title: Insurance Status and Other Non-biological Factors Predict Outcomes in Acute Myelogenous Leukemia: Analysis of Data from the National Cancer Database.
abstract: The treatment of acute myeloid leukemia (AML) has made significant progress in the last 30 years; however, numerous factors affect outcomes in patients with AML. Well-known risk factors are age, cytogenetics, and treatment intensity. The purpose of our study was to investigate the effects of insurance status on the outcome of AML; age, Carlson comorbidity index, distance travelled to the treatment center, and type of treatment center were adjusted by analyzing data from National Cancer Database (NCDB). In the wake of the Affordable Care Act, and its impact on insurance coverage, evaluating the effect having insurance has on health outcome is urgently necessary.
  
  
  
  Data were analyzed from 67,443 men and women (≥18 years of age), who were registered in the NCDB and diagnosed with AML between 1998 and 2011 with follow-up to the end of 2012. The primary predictor variable was payer status, and the outcome variable was overall survival. Additional variables addressed and adjusted, included: sex, age, race, Charleston Comorbidity index, level of education, income, distance traveled, facility type, diagnosing/treating facility, treatment delay, and chemotherapy.
  
  
  
  In multivariate analysis, after adjusting for other predictor variables, payer status was a statistically significant predictor of overall survival for AML. Relative to privately insured patients, patients with Medicaid had a 17% increased risk, those without insurance had a 21% increased risk, those with Medicare had a 19% increased risk and those with unknown insurance status had a 22% increased risk of mortality from AML. The percentage of patients surviving from AML after 24 months was 37.6%, 31.4%, 32.3%, 31.8%, and 33.1% for patients with private, unknown, Medicare, uninsured, and Medicaid payer status, respectively. All factors investigated were found to be significant predictors of AML survival except distance traveled.
  
  
  
  We observed that payer status has a statistically significant relationship with overall survival from AML.
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Samip
authors.initials: S
authors.lastname: Master
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Munker
authors.affiliation: Weill Cornell Medical College, New York, NY, U.S.A.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Glenn
authors.initials: G
authors.lastname: Mills
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A. rshi@lsuhsc.edu.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D015470:Leukemia, Myeloid, Acute / Q000191:economics / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D014481:United States
keywords: AML; insurance; survival