title: Differences in mortality for surgical cancer patients by insurance and hospital safety net status.
abstract: Recent research suggests hospitals serving low-income patients have poorer outcomes. However, safety net hospitals (SNHs) offering access to care regardless of insurance coverage may provide better care than low-income patients would otherwise receive. This study considers the association between insurance and mortality among surgical cancer patients and the role of SNHs. We estimate models of 1- and 5-year mortality on insurance, SNH status, patient characteristics, and hospital surgical volume for colorectal and breast cancer patients. Interaction terms between insurance and SNH status estimate how mortality differs by insurance source at SNHs. Medicaid and uninsurance are associated with significantly higher mortality for colorectal cancer patients. There is a statistically significant improvement in mortality for Medicaid colorectal cancer patients treated in SNHs relative to non-SNHs and a marginally significant improvement for uninsured breast cancer patients treated in SNHs. The results suggest a survival benefit for low-income patients treated in SNHs.
authors.affiliation: Virginia Commonwealth University, Richmond, VA 23298, USA. lsabik@vcu.edu
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Sabik
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014481:United States; D014768:Virginia / Q000453:epidemiology