Health insurance and stage at diagnosis of laryngeal cancer: does insurance type predict stage at diagnosis?
OBJECTIVE
To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage laryngeal cancer.


METHODS
Retrospective cohort study from the National Cancer Database, 1996-2003.


METHODS
Hospital-based practice.


METHODS
Patients with known insurance status diagnosed as having invasive laryngeal cancer at Commission on Cancer facilities (N = 61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage.


METHODS
Overall stage of laryngeal cancer (early vs advanced) and tumor size (T stage) at diagnosis.


RESULTS
Patients with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors.


CONCLUSIONS
Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced laryngeal cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.
Chen
Amy Y
AY
Department of Otolaryngology, Emory University, Atlanta, Georgia, USA. amy.chen@emoryhealthcare.org
Schrag
Nicole M
NM
Halpern
Michael
M
Stewart
Andrew
A
Ward
Elizabeth M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D014481:United States