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Colon cancer survival lower among Medicaid recipients, uninsured
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Medicaid recipients or patients who lack health insurance have lower colon cancer survival rates than individuals with private, non-Medicaid insurance, according to new research published in Diseases of the Colon & Rectum.
Dianne Pulte, MD, of the division of clinical epidemiology and ageing research at the German Cancer Research Center, and colleagues wrote that lack of early intervention among the uninsured and Medicaid patients could be to blame for the lower survival rates.
“A large percentage of adults in the United States are uninsured, putting them at risk of delayed response and suboptimal care,” Pulte said in a video abstract. “Colon cancer is a common malignancy and a potentially curable one, especially in the earlier stages. Thus, disparities in diagnosis and care of patients with colon cancer can have a large effect on the public health.”
Using the Surveillance, Epidemiology, and End Results 18 database, Pulte and colleagues analyzed the medical records of 55,431 patients aged between 15 years and 65 years who were diagnosed with colon cancer between 2007 and 2012. The investigators separated the patients into three groups based on their insurance type: Medicaid (n = 7,611; 13.7%), no insurance (n = 4,131; 7.5%) and other insurance (n = 43,690; 78.8%). The three-year survival rates were 57% for the Medicaid group, 61.2% for the no insurance group, and 75.6% for the other insurance group.
Stage IV disease was more likely in patients in the Medicaid group (34.5%) and the uninsured group (32.8%), compared with the non-Medicaid group (24%).
In patients with stage I to III colon cancer, the Medicaid and uninsured group were less likely to have more than 12 lymph nodes examined and less likely to have definitive surgery than their counterparts in the non-Medicaid group.
While 99.3% of patients with non-Medicaid underwent definitive surgery, just 97.6% of patients with Medicaid and 97.8% of patients with no insurance underwent the same procedures (P < .0001).
When they compared only patients who underwent definitive surgery and adequate lymph node screening, the investigators found that the disparity in survival rates decreased, particularly in patients with no insurance.
“The various care is a major factor in the survival disparity between patients with no insurance and those with non-Medicaid insurance,” Pulte said in the video. “Other factors, including those not yet identified, appear to predominate disparity between patients with Medicaid and those with non-Medicaid insurance. Reducing the number of people who have no insurance would lead to improved public health and lower mortality in colon cancer on the population level.” – by Alex Young
Disclosures : The authors report no relevant financial disclosures.
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