Cancer diagnosis associated with insurance coverage status

Uninsured patients and those covered by Medicaid are at higher risk for being in the later stages of cancer by the time they present for diagnosis than patients with private insurance, according to recent study results.

Using the U.S. National Cancer Database, researchers from the American Cancer Society identified patients diagnosed with cancer between 1998 and 2004. More than 3.7 million patients were included in the final analysis.

The researchers calculated the odds ratios for the effect of insurance status and ethnicity on disease stage at the patients’ time of diagnosis for 12 cancer sites, including breast (women), kidney, melanoma, non-Hodgkin lymphoma, uterus and prostate.

Data revealed that patients without insurance and those with Medicaid coverage were more likely to present with advanced-stage cancer than patients who had private insurance coverage.

This finding was especially apparent among patients with cancers that could have been detected early on through screening or symptom assessment, such as breast, colorectal and lung cancer, according to the researchers. For each of these cases, patients without insurance were at least two times more likely to be diagnosed in stage III or IV than in stage I.

For example, in the case of colorectal cancer, the odds ratios for patients presenting with advanced-stage disease were 2.0 (95% CI, 1.9-2.1) among uninsured patients and 1.6 (95% CI, 1.5-1.7) among Medicaid-insured patients, compared with patients who had private insurance.

The researchers also observed that black and Hispanic patients were more frequently at a higher risk for advanced-stage disease at time of diagnosis, compared with white patients—regardless of insurance coverage status. – by Cara Dickinson

Lancet Oncol. 2008;doi:10.1016/S1470-2045(08)70032-9.