Insurance status mediates racial, ethnic inequities in advanced cervical cancer

Key takeaways:

• White women and those with private insurance were more likely to have early-stage cervical cancer at diagnosis.
• Lack of health insurance accounted for 50% of racial/ethnic disparities in advanced-stage cervical cancer.

Insurance status substantially mediated racial and ethnic inequities among women with advanced-stage cervical cancer, researchers reported in JAMA Network Open.

“Previous studies have found that cervical cancer outcomes, including stage at diagnosis and survival, are associated with insurance status,” Hunter K. Holt, MD, MAS, assistant professor in the department of family and community medicine at the University of Illinois at Chicago, and colleagues wrote. “However, these studies did not evaluate insurance status as a mediator for more advanced cervical cancer stage at diagnosis between different racial and ethnic groups.”

This retrospective, cross-sectional, population-based study included 23,942 women aged 21 to 64 years (median age, 45 years) who received a cervical cancer diagnosis between 2007 and 2016. Using data from the Surveillance, Epidemiology and End Results (SEER) program, researchers identified these women to assess the extent that racial and ethnic differences in advanced-stage cervical cancer may be influenced by insurance status.

In the cohort, 12.9% of women were Black, 24.5% were Hispanic or Latina and 52.9% were white; 59.4% had private or Medicare insurance.

Researchers observed a lower proportion of American Indian or Alaska Native (48.7%), Asian or Pacific Islander (49.9%), Black (41.7%) and Hispanic or Latina (51.6%) women with an early-stage cervical cancer diagnosis compared with white women (53.3%). Compared with women who were uninsured or had Medicaid insurance, a larger proportion of women with private or Medicare insurance had an early-stage cervical cancer diagnosis (41.1% vs. 57.8%).

When adjusted for age, diagnosis year, histologic type, area-level socioeconomic status and insurance status, Black women had higher odds for an advanced-stage cervical cancer diagnosis compared with white women (OR = 1.18; 95% CI, 1.08-1.29).

In addition, lacking health insurance or having Medicaid insurance accounted for racial and ethnic inequities in cervical cancer diagnosis across all racial and ethnic minority groups, with 51.3% for Black women, 52.5% for American Indian or Alaska Native women, 53.8% for Asian or Pacific Islander women and 55.1% for Hispanic or Latina women compared with white women.

“Although our findings suggest that a large proportion of the cancer inequities was associated with insurance status, we also acknowledge that equity in insurance coverage will not eliminate cervical cancer unilaterally,” the researchers wrote.