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

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.