Survival disparities in top five cancers in the United States: A population based study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18545-e18545
Author(s):  
Snigdha Nutalapati ◽  
Quan Chen ◽  
Bin Huang ◽  
Zin Myint
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Metropolitan Areas ◽  
Private Insurance ◽  
The United States ◽  
Education Level ◽  
Male Gender ◽  
Survival Outcomes ◽  
Insurance Status ◽  
Privately Insured

e18545 Background: Health inequity is an important field in cancer research and it is vital to determine the underlying etiologies to eliminate health disparities. Health insurance differences in survival outcomes have been reported for patients residing in California and New Jersey. Likewise, we aim to explore the impact of variations in insurance status and demographic factors on survival outcomes in patients with the top five cancers in the United States using a nationwide cancer registry. Methods: Surveillance, Epidemiology, and End Results (SEER) 18 program was queried to identify patients with a primary diagnosis of lung, breast, colorectal, prostate cancer, and melanoma from 2007 to 2016. Patient characteristics included are age (≥20 years), sex, marital status, metropolitan or non- metropolitan residence, insurance status (private vs. Medicaid vs. uninsured), education level, stage at diagnosis, and survivals. Descriptive and survival analyses were performed using Pearson Chi-square, Kaplan-Meier and Cox regression tests. Results: A total of 935,916 patients were included, of which 344,022 (37%) had breast cancer, 209,762 (22%) prostate cancer, 151,553 (16%) colorectal cancer, 151,468 (16%) lung cancer, and 79,111 (8%) melanoma. Most patients were aged > 50 years (76%) and 55% were female. Privately insured accounted for 83% of all patients, 13% had Medicaid and 4% were uninsured. Male gender, married, patients with higher education level, residing in metropolitan areas were more likely to have private insurance (p < 0.001) compared to female gender (84.3% vs. 81.2%), unmarried (90.1% vs. 68.7%), subjects with very low to moderate education level (88.2% vs. 80.8%), and ones residing in non- metropolitan areas (83.4% vs. 76.3%). Patients with private insurance were more likely to be diagnosed at localized stage compared to Medicaid insured and uninsured (59.2% vs. 38.2% and 36.6%; p < 0.001). On bivariate and multivariate analyses across of all five cancers, age > 50 years (HR 2.0; p < 0.001), male gender (HR 1.3; p < 0.001), single (HR 1.3; p < 0.001), Medicaid insurance (HR 1.2; p < 0.001), and uninsured (HR 1.3; p < 0.001) were associated with worse overall survival than age < 50 years, female, unmarried, and privately insured. Conclusions: Along with noticeable survival disparities by insurance status in lung, breast, colorectal, prostate and melanoma, we noted that privately insured patients are more likely to be presented at an earlier stage compared to patients with Medicaid and uninsured. Additionally, elderly age, lower education level, unmarried and low socioeconomic status had a negative impact on survival. Multidisciplinary care team efforts are critical in mitigating these health disparities.

scholarly journals Insurance Status Impacts Survival in Burkitt Lymphoma

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 916-916
Author(s):  
Jordan S. Goldstein ◽  
Jeffrey M. Switchenko ◽  
Madhusmita Behera ◽  
Christopher Flowers ◽  
Jean L. Koff
Keyword(s):  
United States ◽  
Research Funding ◽  
Private Insurance ◽  
The United States ◽  
Insurance Status ◽  
Proportional Hazard ◽  
Comorbidity Score ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Insured Patients

Abstract Introduction: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma with an estimated 1480 new cases diagnosed in the United States in 2016. BL is simultaneously one of the most aggressive lymphomas, with a tumor volume doubling time of just 24 hours, and one of the most curable, with several clinical trials showing 3-year survival rates over 80%. However, recent studies have identified a significant discrepancy between clinical trial and "real-world" survival, implying access to care may play an important role in BL outcomes. A patient's insurance status represents a major factor in the utilization of cancer therapies and outcomes in the United States. Underinsured patients are more likely to be diagnosed at an advanced stage, receive substandard therapy, and have worse outcomes. We examined the effect of insurance status on survival in adults with BL and compared the impact of insurance status on BL outcomes to that seen in plasmablastic lymphoma (PBL), an aggressive lymphoma that has poor outcomes regardless of treatment. Methods: We used data from the National Cancer Database (NCDB), a nationwide, hospital-based cancer registry jointly sponsored by the American Cancer Society and American College of Surgeons that contains 34 million historical records and captures 75% of newly diagnosed cancer cases in the United States. Commission on Cancer (CoC)-accredited facilities report patients' vital status and date of death to the NCDB annually. We included patients &gt; 18 years old diagnosed 2004-2014 with BL or PBL as the primary tumor who received all or part of initial course of treatment at the reporting facility. Patients missing information on insurance status or survival were excluded, as were those who had non-Medicare/Medicaid government insurance (VA, Indian Health Services). Chi-square tests were used to compare sociodemographic and clinical characteristics by insurance status. All analyses were performed for both BL and PBL and stratified on age 65, due to changes in eligibility for Medicare at that age. Kaplan-Meier survival curves were stratified by insurance status, and log-rank tests were performed. Univariate Cox proportional hazard models were generated to describe the unadjusted associations for the covariables, and multivariable Cox proportional hazard models were generated to estimate the hazard ratio (HR) associated with insurance status when adjusted for prognostic factors. Results: We identified 7,073 BL patients and 475 PBL patients in the NCDB who met inclusion criteria. Of the 5235 BL patients &lt; 65 years, 65.0% had private insurance, 17.2% had Medicaid, 7.6% had Medicare, and 10.2% had no insurance. Of the 1838 BL patients ≥ 65 years, 12.9% had private insurance, 1.5% had Medicaid, 85% had Medicare, and 0.65% had no insurance. Uninsured and Medicaid-insured patients were more likely to be Hispanic or black, have lower socioeconomic status (SES), have B symptoms, be HIV-positive, and have a Charlson-Deyo comorbidity score ≥ 2 when compared with privately insured patients. Medicare patients were more likely to be female, have ≥1 comorbidity, and not receive chemotherapy treatment when compared to privately insured patients. BL patients without private insurance had significantly worse overall survival compared to those with private insurance, regardless of age group (adjusted HR age &lt;65: uninsured 1.41 [95% confidence interval 1.2,1.7], Medicaid 1.17 [1,1.4], Medicare 1.5 [1.2,1.8]; adjusted HR age ≥ 65: uninsured 6 [2.1,17.3], Medicare 1.33 [1,1.8]; see Figure). Conversely, Cox regression models demonstrated that PBL patients without private insurance experienced no significant differences in overall survival in either age group. For BL patients age &lt;65, low SES, presence of B symptoms, advanced stage, HIV-positive status, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes and contributed to the disparities in survival by insurance status. For BL age &gt; 65, B symptoms, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes. Conclusion: We identified insurance status as an important predictor of clinical outcomes for BL. Our findings suggest that expanding access to care may improve survival disparities in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed to improve outcomes. Disclosures Flowers: Celgene: Consultancy, Research Funding; Bayer: Consultancy; V Foundation: Research Funding; Research to Practice: Research Funding; Infinity: Research Funding; Acerta: Research Funding; National Institutes Of Health: Research Funding; Clinical Care Options: Research Funding; Educational Concepts: Research Funding; Abbvie: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; OptumRx: Consultancy; Spectrum: Consultancy; Genentech/Roche: Consultancy, Research Funding; National Cancer Institute: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Onyx: Research Funding; Burroughs Welcome Fund: Research Funding; TG Therapeutics: Research Funding; Prime Oncology: Research Funding; Millennium/Takeda: Research Funding; Janssen Pharmaceutical: Research Funding; Seattle Genetics: Consultancy; Gilead: Consultancy.

Contemporary National Trends of Prostate Cancer Screening Among Privately Insured Men in the United States

Urology ◽  
2016 ◽  
Vol 97 ◽  
pp. 111-117 ◽  
Author(s):  
Simon P. Kim ◽  
R. Jeffrey Karnes ◽  
Cary P. Gross ◽  
Neal J. Meropol ◽  
Holly Van Houten ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
The United States ◽  
National Trends ◽  
Privately Insured

Contemporary national trends of prostate cancer screening among privately insured patients in the United States.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 5065-5065
Author(s):  
Simon P. Kim ◽  
Jeffrey Karnes ◽  
Cary Philip Gross ◽  
Neal J. Meropol ◽  
Holly K. Van Houten ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
The United States ◽  
National Trends ◽  
Insured Patients ◽  
Privately Insured

Insurance status and survival among prostate cancer patients: A population-based study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16563-e16563 ◽  
Author(s):  
Grace L. Lu-Yao ◽  
Jianming He ◽  
William Kevin Kelly ◽  
David J. Delgado ◽  
Leonard G. Gomella
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Disease Risk ◽  
Private Insurance ◽  
Population Based ◽  
Survival Outcomes ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Population Based Study ◽  
All Cause Mortality

e16563 Background: This population-based study assesses the relationship between insurance status and survival outcomes among men with prostate cancer diagnosed before 65 years of age. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 114,871 prostate cancer patients diagnosed before age 65 in 2007-2013. Insurance type was classified as uninsured, Medicaid, and other (including private insurance and coverage from the military or veterans affairs). Disease risk group was based on the NCCN criteria. We used multivariable Cox proportional hazards models to estimate the relative risks of all-cause mortality and prostate cancer specific mortality (PCSM), adjusted by age, race, marital status, region, diagnosis period, and primary treatment. Results: Compared with patients with other insurance, Medicaid and uninsured patients experienced 103% and 41% higher all-cause mortality. The corresponding increase for PCSM were 61% and 32%. Medicaid patients experienced 44% (HR=1.44, 95% 1.25-1.65) higher all-cause mortality than uninsured patients. Table 1 provides data stratified by risk status at diagnosis. Conclusions: Uninsured and Medicaid patients experienced higher PCSM and all-cause mortality compared to other insured patients across all disease severity. Medicaid patients experienced worse all-cause mortality compared with uninsured patients. Further studies are warranted to investigate factors related to poor survival outcomes among uninsured and Medicaid patients. [Table: see text]

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.

Sixty-day unplanned readmissions after robot-assisted versus open-radical prostatectomy.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 244-244
Author(s):  
Prasanth Lingamaneni ◽  
Binav Baral ◽  
Krishna Rekha Moturi ◽  
Trilok Shrivastava ◽  
Omnia Darweesh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Radical Prostatectomy ◽  
Private Insurance ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Robot Assisted ◽  
Post Procedure ◽  
Comorbidity Burden

244 Background: Options for clinically localized prostate cancer include radical prostatectomy, radiation therapy and active surveillance. Robot-assisted radical prostatectomy (RARP) is increasingly being used, and now accounts for the majority of radical prostatectomies performed in the United States. The aim of our study was to evaluate differences in the patient population undergoing open versus robot-assisted prostatectomy, and to compare 60-day readmissions after index hospitalization for radical prostatectomy. Methods: We utilized the Nationwide Readmission database (NRD) to obtain data on patients with prostate cancer admitted in 2016 and 2017 for radical prostatectomy in the United States. We used T-test to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used evaluate risk factors for 60-day unplanned readmissions. Results: A total of 115,551 patients met the inclusion criteria, of which 80.1% underwent RARP. Patients undergoing RARP were slightly older (64.8 vs 63.1 years, p < 0.0001), more likely to have private insurance (51.7% vs 44.3%, p < 0.0001) and undergo surgery at a teaching hospital (83% vs 74.6%, p < 0.0001). Importantly, open prostatectomy (OP) patients had higher rates of co-morbidities, including, hypertension, diabetes mellitus, chronic kidney disease, obstructive lung disease, heart failure, coronary artery disease and malnutrition (p < 0.01 for these co-morbidities). Hospital stay was longer in those who underwent OP (3.1 vs 1.7 days, p < 0.0001), and they were more likely to be discharged to nursing facility (3.0% vs 0.4%, p < 0.0001) or with home health care (10.9% vs 4.8%, p < 0.0001). Hospitalization charges were higher in the RARP population ($60k vs 57k, p = 0.04). Inpatient mortality was low in both groups (0.3% for OP and ~0% for RARP, p < 0.001). 60-day readmission rate was higher in those who underwent OP (9.3% vs 5.0%, p > 0.0001). Overall, the three leading causes for readmission included sepsis (10.6%), post-procedure infection (8.4%) and venous thromboembolism (VTE, 8.3%). Even after adjustment for age and comorbidities, those who underwent OP had higher risk of all-cause readmission (aOR 1.39, 95% CI 1.25-1.53, p < 0.001) and readmissions for sepsis (aOR 1.36, 95% CI 1.02-1.81, p = 0.03) and post-procedure infection (aOR 1.38, 95% CI 1.06-1.81, p = 0.02). Risk of readmission for VTE was similar in both groups. Conclusions: Nationwide, there are differences in demographics and comorbid illness burden in prostate cancer patients selected for open and robot-assisted radical prostatectomy. Better short-term outcomes in the RARP cohort may be partially attributed to lower comorbidity burden in this group. However, despite adjustment for comorbidities, higher risk for all-cause readmissions and readmissions for infectious complications persisted in the OP group.

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