Lack of insurance causes ‘staggering’ disparities in advanced-stage cancer diagnoses
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Key takeaways:
- Lack of health insurance exacerbated racial and ethnic disparities for advanced-stage cancer diagnoses.
- Lack of coverage impacted multiple racial and ethnic groups across multiple cancer types.
Lack of health insurance contributes to a high percentage of racial and ethnic disparities in advanced-stage diagnoses for several cancer types, according to results of a mediation analysis.
This trend persisted among Black, Hispanic and Asian/Pacific Islander individuals compared with white individuals.
Researchers reported a range of mediation from 4.5% to 68.8%.
“The magnitude of the disparities mediated by lack of health insurance for some cancer types in our study is staggering,” Parichoy Pal Choudhury, PhD, principal scientist in biostatistics at American Cancer Society, told Healio.
Background and methods
Prior research showed individuals without health insurance are more likely to be diagnosed with cancer at later stages and also achieve poorer survival than individuals who have coverage, according to study background.
Studies also have shown non-white individuals have a higher likelihood for worse outcomes due to a variety of factors, including socioeconomic status, amenities available in their communities and insurance status.
However, data have been limited about the relationship between insurance and racial and ethnic disparities.
“[Although] a few recent studies show a mediating role of health insurance in explaining racial and ethnic disparities in advanced-stage diagnosis of breast and cervical cancers, for many other cancer sites the contribution of lack of health insurance in explaining such disparities remain unclear,” Pal Choudhury said. “Hence, we felt it was important to conduct the current study.”
Pal Choudhury and colleagues used the National Cancer Database to identify 1,893,026 adults (age range, 18 to 64 years; 11.3% Black, 5.9% Hispanic, 4.6% Asian/Pacific Islander) diagnosed with one of 10 cancer types between 2013 and 2019. Diagnoses included female breast, prostate, colorectum, lung, cervix, uterus, stomach, urinary bladder, and head and neck cancers, as well as melanoma.
All individuals either had private insurance or no coverage.
“Mediating role of health insurance (privately insured vs. uninsured) ... in explaining racial and ethnic disparities in stage at diagnosis” served as the primary endpoint, researchers wrote.
Results and next steps
In all, 6.2% of patients had no insurance and 32.1% had a diagnosis of stage III or IV disease.
Hispanic adults had the highest uninsured rate (20.4%), followed by Black (11.1%), Asian/Pacific Islander (5.6%) and white (4.5%) adults.
Researchers found evidence of mediation of disparities in eight cancers between non-Hispanic Black and white individuals (range of proportions mediated, 4.5% to 29.1%), six cancers between Hispanic vs. non-Hispanic white individuals (range, 13.2% to 68.8%), and in three cancers between non-Hispanic Asian/Pacific-Islander individuals vs. white individuals (range, 5.8% to 11.3%).
Black adults had higher rates of stage III or stage IV cancers of the breast, colorectum, lung, cervix, uterus, urinary bladder, and head and neck, as well as melanoma.
“A significant portion of non-Hispanic Black vs. white disparities in [stage III/stage IV] cancer diagnosis were mediated by lack of health insurance, with the proportion mediated ranging from 4.5% for uterine cancer to 29.1% for head and neck cancer,” researchers wrote.
Hispanic individuals had significantly higher rates of stage III or stage IV breast, lung, prostate, stomach or uterine cancers, as well as melanoma.
“For the six cancer sites, a considerable portion of the racial and ethnic disparities were mediated by lack of health insurance coverage, with proportions mediated ranging from 13.2% for skin melanoma to 68.8% for lung cancer,” Pal Choudhury and colleagues wrote.
Asian/Pacific Islander individuals had “significantly” higher rates for prostate, uterine or lung cancers, as well as melanoma.
“Significant evidence of mediation of racial disparities by lack of health insurance was observed for cancers of the prostate, uterus and skin melanoma, with proportions mediated ranging from 5.8% for skin melanoma to 11.3% for prostate cancer,” researchers wrote.
“Moderate values of proportion mediated would indicate alternative pathways that could explain the residual disparity, highlighting the need for further research focusing on possible mechanisms involving additional factors,” Pal Choudhury said.
Future research could evaluate American Indian/Alaskan Native vs. white individuals, as well as how deductibles and copays factor into the evaluation, Pal Choudhury said.
“The findings from this study could inform appropriate policies geared toward enhancing health insurance coverage for all populations,” Pal Choudhury said. “Given that health insurance is a key determinant of access to high-quality health care in the U.S., such policies could prove instrumental in reducing the racial and ethnic disparities in advanced stage diagnosis of cancer, and, consequently, racial and ethnic disparities in cancer survival.”
For more information:
Parichoy Pal Choudhury, PhD, can be reached at parichoy.palchoudhury@cancer.org.
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