TITLE:
Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival
AUTHORS:
Timothy L. Fitzgerald, Cary Suzanne Lea, Prashanti M. Atluri, Jason Brinkley, Emmanuel E. Zervos
KEYWORDS:
Variability, Colorectal Cancer, Survival
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.13,
November
11,
2014
ABSTRACT: Health care inequalities exist for
patients with colon cancer. We hypothesize that factors such as payers and
medical comorbidities may explain much of this inequality. Methods: Patients
with colon cancer in the NCDB from 2003-2010 were identified in this study.
Results: 541,649 patients were identified. Median age and survival were 68.6
years and 62.5 months. A majority of them (80.2%) were non-Hispanic white
(NHW). African American (AA) and Hispanic (HS) patients were more likely to
have medicaid (MD) or be uninsured (UI) and reside in counties with lower
socio-economic status (SES). From univariate analysis, it was found that
private insurance (PI) had superior survival (98.7 months) compared to MD (46.0
months), medicare (MC) (50.4 months) and UI (54.4 months). Survival was highest
for HS (70.9 months) followed by NHW (63.2 months) and AA (53.0 months). Also,
survival was linked to comorbidity index (CI), SES, chemotherapy, gender and
surgical resection. On multivariate analysis, it was found that male (RR 1.11),
SES, surgery (RR 2.29), chemotherapy (RR 1.96), CI, and stage were associated
with survival. Race was a predictor of survival, with a survival advantage for
HS (RR 0.87) and others (0.87) compared to NHW (1) and AA (1.2). Insurance
status was strongly linked to survival. Compared to PI all other groups had
poorer survival: MC RR 1.11; MD RR 1.44; and NI RR 1.42.Conclusions: Inequality
in outcomes for colon cancer patients is strongly associated with race and
underinsurance.