title: Association of health insurance with outcomes in adults ages 18 to 64 years with melanoma in the United States.
abstract: BACKGROUND
  Studies evaluating insurance status and melanoma outcomes are limited.
  
  
  OBJECTIVE
  We investigated whether health insurance correlates with more advanced disease, receipt of treatment, and survival in melanoma.
  
  
  METHODS
  This was a cross-sectional analysis of 61,650 patients with cutaneous melanoma using the Surveillance, Epidemiology, and End Results database.
  
  
  RESULTS
  Under multivariate analysis, patients with either Medicaid insurance (hazard ratio, 1.83; 95% confidence interval [CI], 1.65-2.04; P < .001) or uninsured status (hazard ratio, 1.63; 95% CI, 1.44-1.85; P < .001) were more likely to die of any cause, including melanoma. Uninsured compared with non-Medicaid insured cases more often presented with increasing tumor thickness (odds ratio [OR], 2.19; 95% CI, 1.76-2.73; P < .001) and presence of ulceration (OR, 1.64; 95% CI, 1.40-1.92; P < .001), and less often received treatment (OR, 1.87; 95% CI, 1.60-2.19; P < .001). Compared with non-Medicaid insured, Medicaid cases more often had increasing tumor thickness (OR, 2.36; 95% CI, 1.91-2.91; P < .001), advanced stage (OR, 1.59; 95% CI, 1.37-1.85; P < .001), and presence of ulceration (OR, 1.40; 95% CI, 1.19-1.63; P < .001), and less often received treatment (OR, 1.61; 95% CI, 1.37-1.89; P < .001).
  
  
  CONCLUSIONS
  This was a retrospective study.
  
  
  CONCLUSIONS
  Patients with melanoma and Medicaid or uninsured status were more likely to present with advanced disease and were less likely to receive treatment, likely contributing to an overall and cause-specific survival detriment. Addressing access to care may help improve these outcomes.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Rusthoven
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Waxweiler
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Fisher
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: david.raben@ucdenver.edu.
authors.forename: David
authors.initials: D
authors.lastname: Raben
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012883:Skin Ulcer / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Affordable Care Act; health care disparities; health insurance; malignant melanoma; treatment outcomes