title: Survival disparities by insurance type for patients aged 15-64 years with non-Hodgkin lymphoma.
abstract: BACKGROUND
  New treatment options and supportive care measures have greatly improved survival of patients with non-Hodgkin lymphoma (NHL) but may not be affordable for those with no insurance or inadequate insurance.
  
  
  METHODS
  Using data from the Surveillance, Epidemiology, and End Results database, we estimated overall and cause-specific survival according to insurance status within 3 years after diagnosis of patients diagnosed with NHL in the U.S. in the period 2007-2011. Because NHL is a heterogeneous condition, we also examined survival in diffuse large B-cell lymphoma (DLBCL).
  
  
  RESULTS
  Survival was higher for patients with non-Medicaid insurance compared with either uninsured patients or patients with Medicaid. For patients with any NHL, the 3-year survival estimates were 68.0% for uninsured patients, 60.7% for patients with Medicaid, and 84.9% for patients with non-Medicaid insurance. Hazard ratios (HRs) for uninsured and Medicaid-only patients compared with insured patients were 1.92 (95% confidence interval [CI]: 1.76-2.10) and 2.51 (95% CI: 2.36-2.68), respectively. Results were similar for patients with DLBCL, with survival estimates of 68.5% for uninsured patients (HR: 1.78; 95% CI: 1.57-2.02), 58%, for patients with Medicaid (HR: 2.42; 95% CI: 2.22-2.64), and 83.3% for patients with non-Medicaid insurance. Cause-specific analysis showed survival estimates of 80.3% for uninsured patients (HR: 1.83; 95% CI: 1.62-2.05), 77.7% for patients with Medicaid (HR: 2.23; 95% CI: 2.05-2.42), and 90.5% for patients with non-Medicaid insurance.
  
  
  CONCLUSIONS
  Lack of insurance and Medicaid only were associated with significantly lower survival for patients with NHL. Further evaluation of the reasons for this disparity and implementation of comprehensive coverage for medical care are urgently needed.
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Cardeza Foundation and Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; German Cancer Consortium, Heidelberg, Germany pultedi@gmail.com.
authors: Dianne
authors: D
authors: Pulte
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Cardeza Foundation and Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; German Cancer Consortium, Heidelberg, Germany.
authors: Lina
authors: L
authors: Jansen
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Cardeza Foundation and Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; German Cancer Consortium, Heidelberg, Germany.
authors: Hermann
authors: H
authors: Brenner
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D015996:Survival Rate; D014481:United States
keywords: Diffuse large B-cell lymphoma; Health care disparities; Non-Hodgkin lymphoma; Survival analysis