Effect of race and insurance status on stage at diagnosis and overall survival of triple-negative breast cancer (TNBC): Analysis of the National Cancer Data Base (NCDB).

e19086 Background: TNBC is a heterogeneous sub-type of breast cancer characterized by younger age of onset, more aggressive course, and higher incidence among African Americans who also experience disparities in access to health care including health insurance coverage and cancer screening. Methods: We performed a retrospective analysis of the NCDB to study the impact of race and insurance status on the stage at diagnosis and overall survival of people with TNBC. Chi-square tests analysis was used for univariate analysis. Cox models were used to test for survival differences between race and insurance status adjusted for other covariates such as age at diagnosis, gender. Results: Among 1,148,016 people with TNBC registered in the NCDB from 2010 to 2016, 87.7% were identified as white and 12.3% were identified as black. The majority (99%) were female. Mean age at diagnosis was 62.0 years for females and 65.9 years for males. Among white patients, 1.8% were uninsured while 3.6% of black patients were uninsured. Advanced stage at diagnosis was less common among white people (9.4%, Stage 3; 4.9%, Stage 4) than black people (13.3%, Stage 3; 7.6%, Stage 4). Uninsured patients had more advanced disease at time of diagnosis (16.2%, Stage 3; 14.1%, Stage 4) than insured patients (9.8%, Stage 3; 5.0%, Stage 4). Overall survival after adjustment for age at diagnosis, gender and insurance status was greater for white patients compared to black patients (harm ratio 0.60). Overall survival after adjustment for age at diagnosis, gender and race was lower for uninsured patients than insured patients (harm ratio 2.25). Conclusions: Racial disparities significantly affect TNBC patients, with black women having lower insurance coverage and worse overall survival. [Table: see text]

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

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.154 ◽

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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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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Impact of Insurance Status on the Day of Admission and Clinical Outcome on Acute Myeloid Leukemia (AML)Patients

Blood ◽

10.1182/blood.v124.21.2274.2274 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2274-2274

Author(s):

Bilal Ahmad ◽

Hossein Maymani ◽

Haseeb Saeed ◽

Mohamad Khawandanah ◽

Samer A Srour ◽

...

Keyword(s):

Overall Survival ◽

Myeloid Leukemia ◽

Private Insurance ◽

P Value ◽

Insurance Status ◽

Uninsured Patients ◽

Public Insurance ◽

Group 2 ◽

Insured Patients ◽

Group 1

Abstract Background: In patients with acute myeloid leukemia (AML), insurance status has not been demonstrated to adversely impact outcomes. However, insurance status appears to be an independent factor in healthcare utilization. University of Oklahoma Health Sciences Center (OUHSC) is the main tertiary hospital in the State of Oklahoma treating patients with acute leukemia. We hypothesized that treatment patterns might be different between the insured and uninsured patients. We hereby attempt to analyze the association between insurance status, week day of admission and outcomes. Methods: We retrospectively analyzed patients from January 2000 to June 2012 diagnosed with AML over 18 years of age, who were treated at OUHSC with induction chemotherapy. Patients were divided into two groups: Group 1 included patients who were admitted on weekdays (Monday-Thursday) and group 2 included patients admitted on weekends (Friday-Sunday). Patients were also sub-classified as having private insurance, public insurance (Medicaid and Medicare) or no insurance. Primary outcomes were overall survival at follow up (OS), complete remission (CR) and Relapse. Chi-Square analysis was utilized to assess if day of admission and insurance status was related to OS, CR and Relapse. Cox Proportional hazards model was used to measure association of insurance status, day of admission and their interaction and Kaplan Meir Survival curves were used to estimate survival rates for day of admission by insurance status. Results: We analyzed total of 161 patients, 157 met inclusion criteria with 69 (44%) having public insurance, 58 (37%) with private insurance and 30 (19%) were uninsured. Group 1 with 94 (60%) patients was admitted on weekdays (Monday–Thursday), and group 2 with 63 (40%) patients was admitted on weekend (Friday-Sunday). The median age at diagnosis was 49 years, 63.7% male 36.3% female. 77.0% white, 10.6% African American, 6.2% Native American and 3.7% Hispanic. We found a significant interaction between insurance status and day of admission, 63% of uninsured patients being admitted on weekend (Fri-Sun) with (p-value=0.0292). When we stratified patients by insurance status there was no difference in survival outcomes for uninsured patients based on day of admission. However, for patients with insurance who were admitted on weekdays Mon-Thurs (Group 1) had a hazard ratio (HR) of death 0.487 relative to those on weekends Fri-Sun (Group 2) (p=0.0238). Median overall survival (OS) for uninsured patients in (Group 2) was 147.5 days (95% CI=79-252) as compare to insured patients in (Group 1) 252 days (95% CI=116-459) with a P value 0.0182. The proportion of patients achieving CR did not differ by day of admission (p=0.3275) and insurance type (0.5678). Relapse was not associated with day of admission (p=0.2284) or by insurance type (p=0.4057). Conclusions: For the patients with the diagnosis of AML who presented to our institution, there was a noticeable trend of uninsured patients being admitted over the weekend. The overall survival was lower for the uninsured patients who were admitted on the weekend as compare to the insured patients who were admitted on weekdays. This trend is both noteworthy and significant and due to its possible impact on standard of care warrants further investigation. Disclosures No relevant conflicts of interest to declare.

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Impact of Insurance Coverage on Outcomes in Primary Breast Sarcoma

Sarcoma ◽

10.1155/2018/4626174 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Julie L. Koenig ◽

C. Jillian Tsai ◽

Katherine Sborov ◽

Kathleen C. Horst ◽

Erqi L. Pollom

Keyword(s):

Overall Survival ◽

Private Insurance ◽

Insurance Coverage ◽

Disease Stage ◽

Insurance Status ◽

Rare Cancer ◽

Breast Sarcoma ◽

Specialized Care ◽

Insured Patients ◽

Privately Insured

Private insurance is associated with better outcomes in multiple common cancers. We hypothesized that insurance status would significantly impact outcomes in primary breast sarcoma (PBS) due to the additional challenges of diagnosing and coordinating specialized care for a rare cancer. Using the National Cancer Database, we identified adult females diagnosed with PBS between 2004 and 2013. The influence of insurance status on overall survival (OS) was evaluated using the Kaplan–Meier estimator with log-rank tests and Cox proportional hazard models. Among a cohort of 607 patients, 67 (11.0%) had Medicaid, 217 (35.7%) had Medicare, and 323 (53.2%) had private insurance. Compared to privately insured patients, Medicaid patients were more likely to present with larger tumors and have their first surgical procedure further after diagnosis. Treatment was similar between patients with comparable disease stage. In multivariate analysis, Medicaid (hazard ratio (HR), 2.47; 95% confidence interval (CI), 1.62–3.77; p<0.001) and Medicare (HR, 1.68; 95% CI, 1.10–2.57; p=0.017) were independently associated with worse OS. Medicaid insurance coverage negatively impacted survival compared to private insurance more in breast sarcoma than in breast carcinoma (interaction p<0.001). In conclusion, patients with Medicaid insurance present with later stage disease and have worse overall survival than privately insured patients with PBS. Worse outcomes for Medicaid patients are exacerbated in this rare cancer.

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

Journal of Cancer Epidemiology ◽

10.1155/2017/4354592 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 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.

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Patient and Tumor Disparities in Breast Cancer Based on Insurance Status

The American Surgeon ◽

10.1177/000313481708300840 ◽

2017 ◽

Vol 83 (8) ◽

pp. 875-880

Author(s):

Celia Quang ◽

Seth Hill ◽

Scott Blair ◽

Donna Lynn Dyess ◽

Joe Spencer Liles

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Advanced Disease ◽

Insurance Status ◽

Breast Cancer Patients ◽

Uninsured Patients ◽

Abnormal Mammogram ◽

Parametric Testing ◽

Insured Patients ◽

To Receive

This study seeks to determine whether uninsured breast cancer patients are more likely to present with advanced disease relative to insured patients. We retrospectively reviewed newly diagnosed breast cancer patients over a 27-month period. Patients were sorted based on insurance status at diagnosis. Demographic and tumor-specific data were collected and analyzed using non-parametric testing. We identified 276 breast tumors in 260 patients. Out of the 260 patients, 71 patients (27.3%) were uninsured and were more likely to be black (P < 0.05), present with a breast-specific complaint rather than an abnormal mammogram (P < 0.05), and present with more advanced disease (52% stage II or worse vs 26.6% in the insured population; P < 0.01). Percentage of invasive carcinoma and tumor biology were independent of insurance status. Insured patients were more likely to receive surgery as first therapy (76.5 vs 46.0%, P < 0.01), whereas uninsured patients were more likely to receive chemotherapy suggesting multimodality treatment. Uninsured patients had a longer time to therapy initiation (56.0 days vs 44.5 days, P < 0.05). Our study confirms that uninsured patients present with higher stage disease are more likely to have breast-specific complaints and are more likely to require chemotherapy as first-line treatment confirming the under-utility of screening mammography within our uninsured patients.

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Tobacco use and race as copredictors of overall survival in patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.20 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 20-20 ◽

Cited By ~ 1

Author(s):

Jeremy Clady Wells ◽

Thomas A. Samuel ◽

Kyana Morton ◽

Stephen W. Looney

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Tobacco Use ◽

Cox Regression ◽

Statistical Significance ◽

Age At Diagnosis ◽

Stage At Diagnosis ◽

Inclusion Criteria ◽

Cox Regression Analysis ◽

History Of

20 Background: Tobacco use (TOB) has been linked to the development of breast cancer (BCa), but limited data exists linking TOB with overall survival (OS) and the influence of race on this relationship. Our previous research has shown that African-American (AA) patients with BCa have worse OS compared with Caucasian (C) patients. This retrospective study examines the effect of TOB on OS in BCa patients at Georgia Regents University (GRU) and the effect of race in conjunction with TOB on OS. Methods: Data were obtained from the GRU Tumor Registry. Inclusion criteria were all female patients diagnosed with BC between 2002 and 2010. The estimated hazard ratio (HR) from Cox regression was used to measure the association between TOB and OS. Race, age at diagnosis, and stage at diagnosis were considered for inclusion as covariates. A stratified OS analysis was also performed dividing patients by race (C vs. AA). Results: Data were collected on 836 females who met inclusion criteria. TOB was categorized as "none" vs. "any" at time of BCa diagnosis The Cox regression analysis indicated a decreased OS for women with any tobacco use (unadjusted HR, 1.45; p = 0.024). Statistical significance was retained when this HR was adjusted for race (HR, 1.47; p = 0.021) and age at diagnosis (HR, 1.45; p = 0.024), but not for stage at diagnosis (HR, 1.21; p = 0.266). In the stratified analysis, the results for C patients were similar to those obtained in the complete sample (HR, 1.62; p = 0.044). Statistical significance was not retained for AA patients (HR 1.31; p = 0.244). We compared C tobacco users (n = 157) vs. AA tobacco users (n = 127) (HR, 1.10; p = 0.716) and C tobacco non-users (n = 291) vs. AA tobacco non-users (n = 261) (HR, 1.36; p= 0.156) and found no statistical significance. Conclusions: Our analysis shows that patients with history of TOB at BCa diagnosis have a 45% chance of decreased OS compared to non-TOB users. The negative impact of TOB is still noted when adjusted for race and age at diagnosis but not for stage at diagnosis. When stratifying by race, we found that any TOB is a significant risk factor among C patients but not among AA patients. We conclude that any history of TOB at BCa diagnosis is an important negative prognostic factor for OS, and this is particularly true in C patients.

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7026 ◽

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.

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.77 ◽

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]

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Association between Insurance Status and Hospital Length of Stay following Trauma

The American Surgeon ◽

10.1177/000313481608200324 ◽

2016 ◽

Vol 82 (3) ◽

pp. 281-288 ◽

Cited By ~ 9

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.

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