qq-3 - Articles Association of insurance status and...

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222 http://oncology.thelancet.com Vol 9 March 2008 Articles Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis Michael T Halpern, Elizabeth M Ward, Alexandre L Pavluck, Nicole M Schrag, John Bian, Amy Y Chen Summary Background Individuals in the USA without private medical insurance are less likely to have access to medical care or participate in cancer screening programmes than those with private medical insurance. Smaller regional studies in the USA suggest that uninsured and Medicaid-insured individuals are more likely to present with advanced-stage cancer than privately insured patients; however, this f nding has not been assessed using contemporary, national-level data. Furthermore, patients with cancer ±rom ethnic minorities are more likely to be uninsured or Medicaid-insured than non-Hispanic white people. Separating the e² ects on stage o± cancer at diagnosis associated with these two types o± patient characteristics can be diffi cult. Methods Patients with cancer in the USA, diagnosed between 1998 and 2004, were identif ed using the US National Cancer Database—a hospital-based registry that contains patient in±ormation ±rom about 1430 ±acilities. Odds ratios and 95% CIs ±or the e² ect o± insurance status (Medicaid, Medicare (65–99 years), Medicare (18–64 years), private, or uninsured) and ethnicity (white, Hispanic, black, or other) on disease stage at diagnosis ±or 12 cancer sites (breast [±emale], colorectal, kidney, lung, melanoma, non-Hodgkin lymphoma, ovary, pancreas, prostate, urinary bladder, uterus, and thyroid) were estimated, while controlling ±or patient characteristics. Findings 3 742 407 patients were included in the analysis; patient characteristics were similar to those o± the corresponding US population not included in the analysis. Uninsured and Medicaid-insured patients were signif cantly more likely to present with advanced-stage cancer compared with privately insured patients. This f nding was most prominent ±or patients who had cancers that can potentially be detected early by screening or symptom assessment (eg, breast, colorectal, and lung cancer, as well as melanoma). For example, the odds ratios ±or advanced-stage disease (stage III or IV) at diagnosis ±or uninsured or Medicaid-insured patients with colorectal cancer were 2·0 (95% CI 1·9–2·1) and 1·6 (95% CI 1·5–1·7), respectively, compared with privately-insured patients. For advanced-stage melanoma, the odds ratios were 2·3 (2·1–2·5) ±or uninsured patients and 3·3 (3·0–3·6) ±or Medicaid-insured patients compared with privately insured patients. Black and Hispanic patients were noted to have an increased risk o± advanced-stage disease (stage III or IV) at diagnosis, irrespective o± insurance status, compared with White patients.
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This note was uploaded on 04/07/2011 for the course HLTH 310 taught by Professor Staff during the Winter '08 term at BYU.

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qq-3 - Articles Association of insurance status and...

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