Variation in insurance status by patient demographics and tumor site among nonelderly adult patients with cancer.
BACKGROUND
In the United States, an estimated 48 million individuals live without health insurance. The purpose of the current study was to explore the Variation in insurance status by patient demographics and tumor site among nonelderly adult patients with cancer.


METHODS
A total of 688,794 patients aged 18 to 64 years who were diagnosed with one of the top 25 incident cancers (representing 95% of all cancer diagnoses) between 2007 and 2010 in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patient characteristics included age, race, sex, marital status, and rural or urban residence. County-level demographics included percent poverty level. Insurance status was defined as having non-Medicaid insurance, Medicaid coverage, or no insurance.


RESULTS
On multivariate logistic regression analyses, younger age, male sex, nonwhite race, being unmarried, residence in counties with higher levels of poverty, and rural residence were associated with being uninsured versus having non-Medicaid insurance (all P <.001). The highest rates of non-Medicaid insurance were noted among patients with prostate cancer (92.3%), melanoma of the skin (92.5%), and thyroid cancer (89.5%), whereas the lowest rates of non-Medicaid insurance were observed among patients with cervical cancer (64.2%), liver cancer (67.9%), and stomach cancer (70.9%) (P <.001). Among uninsured individuals, the most prevalent cancers were lung cancer (14.9%), colorectal cancer (12.1%), and breast cancer (10.2%) (P <.001). Lung cancer caused the majority of cancer mortality in all insurance groups.


CONCLUSIONS
Rates of insurance coverage vary greatly by demographics and by cancer type. The expansion of health insurance coverage would be expected to disproportionally benefit certain demographic populations and cancer types.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Stephen R
SR
Grant
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gary V
GV
Walker
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Division of OVP, Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
B Ashleigh
BA
Guadagnolo
Department of Radiation Oncology, The University of Chicago Medicine, Chicago, Illinois.
Matthew
M
Koshy
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pamela K
PK
Allen
Usama
U
Mahmood
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data* / Q000639:trends; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000473:pathology; D011203:Poverty / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Surveillance, Epidemiology, and End Results (SEER); cancer; disparities; insurance