(P133) Variation in Insurance Status by Patient Demographics and Tumor Site Among the Top Twenty-Five Causes of Cancer

April 15, 2014
Volume 28, Issue 1S

In the United States, an estimated 48 million individuals live without health insurance. The purpose of this study is to explore differences in key factors associated with insurance status among non-Medicare-aged adults diagnosed with the top 25 incident cancers using the Surveillance, Epidemiology, and End Results (SEER) public-use database.

Stephen R. Grant, BS, Gary V. Walker, MD, MPH, Ashleigh Guadagnolo, MD, MPH, Matthew Koshy, MD, Usama Mahmood, MD; UT MD Anderson Cancer Center

Background: In the United States, an estimated 48 million individuals live without health insurance. The purpose of this study is to explore differences in key factors associated with insurance status among non-Medicare-aged adults diagnosed with the top 25 incident cancers using the Surveillance, Epidemiology, and End Results (SEER) public-use database.

Methods: A total of 688,794 patients aged 18-64 years diagnosed with 1 of the top 25 incident cancers (representing 95% of all cancer diagnoses) between 2007 and 2010 in the SEER database were analyzed. Patient characteristics included age, race, gender, marital status, rural residence, and tumor stage. County-level demographics included percent poverty level. Insurance status was defined as insured, Medicaid, or uninsured. A multivariate logistic regression model was used to determine factors associated with lack of insurance.

Results: Of the 688,794 eligible patients, 536,297 (77.9%) had insurance, 76,516 (11.1%) had Medicaid, and 33,798 (4.9%) did not have insurance. On univariate analysis, the following demographic characteristics were associated with lack of insurance: younger age, male gender, nonwhite race, being unmarried, rural residence, and residing in a county with higher poverty level (all P < .0001). The cancer types with the highest rates of insurance coverage were prostate cancer (92.3%), melanoma of the skin (92.5%), and thyroid cancer (89.5%). The lowest rates of insurance were seen among patients with cancer of the cervix (64.2%), liver (67.9%), and stomach (70.9%). Among those uninsured, the top three causes of cancer were lung cancer (14.9%), colorectal cancer (12.1%), and breast cancer (10.2%). Among those with Medicaid, the top three causes of cancer were breast cancer (21.3%), lung cancer (15.7%), and colorectal cancer (9.2%). Males were more likely to be uninsured (5.8% vs 4.7%), and females were more likely to have Medicaid (13.3% vs 10.2%) (P < .0001). Insurance rates increased with age and ranged from 73.6% for 18–29-year-olds to 85.8% for 60–64-year-olds (P < .0001). Nonwhite individuals represented 45.5% of the uninsured vs only 26.9% of the insured (P < .0001). The rate of insurance decreased from 84.1% in 2007 to 81.5% in 2010 (P < .0001). In a multivariate logistic regression, younger age, female gender, nonwhite race, being unmarried, rural residence, and residence in a county with a higher percent below poverty were associated with the lack of insurance.

Conclusions: Large disparities exist in the rates of insurance by cancer type. Younger age, female gender, nonwhite race, being unmarried, rural residence, and residence in a county with a higher percent below poverty were associated with lack of insurance. The expansion of private insurance would be expected to disproportionally benefit certain populations and cancer types.