Impact of insurance status on treatment for stage 0-IV breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6532-6532 ◽  
Author(s):  
Rachel Adams Greenup ◽  
Samantha Marie Thomas ◽  
Oluwadamilola Motunrayo Fayanju ◽  
Terry Hyslop ◽  
Eun-Sil Shelley Hwang
Keyword(s):  
Breast Cancer ◽  
Private Insurance ◽  
Cox Proportional Hazards Model ◽  
Oncologic Outcomes ◽  
Bilateral Mastectomy ◽  
Insurance Status ◽  
Cancer Data ◽  
Risk Of Death ◽  
Stage 1 ◽  
Privately Insured

6532 Background: Health insurance can influence utilization of cancer care. We sought to determine whether insurance status impacts treatment patterns and survival in women with stage 0-IV breast cancer. Methods: Women ages 18-69 years old, diagnosed with unilateral stage 0-IV breast cancer between 2004 and 2014 were selected from the National Cancer Data Base. Insurance status was categorized as Private, Medicare (65+ yo), Medicare (18-64 yo), Medicaid, or Uninsured. After adjustment for known covariates, generalized and binary logistic regression were used to estimate the association of insurance type with receipt of treatment. A multivariate Cox proportional hazards model was used to estimate the association of insurance status with overall survival. Results: A total of 610,450 women met inclusion criteria. Median age was 56 (48-63). Insurance status included: 72.1% Privately insured, 13.9% Medicare 65+, 4.8% Medicare 18-64, 7.1% Medicaid, and 2.1% Uninsured. Women with private insurance were more likely to present with stage 1 breast cancer, and less likely to present with stage 4 disease when compared to Medicaid or Uninsured patients (stage 1: 63.4%, 49.4%, 48.2%, p < 0.01; stage IV: 0.8%, 1.8%, 2.1%, p < 0.01). Risk of death was higher in uninsured or Medicaid patients when compared to those with private insurance (HR 1.52, 95% CI 1.41-1.64; HR 1.6, 95% CI 1.52-1.68). Receipt of chemotherapy and radiation did not differ between Medicaid, Uninsured, or Privately insured patients, but women without private insurance were more likely to receive neoadjuvant chemotherapy (OR 1.14, 95% CI 1.09-1.19; OR 1.16, 95% CI 1.07-1.25, respectively, p < 0.01). Uninsured women were more likely to undergo mastectomy without reconstruction (OR 1.57, 95% CI 1.49-1.65), and less likely to undergo unilateral or bilateral mastectomy with reconstruction than lumpectomy and radiation (OR 0.57, 95% CI 0.53-0.61; OR 0.35, 95% CI 0.32-0.39). Conclusions: Stage at diagnosis and risk of death were higher in Medicaid and uninsured breast cancer patients when compared to those with private insurance. Insurance status did not predict differences in receipt of surgery, chemotherapy, or radiation but did affect oncologic outcomes.

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.

Insurance Status, Comorbidity Level, and Survival Among Colorectal Cancer Patients Age 18 to 64 Years in the National Cancer Data Base From 2003 to 2005

2009 ◽  
Vol 27 (22) ◽  
pp. 3627-3633 ◽  
Author(s):  
Anthony S. Robbins ◽  
Alexandre L. Pavluck ◽  
Stacey A. Fedewa ◽  
Amy Y. Chen ◽  
Elizabeth M. Ward
Keyword(s):  
Colorectal Cancer ◽  
Data Base ◽  
Strong Predictor ◽  
Private Insurance ◽  
National Cancer Data Base ◽  
Cox Proportional Hazards ◽  
Insurance Status ◽  
Cancer Data ◽  
Risk Of Death ◽  
Black Patients

Purpose Previous analyses have found that insurance status is a strong predictor of survival among patients with colorectal cancer aged 18 to 64 years. We investigated whether differences in comorbidity level may account in part for the association between insurance status and survival. Methods We used 2003 to 2005 data from the National Cancer Data Base, a national hospital-based cancer registry, to examine the relationship between baseline characteristics and overall survival at 1 year among 64,304 white and black patients with colorectal cancer. In race-specific analyses, we used Cox proportional hazards models to assess 1-year survival by insurance status, controlling first for age, stage, facility type, and neighborhood education level and income, and then further controlling for comorbidity level. Results Comorbidity level was lowest among those with private insurance, higher for those who were uninsured or insured by Medicaid, and highest for those insured by Medicare. Survival at 1 year was significantly poorer for patients without private insurance, even after adjusting for important covariates. In these multivariate models, risk of death at 1 year was approximately 50% to 90% higher for white and black patients without private insurance. Further adjustment for number of comorbidities had only a modest impact on the association between insurance status and survival. In multivariate analyses, patients with ≥ three comorbid conditions had approximately 40% to 50% higher risk of death at 1 year. Conclusion Among white and black patients aged 18 to 64 years, differences in comorbidity level do not account for the association between insurance status and survival in patients with colorectal cancer.

scholarly journals Stalled at the Intersection: Insurance Status and Disparities in Post Mastectomy Breast Reconstruction

2021 ◽  
Author(s):  
Orli Friedman-Eldar ◽  
Jonathan Burke ◽  
Iago de Castro Silva ◽  
Camille C Baumrucker ◽  
Fernando Valle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Breast Reconstruction ◽  
Private Insurance ◽  
Safety Net ◽  
Insurance Status ◽  
Multivariable Logistic Regression ◽  
Safety Net Hospital ◽  
Insured Patients ◽  
Privately Insured

Abstract PurposePost-mastectomy breast reconstruction (PMBR) is an important component of breast cancer treatment, but disparities relative to insurance status persist despite legislation targeting the issue. We aimed to study this relationship in a large health system combining a safety net hospital and a private academic center.MethodsData were collected on all patients who underwent mastectomy for breast cancer from 2011-2019 in a private academic center and an adjacent public safety-net hospital served by same surgical teams. Multivariable logistic regression was used to assess the effect of insurance status on PMBR, controlling for covariates that included socioeconomic, demographic, and clinical factors.ResultsOf 1,554 patients undergoing mastectomy for breast cancer, 753 (48.5%) underwent PMBR. Out of them, 741 had insurance type recorded, with 592 (79.9%) privately insured patients, 50 (6.7%) Medicare, 68 (9.2%) Medicaid, and 31 (4.2%) uninsured patients. Multivariable logistic regression showed a significantly lower likelihood of undergoing PMBR for uninsured (OR 6.9, 95% CI: 4.1-11.7; p<0.0001), Medicare (OR 2.0, (5% CI: 1.2-3.3; p=0.004), and Medicaid (OR 1.7, 95% CI:1.1-2.7; p=0.02) patients, compared with privately insured patients. Age, stage, race, and hospital type confounded this relationship.ConclusionPatients without health insurance have dramatically reduced access to PMBR compared to those with private insurance. Expanding access to this important procedure is essential to achieve greater health equity for breast cancer patients.

scholarly journals 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

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.

Health insurance literacy, status, and financial toxicity in women receiving treatment for metastatic breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 96-96
Author(s):  
Courtney Williams ◽  
Stacey A. Ingram ◽  
Valerie Lawhon ◽  
Clara Wan ◽  
Kelly Kenzik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Private Insurance ◽  
Metastatic Breast ◽  
Insurance Status ◽  
Financial Toxicity ◽  
Health Insurance Status ◽  
Health Insurance Literacy ◽  
Insured Patients ◽  
Privately Insured

96 Background: Though uninsurance rates declined after the Affordable Care Act, the number of underinsured, or individuals who spend > 10% of their income on out-of-pocket (OOP) medical costs, continues to rise. In patients with metastatic breast cancer (MBC), underinsurance may lead to financial toxicity (FT), or patient-level financial burden and distress, since diagnosis and treatment is extremely costly. This study explores health insurance literacy and the association between FT and health insurance status in women receiving treatment for MBC. Methods: This cross-sectional study utilized survey data collected from 2017-2019 in women age ≥18 receiving treatment for MBC at two academic medical centers in Alabama. FT was measured by the Comprehensive Score for Financial Toxicity (COST) tool (11-item scale from 0-44, with lower scores indicating worse FT). Health insurance status and OOP costs were self-reported. Effect sizes were calculated using Cohen’s d or Cramer’s V. Mixed and generalized linear models clustered by site and treating medical oncologist estimated the association between FT and health insurance status. Results: In 81 women with MBC, median COST score was 24 (interquartile range [IQR] 17-30), 44% had private insurance, 40% Medicare, and 16% Medicaid. Though 25% and 33% of surveyed patients did not know their health insurance premium or deductible cost, respectively, privately insured patients more often knew the cost of their premiums (97%; V = 0.58) and deductibles (81%; V = 0.33) compared to publicly insured patients. In adjusted models, FT levels did not differ significantly based on health insurance type (private insurance COST 21, 95% confidence interval [CI] 18-25; Medicaid COST 23, 95% CI 17-29; Medicare COST 24, 95% CI 20-27). However, risk of severe FT (COST ≤13) was 147% higher for privately insured patients versus Medicare beneficiaries (risk ratio 2.47, 95% CI 1.44-4.21). Conclusions: Despite higher levels of health insurance literacy, privately insured patients receiving treatment for MBC may be at increased risk of severe FT. Further research is needed to understand causes of underinsurance in patients with MBC, which could lead to cancer-related FT.

Race, insurance status and treating facility type associated with completeness of medical record in patients with breast cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 143-143
Author(s):  
Marita Yaghi ◽  
Nadeem Bilani ◽  
Iktej Jabbal ◽  
Leah Elson ◽  
Maroun Bou Zerdan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Missing Data ◽  
Medical Record ◽  
Real World ◽  
Private Insurance ◽  
Insurance Status ◽  
Clinical Parameters ◽  
Facility Type ◽  
Missing Variables ◽  
White Patients

143 Background: The National Cancer Database (NCDB) is a large registry that collates real-world medical record data from millions of patients in the United States. A previous published study using the NCDB found that gaps in the medical record were associated with worse overall survival outcomes. We investigated cases of breast cancer in this registry to understand which factors were predictive of records with missing data. Methods: We screened for missing data in 54 clinical parameters documented by the NCDB pertaining to the diagnosis, workup, management and survival of patients with breast cancer diagnosed between 2004 and 2017. We performed univariate statistics to describe gaps in the dataset, followed by multivariate logistic regression modeling to identify factors associated lack of completeness of the medical record – defined as the presence of > 3 missing variables. Results: A total of n = 2,981,732 patients were included in this analysis. The median number of missing variables per record was 3 (5.6% of clinical parameters surveyed). 52.1% of records had ≤ 3 variables missing, while 47.9% had > 3 variables missing. Predictors of a record with missing data in > 3 variables were: age, race, insurance status and facility type . Regarding race, we found that records of Asian patients were less likely to have missing data as compared to records of White patients (OR 0.75, 95% CI: 0.74-0.76, p < 0.001). Conversely, there was no difference in completeness of the medical record between Black and White patients (OR 0.99, 95% CI: 0.99-1.01, p = 0.890). Patients with private insurance (OR 0.77, 95% CI 0.76-0.79, p < 0.001), or Medicaid (OR 0.65, 95% CI 0.64-0.67, p < 0.001) or Medicare (OR 0.66, 95% CI 0.64-0.67, p < 0.001) were also less likely to have missing data compared to uninsured patients, with patients on private insurance being the least likely to have incomplete records. Finally, patient records from academic programs (OR 0.91, 95% CI 0.90-0.92, p < 0.001) were less likely to contain > 3 missing variables compared to records from patients treated at community cancer programs. Conclusions: Despite high fidelity of NCDB data, social determinants of health including insurance status and treating facility type, were associated with differences in the completeness of the medical record. Improvements in documentation and data quality are necessary to optimize use of real-world data in cancer registries. Further research is needed to determine how these differences could be independently associated with inferior outcomes.

scholarly journals Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts

2018 ◽  
Vol 31 (5) ◽  
pp. 325-330 ◽  
Author(s):  
Zhaoyi Chen ◽  
Jae Min ◽  
Jiang Bian ◽  
Mo Wang ◽  
Le Zhou ◽  
...  
Keyword(s):  
Private Insurance ◽  
Insurance Coverage ◽  
Multivariable Analysis ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Large Hospital ◽  
Risk Of Death ◽  
Voluntary Withdrawal ◽  
Life Threatening ◽  
Independent Association

AbstractObjectiveTo investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU).DesignRetrospective analysis of secondary database.SettingTen years of public de-identified ICU electronic medical records from a large hospital in USA.ParticipantsPatients (18–65 years old) who had private insurance or no insurance were extracted from the database.Main outcome measuresIndependent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities.ResultsAmong 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse.ConclusionsPatients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.

scholarly journals Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015

Cancer ◽  
2019 ◽  
Vol 126 (5) ◽  
pp. 958-970 ◽  
Author(s):  
Allison W. Kurian ◽  
Alison J. Canchola ◽  
Cindy S. Ma ◽  
Christina A. Clarke ◽  
Scarlett L. Gomez
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Contralateral Breast ◽  
Bilateral Mastectomy ◽  
Breast Cancer Data ◽  
Cancer Data

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

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 154-154
Author(s):  
M. Omaira ◽  
M. Mozayen ◽  
R. Mushtaq ◽  
K. Katato
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
African Americans ◽  
Private Insurance ◽  
Ethnic Disparities ◽  
The United States ◽  
Insurance Status ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
The Impact

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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