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Children insured by Medicaid have similar cancer survival rates as those privately insured
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Children diagnosed with cancer and insured by Medicaid had similar survival rates as privately insured children, according to the results of a study published in Cancer.
Uninsured children demonstrated a slight increase in cancer death, researchers reported.
“From cancer registry studies of adults, we know that people with Medicaid and [those] who are uninsured at diagnosis for some cancers are more likely to die [of] their cancer,” Kim Johnson, MPH, PhD, associate professor and chair of Epidemiology/Biostatistics Specialization in the Brown School Master of Public Health Program at Washington University in St. Louis, told HemOnc Today. “However, to our knowledge, this is one of the first studies in children to evaluate whether insurance coverage, as well as the type of insurance coverage at diagnosis, impacts cancer survival.”
An estimated 10,380 children aged younger than 15 years are diagnosed with cancer each year in the United States. Although 5-year survival rates climbed from 58% in the mid-1970s to 83% between 2005 and 2011, approximately 1,250 children were projected to die of cancer in 2016.
Johnson and colleagues used data from the SEER database to identify 8,219 children aged younger than 15 years diagnosed with cancer from 2007 to 2009.
The association between insurance status and 5-year childhood cancer mortality served as the primary outcome measure.
Overall, 131 children had no insurance, 2,838 had Medicaid and 4,297 had private insurance.
At 5 years, the mean survival time was 1.32 months (95% CI, –4.31 to 1.66) shorter for uninsured children and 0.62 months (95% CI, –1.45 to 0.22) shorter for children with Medicaid compared with those with private insurance.
Uninsured children had a 26% (HR = 1.26; 95% CI, 0.84-1.9) higher risk for cancer death than those privately insured at diagnosis. The risk appeared similar for those with Medicaid and private insurance (HR = 1.06; 95% CI, 0.93-1.21).
“Our results suggest that cancer survival is largely similar between children with Medicaid and those with private insurance at diagnosis,” Johnson said. “We did find that children who were uninsured at diagnosis had slightly inferior survival compared [with] those who were insured at diagnosis, but the results were based on very few uninsured children, so this finding should be interpreted with caution. A larger study is needed to clarify whether being uninsured at diagnosis negatively impacts cancer survival in children.”
Researchers also reported that children uninsured at diagnosis appeared 2.43-fold (95% CI, 1.09-5.42) more likely to be at a regional or distant cancer stage than privately insured children. Further, cancer mortality risk increased among those diagnosed at regional (HR = 2.63; 95% CI, 1.84-3.76) and distant (HR = 8.48; 95% CI, 6.04-11.91) stages. However, researchers cautioned these associations are preliminary, because the analysis included only five cancer subtypes with sufficient staging information: retinoblastomas; renal tumors; hepatic tumors; malignant bone tumors and soft tissue and extraosseous sarcomas; and other malignant epithelial neoplasms and malignant melanomas.
Limitations of the study included possible misclassification of insurance status, and that poverty was measured at the county level and not at the individual level.
The key toward closing gaps in health care disparities among insured and uninsured children is to encourage states to set the Children’s Health Insurance Program (CHIP) eligibility levels as high as possible, Johnson said.
“In addition, it is critical that there be reauthorization of funds for existing CHIP programs,” she said. “It is also important to fund programs that provide outreach to families about their health insurance options because some families may be unaware that their children are eligible for CHIP.” – by Chuck Gormley
For more information:
Kim Johnson, MPH, PhD, can be reached at kijohnson@wustl.edu.
Disclosures: The authors report no relevant financial disclosures.
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