Insurance and Mortality in Breast and Other Cancers
Posted: Wednesday, October 16, 2019
According to a population-based study by Alexander P. Cole, MD, of Harvard Medical School, and colleagues, cancer-specific mortality is higher for uninsured patients with breast cancer, and other cancers, relative to those with health insurance. The study’s findings were published in the JNCCN–Journal of the National Comprehensive Cancer Network.
“Insurance coverage at the time of diagnosis is independently associated with reduced [cancer-specific mortality] among patients with ovarian, pancreatic, lung, colorectal, breast, and prostate cancers,” concluded the authors. “Understanding the strength of the association between insurance status and cancer outcomes has clear relevance given ongoing legislative debates about policies, which have the potential to alter insurance rates.”
In this study, the insurance status and cancer-specific mortality rates of patients with cancer (representing about 26% of the U.S. population) were obtained from the Surveillance, Epidemiology, and End Results database. Overall, 97% of patients with breast cancer included in the analysis had insurance. Uninsured patients had higher rates of metastases at the time of diagnosis (13.7% vs. 4.9% of patients) and received less definitive treatment than insured patients (79% vs. 94% of patients).
In the combined cohort of 332,703 patients with cancer, no insurance coverage was associated with worse overall cancer-specific mortality (P < .0001). After the investigators adjusted for disease stage at diagnosis, the adjusted hazard ratio for uninsured patients with breast cancer improved from 2.19 to 1.43.
“Insurance coverage has the largest magnitude of association with breast and prostate cancers…. In contrast, insurance coverage conferred a less pronounced benefit in ovarian and pancreatic cancers,” concluded the authors. “Our results are consistent with a large portion of the benefit of insurance coverage arising from detection and treatment of prevalent, but curable, early-stage cancers.”
Disclosure: The study authors reported no conflicts of interest.