title: The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer.
abstract: OBJECTIVE
  Uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes. As healthcare reform proceeds in the US, this disparity may gain increasing importance. Our objective was to investigate the impact of health insurance status on the presentation, treatment, and survival among colorectal cancer (CRC) patients.
  
  
  METHODS
  A total of 10,692 patients diagnosed with CRC between 2004 and 2008 identified from the Tennessee Cancer Registry were stratified into five groups: Private, Medicare, Military, Medicaid, and uninsured. Multivariable regression models were constructed to test the association of insurance with receipt of recommended adjuvant therapy and overall survival (OS).
  
  
  RESULTS
  Uninsured and Medicaid patients were more often African American (AA) and presented with higher stage tumors (P < 0.001). Medicare patients were less likely to receive recommended adjuvant therapy (OR 0.54). Lack of insurance, Medicaid, and failure to receive recommended adjuvant therapy were independently associated with worse OS.
  
  
  CONCLUSIONS
  Although uninsured and Medicaid patients receive recommended adjuvant therapy comparable to other patients, they present with later stage disease and have a worse OS. Future studies are needed to better explain these disparities especially in the light of changing healthcare climate in the US.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Parikh
authors.forename: Jamie
authors.initials: J
authors.lastname: Robinson
authors.forename: Victor M
authors.initials: VM
authors.lastname: Zaydfudim
authors.forename: David
authors.initials: D
authors.lastname: Penson
authors.forename: Martin A
authors.initials: MA
authors.lastname: Whiteside
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
keywords: adjuvant chemotherapy; colorectal cancer; disparities; health insurance; outcomes