This article is more than 5 years old. Information may no longer be current.

Insurance status associated with outcomes with melanoma

Patients with malignant melanoma who were uninsured or on Medicaid were more likely to present with advanced disease and less likely to receive treatment, which likely contributed to worse survival when compared with patients with non-Medicaid insurance, according to study results.

Researchers used the Surveillance, Epidemiology and End Results (SEER) database to conduct a cross-sectional analysis of 61,650 patients (median age, 52 years) diagnosed with cutaneous malignant melanoma between 2007 and 2012. There was a median follow-up of 30 months.

Insurance status included non-Medicaid insurance (70% of patients), Medicaid (5.2%), uninsured (3.0%) and unknown (24.2%).

Patients more likely to die of any cause, including melanoma included those on Medicaid (HR = 1.83; 95% CI, 1.65-2.04) or with uninsured status (HR = 1.63; 95% CI, 1.44-1.85), according to multivariate analysis. In a comparison with non-Medicaid insured patients, the uninsured cohort more often presented with increasing tumor thickness (OR = 2.19; 95% CI, 1.76-2.73) and ulceration presence (OR = 1.64; 95% CI, 1.4-1.92) and less often received treatment (OR = 1.87; 95% CI, 1.6-2.19). Patients on Medicaid more often experienced increasing tumor thickness (OR = 2.36; 95% CI, 1.91-2.91), advanced summary stage (localized vs. regional; OR = 1.59; 95% CI, 1.37-1.85) and ulceration presence (OR = 1.4; 95% CI, 1.19-1.63), while less often receiving treatment (OR = 1.61; 95% CI, 1.37-1.89).

“Insurance status appears to be associated with disease presentation, receipt of treatment and [overall survival] for patients with melanoma,” the researchers concluded. “Although solving the uninsured crisis existing in this country will be one major step in reducing the gap in care and outcomes from melanoma, providing universal coverage alone will not address current socioeconomic disparities, which likely contributed to the outcomes found in this study.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.