title: Cancer-specific outcomes among young adults without health insurance.
abstract: OBJECTIVE
  The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults.
  
  
  METHODS
  We used the SEER program to identify 39,447 patients age 20 to 40 years diagnosed with a malignant neoplasm between 2007 and 2009. The association between insurance status and stage at presentation, employment of definitive therapy, and all-cause mortality was assessed using multivariable logistic or Cox regression, as appropriate.
  
  
  RESULTS
  Patients who were uninsured were more likely to be younger, male, nonwhite, and unmarried than patients who were insured and were also more likely to be from regions of lower income, education, and population density (P < .001 in all cases). After adjustment for pertinent confounding variables, an association between insurance coverage and decreased likelihood of presentation with metastatic disease (odds ratio [OR], 0.84; 95% CI, 0.75 to 0.94; P = .003), increased receipt of definitive treatment (OR, 1.95; 95% CI, 1.52 to 2.50; P < .001), and decreased death resulting from any cause (hazard ratio, 0.77; 95% CI, 0.65 to 0.91; P = .002) was noted.
  
  
  CONCLUSIONS
  The improved coverage fostered by the ACA may translate into better outcomes among most young adults with cancer. Extra consideration will need to be given to ensure that patients who will face premium increases in the individual market can obtain insurance coverage under the ACA.
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA. aaaizer@partners.org.
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Falit
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Mallika L
authors.initials: ML
authors.lastname: Mendu
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Alexander
authors.affiliation: Ayal A. Aizer and Benjamin Falit, Harvard Radiation Oncology Program; Mallika L. Mendu and Quoc-Dien Trinh, Brigham and Women's Hospital; Toni K. Choueiri, Neil E. Martin, Brian M. Alexander, and Paul L. Nguyen, Brigham and Women's Hospital/Dana-Farber Cancer Institute Boston, MA; Ming-Hui Chen, University of Connecticut, Storrs, CT; Karen E. Hoffman, University of Texas MD Anderson Cancer Center, Houston, TX; and Jim C. Hu, University of California Los Angeles, Los Angeles, CA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D009369:Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D063868:Patient Outcome Assessment; D011203:Poverty / Q000191:economics; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult