The impact of insurance status on racial disparities in cancer outcomes for nonelderly adults: A population based analysis.

e18168 Background: Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse and progression. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults (AYA) with cancer. Methods: We identified all Ontario AYA 15-21 years of age diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992 and 2012. Chart abstraction was used to determine the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms that determined EOIT based a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared to chart abstracted data. Results: The cohort comprised 1,404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity 87.0%, specificity 93.3%, PPV 81.5%, negative predictive value 95.5%). Conclusions: While administrative data alone did not validly identify cancer-related events, using administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.

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Insurance Status and Racial Disparities in Cancer-Specific Mortality in the United States: A Population-Based Analysis

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-16-0976 ◽

2017 ◽

Vol 26 (6) ◽

pp. 869-875 ◽

Cited By ~ 24

Author(s):

Hubert Y. Pan ◽

Gary V. Walker ◽

Stephen R. Grant ◽

Pamela K. Allen ◽

Jing Jiang ◽

...

Keyword(s):

United States ◽

Racial Disparities ◽

The United States ◽

Population Based ◽

Insurance Status ◽

Specific Mortality ◽

Cancer Specific Mortality

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Insurance Status and the Use of Guideline Therapy in the Treatment of Selected Cancers

Journal of Clinical Oncology ◽

10.1200/jco.2004.00.1297 ◽

2005 ◽

Vol 23 (36) ◽

pp. 9079-9088 ◽

Cited By ~ 105

Author(s):

Linda C. Harlan ◽

Amanda L. Greene ◽

Limin X. Clegg ◽

Margaret Mooney ◽

Jennifer L. Stevens ◽

...

Keyword(s):

Cancer Patients ◽

Private Insurance ◽

Insurance Coverage ◽

Population Based ◽

Insurance Status ◽

Black Patients ◽

Rectal Cancers ◽

Definition Of ◽

Insured Patients ◽

The Impact

Purpose This study estimates the impact of type of insurance coverage on the receipt of guideline therapy in a population-based sample of cancer patients treated in the community. Patients and Methods Patients (n = 7,134) from the National Cancer Institute's Patterns of Care studies who were newly diagnosed with 11 different types of cancer were analyzed. The definition of guideline therapy was based on the National Comprehensive Cancer Network treatment recommendations. Insurance status was categorized as a mutually exclusive hierarchical variable (no insurance, any private insurance, any Medicaid, Medicare only, and all other). Multivariate analyses were used to examine the association between insurance and receipt of guideline therapy. Results Adjusting for clinical and nonclinical variables, insurance status was a modest, although statistically significant, determinant of receipt of guideline therapy, with 65% of the privately insured patients receiving recommended therapy compared with 60% of patients with Medicaid. Seventy percent of the uninsured patients received guideline therapy, which was nonsignificantly different compared with private insurance. When stratified by race, insurance was a statistically significant predictor of the receipt of guideline therapy only for non-Hispanic blacks. Conclusion Overall, levels of guideline treatment were lower than expected and particularly low for patients with Medicaid or Medicare only. The use of guideline therapy for ovarian and cervical cancer patients and for patients with rectal cancers was unrelated to type of insurance. Of particular concern is the significantly lower use of guideline therapy for non-Hispanic black patients with Medicaid. After adjusting for other factors, only half of these patients received guideline therapy.

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The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

Head & Neck ◽

10.1002/hed.26807 ◽

2021 ◽

Author(s):

Navika Shukla ◽

Yifei Ma ◽

Uchechukwu C. Megwalu

Keyword(s):

Racial Disparities ◽

Oropharyngeal Cancer ◽

Insurance Status ◽

Cancer Outcomes

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The impact of race, age, and sex in follicular lymphoma (FL): A comprehensive SEER analysis in the pre- and post-rituximab (R) eras.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8072 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8072-8072

Author(s):

Chadi Nabhan ◽

Briseis Aschebrook-Kilfoy ◽

Brian C-H Chiu ◽

Kimberly R. Kruczek ◽

Angelo Clemenzi-allen ◽

...

Keyword(s):

Overall Survival ◽

Racial Disparities ◽

Racial Disparity ◽

Age Groups ◽

Population Based ◽

Asian Pacific Islander ◽

Asian Pacific ◽

The Impact ◽

Modern Era ◽

Age And Sex

8072 Background: While racial disparity has been well documented in a number of cancers, the impact of race in FL outcomes is not well defined. Further, the importance of gender in FL has not been fully explored. Methods: We examined population-based FL overall survival (OS) data from SEER 13 (1993-2008) regarding race, sex, age, and socioeconomic status (SES) over two consecutive 8-year (yr) periods: Era 1 (1993-2000, n=7,409) and Era 2 (2001–2008, n=9,083). Results: We identified16,492 FL patients (pts) (white (W): n=13,441; Hispanic (H): n=1,417; Asian/Pacific Islander (A/PI): n=887; and Black (B): n=747). Median ages at diagnosis differed significantly according to: (in yrs, W: 62.1, H: 57.3, A/PI: 60.5, B: 56.6; P<0.01 for each race vs. W). For all pts, OS was superior in Era 2 vs. Era 1 (5-yr OS: 77% vs. 68%, respectively, P<0.0001). Further, OS was significantly improved for all age groups (<50, 50-59, 60-69, and 70-79 yrs) as well as for males (P=0.0019) and females (P<0.0001) across eras. Interestingly, females had superior OS compared with males in Era 1 (P=0.004), but not in Era 2 (P=0.83). We subsequently compared OS within and across races (Table). All races, except A/PI, had improved 5-yr OS rates (age adjusted) from Era 1 to Era 2 (W: <0.001, H: 0.049, A/PI: 0.15, B: 0.003). Notably, A/PIs had the highest OS in Era 1, while H had the poorest OS in Era 2. These differences were more evident in males compared with females within each race. Finally, pts with higher SES had better OS in both eras, although OS was improved across eras for lower and higher SES populations. Conclusions: Collectively, we identified improved OS across eras, which was apparent for all ages, both sexes, and all races. We did not find superior outcome for females in the modern era as has been recently noted. However, several racial disparities persist, including inferior OS for H and superior OS A/PIs in the contemporary era. The disproportionate improvement in outcomes for some, but not all races, warrants continued study of racial disparities in FL. [Table: see text]

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