RELATION BETWEEN HEALTH INSURANCE COVERAGE AND OUTCOMES AMONG WOMEN WITH BREAST CANCER IN FLORIDA
Author(s)
Tawk RH1, Ali A2, Adunlin G2, Xiao H2
1Florida A&M University, Tallahassee, FL, USA, 2Florida A & M University, Tallahassee, FL, USA
OBJECTIVES: Breast cancer (BC) poses disproportionate burden of disease among medically underserved and minority women. African-American women continue to be diagnosed with advanced BC and to have the highest mortality rates and the poorest survival rates from BC. The purpose of the study is to determine the relationship among race, insurance, and BC death. METHODS: African Americans and Non-Hispanic Whites female BC patients diagnosed between 2007 and 2010 in Florida, and treated at a network of 9 hospitals were identified by electronic medical record search. BC incidence cases were obtained from Florida Cancer Data System (FCDS) which is the largest population-based cancer incidence registry in the nation. FCDS cases were linked to Electronic Medical Records (EMRs). Cause specific survival was the major Outcome measure. Nonparametric survival curves for the various insurance categories were generated using the Kaplan-Meier method. Socio-demographics included age at diagnosis, race, insurance, marital status, poverty level. Tumor characteristics consisted of tumor stage, tumor grade, tumor size, estrogen receptor status, progesterone receptor status. Risk of BC death was first examined as a function of insurance status. Hazard ratios were then obtained using Cox proportional hazards model after adjusting for socio-demographics, tumor characteristics when associating insurance status with BC related death. RESULTS: Study population was older (74% more than 50 years old), had more whites, 55.55 % were married and included a greater proportion of patients on public coverage (46%). Survival was worse for uninsured patients than for privately insured patients with all stages. The adjusted risk of BC death was 40% higher for uninsured patients than for privately insured patients. CONCLUSIONS: Uninsured patients presented with worse survival than did privately insured patients. Findings from this study demonstrate that patients without insurance experience worse outcomes and would benefit the most from improved access to screening and optimal cancer care.
Conference/Value in Health Info
2015-05, ISPOR 2015, Philadelphia, PA, USA
Value in Health, Vol. 18, No. 3 (May 2015)
Code
PHS23
Topic
Clinical Outcomes
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
Oncology