chi-square, logistic, and multinomial logistic regression were used. Findings: The original 2018 BRFSS dataset included 437,436 participants and 145,837 women were selected based on inclusion criteria. Participant age ranged from 40 to 74 years. The majority were White only non-Hispanic (78.1%), reported having a mammogram in the past two years (76.1%), had earned < a 4-year college degree (61.1%), had an annual income of < $75,000 (58.4%) and married (58.2%). Less than half had a healthcare plan through an employer (44.9%) and were employed (40.5%). Participants who had a plan purchased through an employer or union were more likely to have a mammogram in the past two years when compared with other health coverage. Furthermore, White only, non-Hispanics were 1.25 times more likely and Black only, non-Hispanics were 1.98 times more likely to have a mammogram in the past two years compared to participants from other racial and ethnic groups. Conclusion The findings of this study provide an additional indication that race, and health insurance status do impact breast cancer screening. Clinical Relevance: Knowledge gained from this study can be used by practicing nurses to educate racial and ethnic minority women on the significance of breast cancer screening and prevention.

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Survival in Women with De Novo Metastatic Breast Cancer: A Comparison of Real-World Evidence from a Publicly-Funded Canadian Province and the United States by Insurance Status

Current Oncology ◽

10.3390/curroncol29010034 ◽

2022 ◽

Vol 29 (1) ◽

pp. 383-391

Author(s):

Marie-France Savard ◽

Elizabeth N. Kornaga ◽

Adriana Matutino Kahn ◽

Sasha Lupichuk

Keyword(s):

Breast Cancer ◽

Health Care ◽

Metastatic Breast Cancer ◽

De Novo ◽

Private Insurance ◽

Metastatic Breast ◽

The United States ◽

Insurance Status ◽

The Us ◽

Privately Insured

Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.

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Insurance Is No Longer a Determinant to Improve Overall Survival for Patients Diagnosed with HL, DLBCL or PCNS in an Enriched Hispanic Community

Blood ◽

10.1182/blood-2021-151816 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1974-1974

Author(s):

Carolina Velez-Mejia ◽

Qianqian Liu ◽

Joel E Michalek ◽

Adolfo Enrique Diaz Duque

Keyword(s):

Overall Survival ◽

Research Funding ◽

Ethnic Disparities ◽

Central Nervous System Lymphoma ◽

B Cell Lymphoma ◽

The United States ◽

Insurance Status ◽

Community Healthcare ◽

Cancer Subtypes ◽

Uninsured Population

Abstract Background Variables that determine overall survival (OS) in patients diagnosed with Hodgkin (HL) and Non-Hodgkin lymphomas (NHL) have been widely studied in the United States. Inequalities in survival has been noted when patients lack insurance (Cancer PMID: 26058564). However, healthcare disparities exist within the different cancer subtypes and ethnic minorities. In the case of Follicular lymphoma, uninsurance has been linked with worse outcomes (Blood PMC6137560). For Burkitt and plasmablastic lymphomas, insurance does not seem to have a repercussion in survival (Blood 136 Supplement 1:45-46) (Leuk Lymphoma PMC6923579). In subgroup analysis, Hispanics (HI) have been noted to have higher rate of uninsurance with no significant distinction in OS in patients with DLBCL (Blood136 Supplement 1: 9). There is a need to understand determinants in ethnic disparities in outcomes for HL and NHL. This is the first large statewide population-based study differentiating ethnicity, insurance status and survival for HL, diffuse large B cell lymphoma (DLBCL) and primary central nervous system lymphoma (PCNS) in Texas. Material and Methods A retrospective analysis of patients diagnosed with HL, DLBCL, PCNS recorded in the Texas Cancer Registry from 2006-2017 was carried out. Inclusion criteria was histopathologic proven HL, DLBCL, and PCNS. Patients were divided into HI and non-Hispanics (NH), and subsequently in insured (i) and uninsured (un), for a total of four cohorts for comparison: iHI, unHI, iNH and unNH. Survival time was measured using the day of diagnosis to last date of follow up or death. For each cohort, median survival (MS) and analysis at 2,5 and 10 years (y) was calculated. Survival distribution were determined based on Kaplan-Meier curves. Results From 2006-2017, 21,229 patients with HL, DLBCL, PCNS were diagnosed in Texas. Of these, 6,004 patients (iHI n=1,369, unHI n=376, iNH n=3,781, unNH n=478) were diagnosed with HL (Graph 1), 14,366 patients (iHI n=2,810, unHI n=635, iNH n=10,273, unNH n=648) were diagnosed with DLBCL (Graph 2) and 859 patients (iHI n=195, unHI n=54, iNH n=559, unNH n=51) were diagnosed with PCNS (Graph 3). MS was outstanding for uninsured compared to insured patients with HL, DLBCL and PCSN. In HL, MS for iHI was 9.8 y, unHI was not reached, iNH was 10.3 y, and unNH was 10.8 y. In DLBC, MS was 3.7 y, 9.3 y, 4.2 y and 5.3 y, respectively. In PCNS, MS for these groups corresponded to 0.9 y, 0.8 y, 0.7 y and 3.2 y. Survival probability at 2-,5- and 10y among i vs un was noteworthy in HL, DLBCL and PCNS (Table 1). In HL, iHI was 0.762, 0.686 and 0.448; unHI was 0.873, 0.784 and N/A; iNH was 0.843, 0.765 and 0.584, and unNH was 0.846, 0.782 and 0.703, respectively. In DLBCL, for iHI it was 0.573, 0.456 and 0.222; unHI was 0.685, 0.631 and 0.350; iNH was 0.602, 0.469 and 0.174; unNH was 0.583, 0.510 and 0.239, accordingly. In PCNS, for iHI it was 0.374, 0.219 and N/A; unHI was 0.314, 0.174 and N/A; iNH was 0.354, 0.229 and 0.061; unNH was 0.516, 0.473 and 0.473, correspondingly. Overall Survival (OS) was statistically significant for iHI vs unHI vs iNH vs unNH when comparing HL, DLBCL and PCNS, with p values of <0.0001, <0.0001 and 0.037, respectively (Graph1-3). In HL the group with the best OS was unHI. This was also evidenced for DLBCL. However, for PCNS this trend was noted in unNH. In both three malignancies, the highest OS rate was reported in uninsured population. Conclusions For HL, DLBCL and PCNS the uninsured population has statistically significant better OS at 10 y. Interestingly for HL and DLBCL this corresponded to unHI while for PCNS was unNH. This paroxysmal finding may be due to standardized treatment, immediate healthcare enrolling after diagnosis and/or different community healthcare practices. Additionally, this population may have unique behaviors such as higher rate of compliance/adherence, environmental exposures or genetic predisposition to improved survival. Nonetheless, lack of insurance may delay diagnosis, need for multiple lines of chemotherapies, increase the rate of metastatic disease or recurrences. Accordingly, as more expensive and personalized therapies evolve, insurance status can limit access to these treatment regimens. Therefore, although insurance is no longer a determinant for improving OS for patients diagnosed with HL, DLBCL or PCNS, it can have implications for other oncological outcomes. Figure 1 Figure 1. Disclosures Diaz Duque: Incyte: Consultancy; Morphosys: Speakers Bureau; Astra Zeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

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