Insurance status and risk of cancer mortality among adolescents and young adults
Open Access
- 9 December 2014
- Vol. 121 (8), 1279-1286
- https://doi.org/10.1002/cncr.29187
Abstract
BACKGROUND Adolescents and young adults with cancer have inferior survival outcomes compared with younger pediatric patients and older adult patients. Lack of insurance may partly explain this disparity. The objective of this study was to identify associations between insurance status and both advanced‐stage cancer and cancer‐specific mortality. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) 18 registries, 57,981 patients ages 15 to 39 years were identified who were diagnosed between 2007 and 2010 and had complete insurance and staging information. Multinomial logistic regression models were used to identify associations between insurance type and disease stage, with the models adjusted for sex, age, and race. Cox proportional hazards models were used to estimate cancer‐specific mortality. RESULTS Overall, 84% of patients were aged ≥25 years, 64% were women, and 79% were privately insured. Compared with patients who had private insurance, those who had nonprivate insurance tended to present with more advanced‐stage disease and to die more quickly and more commonly from their cancer. Patients ages 25 to 39 years who had Medicaid coverage or no insurance had 3.2 times and 2.4 times higher odds of having stage IV disease, respectively, than privately insured patients (95% confidence interval [CI], 3.0‐3.5 times higher odds and 2.1‐2.6 times higher odds, respectively). Among those with stage I/II and III/IV cancers, the risk of death was 2.9 times greater (95% CI, 2.2‐3.9 times greater) and 1.7 times greater (95% CI, 1.5‐1.9 times greater), respectively, than the risk for privately insured patients. Patients who died from stage III/IV cancers survived at least 2 months longer if they had private insurance. CONCLUSIONS Among young adults, insurance status is independently associated with advanced‐stage cancer and the risk of death from cancer, even for patients who have low‐stage disease. Broader insurance coverage and access to health care may improve some of the disparate outcomes of adolescents and young adults with cancer. Cancer 2015;121:1279–1286. © 2014 American Cancer Society.Keywords
This publication has 17 references indexed in Scilit:
- Insurance status and distant‐stage disease at diagnosis among adolescent and young adult patients with cancer aged 15 to 39 years: National Cancer Data Base, 2004 through 2010Cancer, 2014
- Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?Journal of Cancer Survivorship, 2014
- Are survivors who report cancer‐related financial problems more likely to forgo or delay medical care?Cancer, 2013
- Rethinking Adherence: A Proposal for a New Approach to Risk AssessmentJournal of Adolescent and Young Adult Oncology, 2013
- Young adults, cancer, health insurance, socioeconomic status, and the Patient Protection and Affordable Care ActCancer, 2012
- Association between insurance and socioeconomic status and risk of advanced stage Hodgkin lymphoma in adolescents and young adultsCancer, 2012
- Potential Favorable Impact of the Affordable Care Act of 2010 on Cancer in Young Adults in the United StatesThe Cancer Journal, 2010
- The adolescent and young adult gap in cancer care and outcomeCurrent Problems in Pediatric and Adolescent Health Care, 2005
- Cancer, Medicaid enrollment, and survival disparitiesCancer, 2005
- Barriers to Medicaid Enrollment: Who Is at Risk?American Journal of Public Health, 2005