Insurance disparity in the United States cancer survivors’ smoking rates: A trend study from NHIS 2008-2017.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1553-1553
Author(s):  
Yannan Zhao ◽  
Binbin Zheng-Lin ◽  
Biyun Wang ◽  
Xi-Chun Hu ◽  
Changchuan Jiang
Keyword(s):  
Cancer Survivors ◽  
Statistical Power ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Smoking Behavior ◽  
The United States ◽  
Current Smoking ◽  
Complex Design ◽  
Adult Cancer Survivors ◽  
Smoking Behaviors

1553 Background: Smoking rates have been decreasing in the U.S over the last decade. Smoking cessation is a critical part of cancer treatment and survivorship care. However, little is known about the trend of smoking rates in U.S. cancer survivors and how it varied by individuals’ insurance coverages. Methods: We conducted a retrospective study to evaluate the temporal trend of smoking rates using the National Health Interview Survey from 2008 through 2017. Adult cancer survivors (n = 20122) were included in the analysis. The outcomes were self-reported current smoking behavior. Insurance coverage was categorized into any private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare + any private (age > 65), and other coverage (age > 65). We combined every two years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design. Results: The smoking rates in cancer survivors decreased from 18.4% in 2008 to 12.5% in 2017. However, the smoking rates varied remarkably by insurance status (p < 0.001). There was a decreasing trend of smoking rates in participants with any private (age ≤65) (17.3% in 2008/2009 to 12.0% in 2016/2017), Medicare + any private (age > 65) (7.5% in 2008/2009 to 5.9% in 2016/2017), and other coverage (age > 65) (13.2% in 2008/2009 to 9.2% in 2016/2017) whereas the current smoking rates remains high in cancer survivors with other coverage (age ≤65) (40.1% in 2008/2009 to 34.4% in 2016/2017) and uninsured (age ≤65) (43.4% in 2008/2009 to 43,1% in 2016/2017). Conclusions: Cancer survivors report less smoking behaviors over the last decade which is similar to the general population. However, the smoking rate remains dangerously high in non-elderly cancer survivors without any private insurance.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

scholarly journals 2736. Insurance Disparity in United States Cancer Survivors’ Influenza Vaccination Rates: A Trend Study from NHIS 2005–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S963-S963
Author(s):  
Xin Zheng ◽  
Changchuan Jiang
Keyword(s):  
Cancer Survivors ◽  
Influenza Vaccination ◽  
Cancer Patients ◽  
Private Insurance ◽  
Insurance Coverage ◽  
National Level ◽  
Disease Process ◽  
Vaccination Rates ◽  
Flu Vaccination ◽  
Adult Cancer Survivors

Abstract Background Patients with underlying cancer often have suppressed immunity from disease process and cancer therapy, making this population particularly vulnerable to influenza. Few studies have investigated the overall flu vaccination rates; however, little is known regarding the trend of vaccination rates in US cancer survivors and how it varied by individuals’ insurance coverage. Methods We conducted a retrospective cross-sectional study to evaluate the temporal trend of flu vaccination rates using the National Health Interview Survey from 2005 through 2017. Adult cancer survivors (n = 24,381) were included in the analysis. The outcomes were self-reported flu vaccination during the past 12 months with either inactivated or live attenuated nasal vaccine. Insurance coverage was categorized into private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare and private (age > 65), and other coverage (age > 65). We combined every 2 years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design and NCI-Joinpoint 4.7 was used for joinpoint regression in the trend analysis. Results The overall cancer survivors’ flu vaccination rates improved from 45% in 2005 to 63% in 2017, whereas the cancer-free group improved from 18% in 2005 to 41% in 2017. With cancer survivors, influenza vaccination rates varied remarkably by insurance status (P < 0.001). Elderly survivors (age 65+) with any type of insurance consistently had higher flu vaccination rates than survivors younger than 65 (averaging 70% vs. 40%). For cancer patients age 65 or younger, whether insured or not, the overall flu vaccination rates had improved since 2005. However, for the subgroup who had coverage but not with private insurance, the vaccination rates had been declining since 2012 (50% in 2012/2013 to 45% in 2016/2017). Conclusion Despite the overall increase of flu vaccination rates in both cancer survivors and cancer-free participants since 2005, the growth rate has plateaued since 2015. This is likely related to shifts in healthcare law on the national level. Such impact is particularly significant in cancer patients who are younger and do not have private insurance coverage. Such vulnerable and underserved population will need more resources to help improve their influenza vaccination rate. Disclosures All authors: No reported disclosures.

Dietary Supplement Use Among Adult Cancer Survivors in the United States

2019 ◽  
Author(s):  
Mengxi Du ◽  
Jeffrey B. Blumberg ◽  
Zhilei Shan ◽  
Gail Rogers ◽  
Fan Chen ◽  
...  
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Dietary Supplement ◽  
The United States ◽  
Supplement Use ◽  
Adult Cancer Survivors ◽  
Dietary Supplement Use

scholarly journals Changes among US Cancer Survivors: Comparing Demographic, Diagnostic, and Health Care Findings from the 1992 and 2010 National Health Interview Surveys

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Natasha D. Buchanan ◽  
Jessica B. King ◽  
Juan L. Rodriguez ◽  
Arica White ◽  
Katrina F. Trivers ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Support Groups ◽  
National Health ◽  
Clinical Care ◽  
Quality Care ◽  
Insurance Coverage ◽  
Cancer Control ◽  
The United States ◽  
Institute Of Medicine ◽  
Health Interview

Background. Differences in healthcare and cancer treatment for cancer survivors in the United States (US) have not been routinely examined in nationally representative samples or studied before and after important Institute of Medicine (IOM) recommendations calling for higher quality care provision and attention to comprehensive cancer care for cancer survivors. Methods. To assess differences between survivor characteristics in 1992 and 2010, we conducted descriptive analyses of 1992 and 2010 National Health Interview Survey (NHIS) data. Our study sample consisted of 1018 self-reported cancer survivors from the 1992 NHIS and 1718 self-reported cancer survivors from the 2010 NHIS who completed the Cancer Control (CCS) and Cancer Epidemiology (CES) Supplements. Results. The prevalence of reported survivors increased from 1992 to 2010 (4.2% versus 6.3%). From 1992 to 2010, there was an increase in long-term cancer survivors and a drop in multiple malignancies, and surgery remained the most widely used treatment. Significantly fewer survivors (<10 years after diagnosis) were denied insurance coverage. Survivors continue to report low participation in counseling or support groups. Conclusions. As the prevalence of cancer survivors continues to grow, monitoring differences in survivor characteristics can be useful in evaluating the effects of policy recommendations and the quality of clinical care.

Health insurance literacy, financial hardship and financial sacrifices among cancer survivors in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1560-1560
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Zhiyuan Zheng ◽  
Matthew P. Banegas ◽  
Donatus U. Ekwueme ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Financial Burden ◽  
Age Groups ◽  
The United States ◽  
Financial Hardship ◽  
Adult Cancer Survivors ◽  
Health Insurance Literacy ◽  
Medical Bills

1560 Background: Rising costs of cancer care have imposed substantial financial burden on cancer survivors. To date, little is known about the associations between potentially modifiable patient characteristics, including health insurance literacy (HIL), on financial burden among cancer survivors. This study aimed to evaluate the associations between HIL and financial hardship and financial sacrifices among adult cancer survivors in the United States. Methods: We identified 914 adult cancer survivors from the 2016 Medical Expenditure Panel Survey Experiences with Cancer Questionnaire. HIL was measured based on the question “Did you ever have a problem understanding health insurance or medical bills related to your cancer, its treatment, or the lasting effects of that treatment?” Medical financial hardship was measured in three domains—1) material (e.g. problems paying medical bills); 2) psychological (e.g. worry about large medical bills); and 3) behavioral (e.g. delay or forego healthcare because of cost). Financial sacrifices were based on questions related to changes in spending on vacation or leisure activities. We used multivariable logistic regression modeling to separately evaluate the associations between HIL problems and 1) financial hardship and 2) financial sacrifices. Results: 18.9% cancer survivors aged 18-64 years and 14.6% survivors ≥65 years reported HIL problems. Regardless of age groups, cancer survivors with HIL problems were more likely to report any material (OR =3.2; 95% CI:1.9-5.2) or psychological (OR=7.2; 95% CI: 4.1-12.7) financial hardship than those without the problems, as well as more likely to delay or forgo multiple medical care due to cost, including prescription medicine (OR=3.6; 95% CI: 1.8-7.1), specialist visit (OR=2.6; 95% CI: 1.2-5.8), and follow-up care (OR=2.1, 95% CI 1.2-4.0). Higher likelihood of reporting all measures of financial sacrifices were observed among those with HIL problems in both age groups (all p<0.05). Conclusions: Cancer survivors with HIL problems were more likely to report financial hardship and financial sacrifices than those without the problems. Improving HIL may help mitigate financial hardship.

scholarly journals The Evolution of Medical Spending Risk

2009 ◽  
Vol 23 (4) ◽  
pp. 25-48 ◽  
Author(s):  
Jonathan Gruber ◽  
Helen Levy
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Spending ◽  
The United States ◽  
Consumer Expenditure ◽  
Out Of Pocket Payments ◽  
Over Time

How has the economic risk of health spending changed over time for U.S. households? We describe trends in aggregate health spending in the United States and how private insurance markets and public insurance programs have changed over time. We then present evidence from Consumer Expenditure Survey microdata on how the distribution of household spending on health—that is, out-of-pocket payments for medical care plus the household's share of health insurance premiums—has changed over time. This distribution has shifted up over time—households spend more on medical care and insurance than they used to—but for the purposes of measuring change in risk, it is not the mean but the dispersion of this distribution that is of interest. We consider two measures of dispersion that serve as proxies for household risk: the standard deviation of the distribution of household health spending and the ratio of the 90th percentile of spending to the median (the so-called “90/50 gap”). We find, surprisingly, that neither has increased despite the rapid rise in aggregate health spending. This conclusion holds true for broad subgroups of the population (for example, the nonelderly as a group) but not for some narrowly-defined subgroups (for example, low-income families with children). We next consider how much risk households should face, from the perspective of economic efficiency. Household risk may not have changed much over the past several decades, but do we have any evidence that this level represents either too much or too little risk? Finally, we discuss implications for public policy—in particular, for current debates over expanding health insurance coverage to the uninsured.

Crisis in U.S. Health Care: Corporate Power Still Blocks Reform

2017 ◽  
Vol 48 (1) ◽  
pp. 5-27 ◽  
Author(s):  
John Geyman
Keyword(s):  
Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Public Support ◽  
Universal Coverage ◽  
The United States ◽  
Industrial Complex ◽  
Current Crisis ◽  
The Government

The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities. Reform efforts to establish universal insurance coverage have failed on six occasions over the last century, largely through opposition of corporate stakeholders in the medical-industrial complex. This article provides historical perspective to previous reform attempts, updates the current battle between Republicans and Democrats over repeal of the 2010 Affordable Care Act (ACA), and compares three financing alternatives—continuation of the ACA; its replacement by a Republican plan (the House’s American Health Care Act or its Senate counterpart, the Better Care Reconciliation Act); and single-payer national health insurance (NHI or Medicare for All). Markers are described that reveal the extent of the current crisis in U.S. health care. Evidence is presented that the private insurance industry, increasingly dependent on bailout by the government, is in a “death spiral.” NHI is gaining increasing public support as the only financing alternative to provide universal coverage. Nine lessons that are still unlearned in the United States concerning health care are discussed, together with future prospects to establish universal coverage in this embattled and changing political environment.

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