Insurance Status and Racial Disparities in Cancer-Specific Mortality in the United States: A Population-Based Analysis.
Background:Cancer-specific mortality (CSM) is known to be higher among blacks and lower among Hispanics compared with whites. Private insurance confers CSM benefit, but few studies have examined the relationship between insurance status and racial disparities. We sought to determine differences in CSM between races within insurance subgroups.Methods:A population-based cohort of 577,716 patients age 18 to 64 years diagnosed with one of the 10 solid malignancies causing the greatest mortality over 2007 to 2012 were obtained from Surveillance, Epidemiology, and End Results. A Cox proportional hazards model for CSM was constructed to adjust for known prognostic factors, and interaction analysis between race and insurance was performed to generate stratum-specific HRs.Results:Blacks had similar CSM to whites among the uninsured [HR = 1.01; 95% confidence interval (CI), 0.96-1.05], but higher CSM among the Medicaid (HR = 1.04; 95% CI, 0.01-1.07) and non-Medicaid (HR = 1.14; 95% CI, 1.12-1.16) strata. Hispanics had lower CSM compared with whites among uninsured (HR = 0.80; 95% CI, 0.76-0.85) and Medicaid (HR = 0.88; 95% CI, 0.85-0.91) patients, but there was no difference among non-Medicaid patients (HR = 0.99; 95% CI, 0.97-1.01). Asians had lower CSM compared with whites among all insurance types: uninsured (HR = 0.80; 95% CI, 0.76-0.85), Medicaid (HR = 0.81; 95% CI, 0.77-0.85), and non-Medicaid (HR = 0.85; 95% CI, 0.83-0.87).Conclusions:The disparity between blacks and whites was largest, and the advantage of Hispanic race was absent within the non-Medicaid subgroup.Impact:These findings suggest that whites derive greater benefit from private insurance than blacks and Hispanics. Further research is necessary to determine why this differential exists and how disparities can be improved.Cancer Epidemiol Biomarkers Prev; 26(6); 869-75. ©2017 AACR.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. hpan4@mdanderson.org usama.mahmood@gmail.com.
Hubert Y
HY
Pan
Department of Radiation Oncology, Banner Cancer Center, Gilbert, Arizona.
Gary V
GV
Walker
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Stephen R
SR
Grant
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Pamela K
PK
Allen
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
Jing
J
Jiang
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
B Ashleigh
BA
Guadagnolo
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
Benjamin D
BD
Smith
Department of Radiation Oncology, University of Chicago, Chicago, Illinois.
Matthew
M
Koshy
Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
Chad G
CG
Rusthoven
Department of Radiation Oncology, Long Beach Memorial Medical Center, Long Beach, California. hpan4@mdanderson.org usama.mahmood@gmail.com.
Usama
U
Mahmood
D000368:Aged; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D014481:United States